Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-22T11:41:54.716Z Has data issue: false hasContentIssue false

Using fMRI to Study the Neural Correlates of Virtual Reality Analgesia

Published online by Cambridge University Press:  07 November 2014

Abstract

Excessive pain during medical procedures, such as burn wound dressing changes, is a widespread medical problem and is especially challenging for children. This article describes the rationale behind virtual reality (VR) pain distraction, a new non-pharmacologic adjunctive analgesia, and gives a brief summary of empirical studies exploring whether VR reduces clinical procedural pain. Results indicate that patients using VR during painful medical procedures report large reductions in subjective pain. A neuroimaging study measuring the neural correlates of VR analgesia is described in detail. This functional magnetic resonance imaging pain study in healthy volunteers shows that the large drops in subjective pain ratings during VR are accompanied by large drops in pain-related brain activity. Together the clinical and laboratory studies provide converging evidence that VR distraction is a promising new non-pharmacologic pain control technique.

Type
Review Articles
Copyright
Copyright © Cambridge University Press 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Carrougher, GJ, Ptacek, JT, Sharar, SR, et al.Comparison of patient satisfaction and self-reports of pain in adult burn-injured patients. J Burn Care Rehabil. 2003;24:18.Google Scholar
2.Cherny, N, Ripamonti, C, Pereira, J, et al.Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol. 2001;19:25422554.Google Scholar
3.Melzack, R. The tragedy of needless pain. Sci Amer. 1990;262:2733.CrossRefGoogle ScholarPubMed
4.Melzack, R, Wall, PD. Pain mechanisms: a new theory. Science. 1965;150:971979.CrossRefGoogle ScholarPubMed
5.Hoffman, HG. Virtual-reality therapy. Sci Amer. 2004;291:5865.Google Scholar
6.Hoffman, HG, Patterson, DR, Magula, J, et al.Water-friendly virtual reality pain control during wound care. J Clin Psychol. 2004;60:189195.CrossRefGoogle ScholarPubMed
7.Hoffman, HG, Doctor, JN, Patterson, DR, Carrougher, GJ, Furness, TA 3rd. Use of virtual reality for adjunctive treatment of adolescent burn pain during wound care: a case report. Pain. 2000;85:305309.Google Scholar
8.Hoffman, HG, Patterson, DR, Carrougher, GJ, Sharar, SR. The effectiveness of virtual reality based pain control with multiple treatments. Clin J Pain. 2001;17:229235.CrossRefGoogle ScholarPubMed
9.Hoffman, HG, Patterson, DR, Carrougher, GJ. Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. Clin J Pain. 2000;16:244250.Google Scholar
10.Das, DA, Grimmer, KA, Sparnon, AL, McRae, SE, Thomas, BH. The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: a randomized controlled trial [ISRCTN87413556]. BMC Pediatr. 2005;5:1.Google Scholar
11.Hoffman, HG, Patterson, DR, Carrougher, GJ, et al.The effectiveness of virtual reality pain control with multiple treatments of longer durations: a case study. Int J Hum Comput Interact. 2001;13:112.Google Scholar
12.Bushnell, MC, Duncan, GH, Hofbauer, RK, Ha, B, Chen, JI, Carrier, B. Pain perception: is there a role for primary somatosensory cortex? Proc Natl Acad Sci U S A. 1999;96:77057709.CrossRefGoogle Scholar
13.Rogers, R, Wise, RG, Painter, DJ, Longe, SE, Tracey, I. An investigation to dissociate the analgesic and anesthetic of ketamine using functional magnetic resonance imaging. Anesthesiology. 2004;100:292301.Google Scholar
14.Wise, RG, Rogers, R, Painter, D, et al.Combining fMRI with a pharmacokinetic model to determine which brain areas activated by painful stimulation are specifically modulated by remifentanil. Neuroimage. 2002;16:9991014.Google Scholar
15.Porro, CA. Functional imaging and pain: behavior, perception, and modulation. Neuroscientist. 2003;9:354369.Google Scholar
16.Bantick, SJ, Wise, RG, Ploghaus, A, Clare, S, Smith, SM, Tracey, I. Imaging how attention modulates pain in humans using functional MRI. Brain. 2002;125(pt 2):310319.Google Scholar
17.Derbyshire, SW, Jones, AK, Gyulai, F, Clark, S, Townsend, D, Firestone, LL. Pain processing during three levels of noxious stimulation produces differential patterns of central activity. Pain. 1997;73:431435.Google Scholar
18.Nakata, H, Inui, K, Wasaka, T, et al.Movements modulate cortical activity evoked by noxious stimulation. Pain. 2004;107:9198.Google Scholar
19.Rainville, P, Duncan, GH, Price, DD, Carrier, B, Bushnell, MC. Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science. 1997;277:968971.Google Scholar
20.Hofbauer, RK, Rainville, P, Duncan, GH, Bushnell, MC. Cortical representation of the sensory dimension of pain. J Neurophysiol. 2001;86:402411.Google Scholar
21.Hoffman, HG, Richards, T, Coda, B, Richards, A, Sharar, SR. The illusion of presence in immersive virtual reality during an fMRI brain scan. Cyberpsychol Behav. 2003;6:127131.Google Scholar
22.Hoffman, HG, Richards, TL, Coda, B, et al.Modulation of thermal pain-related brain activity with virtual reality: evidence from fMRI. Neuroreport. 2004;15:12451248.Google Scholar
23.Hoffman, HG, Garcia-Palacios, A, Patterson, DR, Jensen, M, Furness, T 3rd, Ammons, WF Jr.The effectiveness of virtual reality for dental pain control: a case study. Cyberpsychol Behav. 2001;4:527535.Google Scholar
24.Wright, JL, Hoffman, HG, Sweet, RM. Virtual reality as an adjunctive pain control during transurethral microwave thermotherapy. Urology. 2005;66:1320.CrossRefGoogle ScholarPubMed
25.Steele, EB, Grimmer, K, Thomas, B, Mulley, B, Fulton, I, Hoffman, H. Virtual reality as a pediatric pain modulation technique: a case study. Cyberpsychol Behav 2003;6:633638.CrossRefGoogle ScholarPubMed