Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA.
Stanford School of Medicine, Stanford, CA, USA.
J Clin Anesth. 2022 Sep;80:110876. doi: 10.1016/j.jclinane.2022.110876. Epub 2022 May 4.
Virtual reality (VR) is an emerging tool to reduce pain and anxiety during procedures. Although VR's clinical benefits are reported, biometric data quantifying VR's effect on pain tolerance is lacking. We used time-lapse, subjective, and biometric data to evaluate VR's effect on modulating pain.
Randomized, controlled crossover within-subject clinical trial.
This study was conducted in the Chariot Lab at Lucile Packard Children's Hospital and outdoors at Stanford University School of Medicine.
156 healthy volunteers were included.
Participants underwent pain-inducing ice immersions while connected to biometric sensors. Participants were randomized to immerse their dominant or non-dominant hand with VR or control (no VR) for one immersion, and then crossed-over to the other hand for the second immersion. We instructed participants to submerge their hand until they reached their pain tolerance or until four minutes elapsed.
Outcomes included ice immersion duration, perceived pain scores, and skin conductance response density (SCRD), a marker of sympathetic arousal. We used survival analysis and mixed effects models to compare measurements with and without VR.
153 participants were included in the analysis. Participants with VR were 64% less likely to remove their hands from the ice bath throughout the immersion's duration compared to control (P < 0.001). Participants with VR reported significantly lower pain scores after controlling for dominant hand treatment assignment, VR vs. no VR treatment order, and gender (P < 0.001). SCRD increased as time progressed for both VR and control groups (P = 0.047 combined), with no significant mean group differences.
Participants with VR were more likely to survive the 4-min ice bath challenge longer and with lower levels of pain perception, supporting VR's effectiveness as a distraction tool during painful procedures. We observed no differences in sympathetic response when comparing VR to no VR.
虚拟现实（VR）是一种新兴的工具，可以减少手术过程中的疼痛和焦虑。虽然已经报道了 VR 的临床益处，但缺乏量化 VR 对疼痛耐受力影响的生物计量数据。我们使用延时、主观和生物计量数据来评估 VR 对调节疼痛的影响。
在 Chariot 实验室（位于露西尔·帕卡德儿童医院内）和斯坦福大学医学院外进行的随机、对照、交叉自身对照临床试验。
本研究在 Chariot 实验室（位于露西尔·帕卡德儿童医院内）和斯坦福大学医学院外进行。
共纳入 156 名健康志愿者。
参与者在连接生物计量传感器的情况下进行疼痛诱发的冰浸。参与者被随机分配将优势手或非优势手浸入 VR 或对照（无 VR）中进行一次浸入，然后交叉到另一只手进行第二次浸入。我们指导参与者将手浸入水中，直到达到疼痛耐受度或四分钟结束。
结果包括冰浸持续时间、感知疼痛评分和皮肤电导率反应密度（SCRD），这是交感神经唤醒的标志物。我们使用生存分析和混合效应模型比较了有和没有 VR 的测量结果。
153 名参与者纳入分析。与对照组相比，使用 VR 的参与者在整个浸入过程中更不容易将手从冰浴中取出（64%）（P < 0.001）。在控制了优势手治疗分配、VR 与无 VR 治疗顺序和性别后，使用 VR 的参与者报告的疼痛评分显著较低（P < 0.001）。随着时间的推移，VR 和对照组的 SCRD 均增加（P = 0.047，联合），但组间无显著差异。
与对照组相比，使用 VR 的参与者更有可能在 4 分钟的冰浴挑战中坚持更长时间，并且疼痛感知程度更低，这支持了 VR 在疼痛过程中作为分散注意力工具的有效性。当比较 VR 与无 VR 时，我们观察到交感反应没有差异。
