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Expert: 3-D Games Can Help Ease Pain, Anxiety

Three-dimensional virtual reality video games may prove to be the latest weapon in the fight against pain.

In a number of pilot studies, virtual reality (VR) has been shown to reduce the anxiety and pain associated with a variety of medical procedures and conditions, says Jeffrey I. Gold, PhD, associate professor of anesthesiology and pediatrics at the University of Southern California's Keck School of Medicine in Los Angeles.

So far, 3-D virtual reality is only available to people with pain participating in clinical trials. But Gold tells WebMD he believes it will soon join narcotics, biofeedback, and other modalities in the arsenal against acute and chronic pain.

At the recent meeting of the American Pain Society in Baltimore, Gold discussed how virtual reality can help relieve pain.

What is virtual reality?

You can think of it as an immersive type of 3-D video game. Patients don a VR head mount (helmet) while watching a video such as a cartoon. Special software and a joystick let them look all around and take in the whole environment, including special-effect sounds and sometimes even smells.

It's a much different experience than watching a video game on a flat screen.

In one VR game we use in our pain studies, the special head-tracking gear lets patients fly through the air on the back of the penguin, picking up fish while they race against the clock. Three-D animations and sound effects complete the experience.

What is some of the evidence that virtual reality relieves pain?

In small studies over the last 10 years, kids and adults who engaged in a virtual reality gaming environment during medical procedures such as having blood drawn or undergoing chemotherapy consistently reported less pain, discomfort, and fear.

In one preliminary study, immersive VR distraction reduced patients' pain ratings during severe burn wound care by 30 percent to 50 percent. Compared with patients who took pain medications alone, patients receiving VR during physical therapy reported bigger reductions in the amount of time spent thinking about pain and pain intensity.

In a pilot study of 100 kids having their blood drawn, those immersed in a virtual 3-D environment [had less pain] than those who watched a cartoon or who played video games on a flat screen. There was less distress for the technician and the parent as well.

Typically, kids cry for their parents and multiple attempts are needed. With the VR, kids felt a tiny needle prick and that was it.

How does VR work to relieve pain?

That's what we're trying to figure out.

I have an NIH-funded study using functional magnetic resonance imaging (fMRI) to look at what mechanisms in the brain can explain the effects of VR on experimental pain.

So far, we've studied five healthy adults. We give them painful stimuli in the form of a warm burst of pain delivered to the arm. Then we image the brain while the participant is and isn't playing a VR racing game.

Early results suggest VR produces an endogenous opiate-like response in brain regions known to be involved with pain. There seems to be a release of endorphin "feel-good" chemicals in the brain.

Is this different than what you would expect with normal video games?

We think that normal video games may help to slightly relieve pain by distracting the patient -- having you focus attention on one thing so that you are not paying as much attention to others.

I think VR is that, but because it is a gaming environment and people are cruising and engaged and having a good time, something is also going on biochemically.

VR actually seems to decrease pain signaling in areas of the brain associated with pain.

What's next?

A lot.

There are other studies under way in children and adults with acute pain, but so far we haven't looked at VR and chronic pain.

And we want to take blood samples and measure chemicals associated with pain to gain more insight into how VR works.

We also want to see how VR works in conjunction with biofeedback and hypnosis.

Eventually, we see VR as a type of complementary medicine. We don't think it can completely replace pain medication but we hope it can decrease the need for it.

One problem is that head-mounted displays cost from $500 up to $30,000 and so far, gaming companies haven't shown much interest.
By Charlene Laino
Reviewed by Laura Martin
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