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Adding Virtual Reality Increases Pain In Burn Patients? Huh?

29 Mar

Editorial comment:
 
Some of you know I’ve always cast a wary eye on Virtual Reality as a technique, mainly because its cost makes it unrealistic for most people and situations; and because instead of directing focus inward, the way hypnosis and guided imagery do, to increase internal locus of control and empowerment for self-driven change, it takes end-users’ attention outward, so that they must depend on the VR machinery to create sensation.
 
Except for the relative few who are congenitally incapable of doing self-directed imagery for relaxation, this seems like a self-defeating, redundant, expensive option.  These researchers deserve great praise for their integrity. They published a study where the findings ran counter to their hopes and wishes for VR.

I should also add that VR with a distraction focus has been found effective for helping chemotherapy patients manage that procedure and its side effects.  It’s a powerful distracter.  But for deep, inner relaxation and healing, folks, stick with the stuff that drives attention inward:  guided imagery, hypnosis, music therapy etc.  I mean, I’m just sayin’…..

Anyway, here’s the study:
 
Researchers at Alfred Hospital in Melbourne, Australia tested whether adding Virtual Reality guided relaxation to the administration of morphine before a painful procedure - the changing of dressings on burn patients - helped reduce the severity of pain that this procedure causes.
 
A prospective randomized clinical trial was conducted on patients with third degree burns.  Patients requiring awake dressing changes were randomly assigned to either single use, virtual reality relaxation plus an intravenous morphine infusion (via PCA or a patient controlled analgesia pump) or to intravenous morphine PCA infusion alone.  Patients rated their worst pain intensity during the dressing change using a visual analogue scale.
 
Of the 88 eligible and consenting patients having awake dressings changes, 43 were assigned to virtual reality relaxation plus intravenous morphine PCA infusion and 43 to morphine PCA infusion alone.
 
The group receiving virtual reality relaxation plus morphine PCA infusion reported significantly higher (30%) pain intensities during the dressing change (mean=7.3) compared with patients receiving morphine PCA alone (mean=5.3) (p=0.003) (95% CI 0.6-2.8).
 
The investigators conclude that adding virtual reality guided relaxation to morphine PCA infusion in burns patients resulted in a significant increase in pain experienced during awake dressings changes.  Because of this, VR cannot be recommended for general use in burn patients having awake dressings changes.

Citation:  Konstantatos AH, Angliss M, Costello V, Cleland H, Stafrace S. Predicting the effectiveness of virtual reality relaxation on pain and anxiety when added to PCA morphine in patients having burns dressings changes. Burns. 2009 Jun;35(4):491-9. Epub 2008 Dec 27. This email address is being protected from spambots. You need JavaScript enabled to view it.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award