Immersive Virtual Reality Eases Trigger-Point Injection Pain

Fran Lowry

March 12, 2019

DENVER — Distracting chronic pain patients from trigger point injections (TPIs) by transporting them, via virtual reality (VR), to a beautiful beach complete with the soothing sound of waves helps ease the pain of these procedures, new research shows.

In a randomized study of 47 patients who underwent a TPI, the VR group was immersed in images of a sunny beach — with relaxing waves and soothing music playing in the background. Change in pain scores on a visual analogue scale (VAS) was significantly greater for this group than for those who did not receive VR distraction.

Manila Shrestha

"The efficacy of pain treatments may be impacted by various factors, such as anxiety and pretreatment pain intensity, and this can cause patients to skip appointments," lead investigator Manila Shrestha, a student in informatics at the University of California, Davis, told Medscape Medical News.

Distraction is something that most pediatricians use when they are preparing to vaccinate a toddler, but it is also helpful in patients with chronic pain, Shrestha added.

"Virtual reality is being used in children who are undergoing IV placement. It distracts them from focusing on the procedure and the pain. Virtual reality is also used in patients undergoing chemotherapy and in burn patients during dressing changes. I wanted to see how it would work for trigger-point injections," she said.

The findings were presented here at the American Academy of Pain Medicine (AAPM) 2019 Annual Meeting.

Painful Trigger Points

Myofascial trigger points are localized tender areas in a taut band of skeletal muscle. They are discrete, focal, and hyperirritable, said Shrestha.

"Trigger points are painful when they are compressed, and this can result in referred pain in the same or distant position, twitch, autonomic phenomena, and motor dysfunction," she said.

"TPI is one of the most commonly used treatments for myofascial trigger points," she added.

For the study, investigators randomly assigned about half of the 47 participants (79% women) to receive VR and the others to not receive VR.

Pre- and post-procedure VAS pain scores, which ranged from 0 to 10, were compared between the groups. The researchers also compared anxiety and patient satisfaction scores among the two groups.

Results showed that the average change in pain score favored the VR group.

The VAS scores were 3.71 for the VR group vs 1.31 for the control group. The difference was statistically significant (P = .004).

The average change in anxiety score also favored the VR group, at 6.14 vs 3.09 for the control group, but this difference was not statistically significant (P = .35).

In addition, global impression of change was higher, albeit not significantly, in the VR group (4.76) than in the control group (2.35; P = .25).

Interestingly, patient satisfaction scores were higher in the control group (4.47) than in the VR group (3.67; P = .05).

"We think this is because the VR patients had to wear goggles, and this made it difficult for them to get comfortable because they were either in a seated position or lying on their stomach. It was difficult for them to wear the VR goggles in those positions, especially if they had neck pain," she added.

Low-Cost Option?

Commenting on the findings for Medscape Medical News, Robert Bolash, MD, Cleveland Clinic, Ohio, said the study reflects current interest in nonpharmacologic ways to reduce anxiety and pain.

"There is increasing interest in nonpharmacologic anxiolytics and analgesics," said Bolash, who was not involved with the research.

"This form of analgesia is in its infancy but definitely warrants further study. VR certainly has the potential to be a low-cost analgesic as part of a multimodal pain treatment strategy," he added.

Shrestha has disclosed no relevant financial relationships. Bolash reported financial relationships with Abbott/St. Jude, Jazz Pharmaceuticals, and Medtronic.

American Academy of Pain Medicine (AAPM) 2019 Annual Meeting: Abstract 224. Presented March 9, 2019.

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