Most people feel pain on a regular basis. We’ve all stubbed our toe or hit our head on a cupboard door. Our first instinct is to rub the area that’s in pain, this is because when we rub a painful area, the pain reduces. This is the underlying concept of gate control theory (GCT).
Gate Control Theory
Melzack and Wall (1965) first described GCT as a pain modulation system. The human body has a nerve supply which carries electrical impulses which are generated in response to sensations such as touch or temperature. These signals are transmitted to the spinal cord and the brain. The spinal cord contains a neurological gate which allows or blocks certain stimuli to the brain. GCT explains that a non-painful sensation can override and reduce a painful sensation such as a burn or a cut.
GCT is based on a cognitive-behavioural approach to pain modulation/management. This theory explains how auditory, visual, tactile, distraction and massage-based interventions provide pain relief (Uma & Clement, 2020).
Pain is a subjective sensation we perceive and psychological factors such as attention, understanding, control and expectations of the pain can alter the strength of these perceptions (McGrath, 1994).
Analgesic Virtual Reality
Virtual reality (VR) is being used for pain reduction and management for both acute and chronic pain. As aforementioned, psychological factors such as attention can have a profound effect on our pain perception and VR is a tool used by many as a distraction from the physical world. Several studies have suggested that VR can be effective as either a complementary adjunct or an alternative to non-pharmacologic analgesic (Ahmadpour et al., 2019).
In a pilot study from the Journal of Virtual Reality, Jones et al. (2018) found that their results indicated that the VR sessions provided an average of 66% reduction in pain during the VR session and a 45% reduction immediately after the session for the chronic pain patients. Furthermore, a decrease of pain was reported to last an average of 30 hours after the session.
Howard Rose, co-founder, and CEO of Firsthand Technology is a pioneer in the field of VR for over 20 years. Firsthand Technology design and develop research-based VR projects and applications for burn pain relief, PTSD and inspiration for children to improve dental self-care habits (Firsthand Technology, n.d.).
COOL! is a VR application by Firsthand Technology used to reduce pain and anxiety of medical procedures or the burden of acute and chronic pain. “Easy to use, simple to learn – leave pain behind and embark on a journey playing paintball with lovable otters in jewel-crusted caves and crystalline streams” (Firsthand Technology, n.d.-b).
Lieutenant Sam Brown was on his final day of duty in Afghanistan when his vehicle hit an IED (improvised explosive device) which blew up the vehicle and engulfed him in flames leaving him with third degree burns over 30% of his body. His injury was so severe he had to be kept in a medically induced coma for the first few weeks. During rehabilitation, Brown was offered an experimental pain relief method, SnowWorld (now evolved into COOL!). SnowWorld provides a distraction from the pain by overwhelming the senses and diverting the brain’s attention. SnowWorld provided an excellent distraction from the pain without the need for drugs. “I really had very little sensation of pain, as I had previously experienced” (Williams, 2012).
Benefits of VR Pain Modulation
Applications such as COOL! Through the use of immersive VR environments are gaining popularity around the world. There are several benefits that come from the use of VR analgesia, one significant benefit is that there are no side effects to it, unlike using pharmacological analgesics.
A study by McSherry et al. (2017) found that immersive VR during painful wound care procedures significantly reduced the amount of opioid medication administered (39% less), compared to no immersive VR. All subjects who have experienced immersive VR environments for distraction from pain say that they enjoyed it and would like to use it on future wound procedures.
The current opioid epidemic is the most severe public health crisis in US history. Successfully addressing this epidemic is not an easy task. Advances in science, development of more effective and acceptable treatments and implementation of public health procedures will need be required to combat said epidemic (Volkow & Blanco, 2020).
In the US, 70,630 people died from opioid drug overdose in 2019 and 10.1 million people misused prescription opioids in the last year including 1.6 million people who had an opioid use disorder (Assistant Secretary of Public Affairs (ASPA), 2021). These numbers are staggering, but with VR based interventions for pain relief, there is a great potential for the reduction of opioid use for pain relief (Firsthand Technology, 2021).
Not only do opioids come with addiction problems, but they aren’t a panacea and won’t cure any anxiety and they effect social interactions and make them more difficult. One cannot function properly when under the influence of opioids. VR interventions are an adjunct to the painkillers we take and don’t have any effect on our social interaction and it’s not likely one can get addicted to the VR software (VIrtual Reality, the Opioid Crisis, and Pain, 2017).
VR analgesia provides a greater quality of life for those with chronic or acute pain when undergoing medical procedures or pain relief interventions. VR’s effectiveness in reducing pain is outstanding in most cases and the need for drugs are reduced or even unnecessary.
Ahmadpour, N., Randall, H., Choksi, H., Gao, A., Vaughan, C., & Poronnik, P. (2019). Virtual Reality interventions for acute and chronic pain management. The International Journal of Biochemistry & Cell Biology, 114, 105568. https://doi.org/10.1016/j.biocel.2019.105568
Assistant Secretary of Public Affairs (ASPA). (2021, February 19). About the Epidemic. HHS.Gov. https://www.hhs.gov/opioids/about-the-epidemic/index.html
Firsthand Technology. (2021, July 1). VR Pain Relief: Response to the Opioid Crisis with Dr. Shorin Nemeth [Video]. Vimeo. https://vimeo.com/296985378
Firsthand Technology. (n.d.). Howard Rose: CEO, Design Director – Firsthand Technology. Firsthand. Retrieved July 6, 2021, from https://firsthand.com/howardrose/
Firsthand Technology. (n.d.-b). VR for Health and Wellness. Firsthand. Retrieved July 6, 2021, from https://firsthand.com/health-software/#toggle-id-1
Hoffman, H. G., Richards, T. L., van Oostrom, T., Coda, B. A., Jensen, M. P., Blough, D. K., & Sharar, S. R. (2007). The Analgesic Effects of Opioids and Immersive Virtual Reality Distraction: Evidence from Subjective and Functional Brain Imaging Assessments. Anesthesia & Analgesia, 105(6), 1776–1783. https://doi.org/10.1213/01.ane.0000270205.45146.db
Jones, T., Skadberg, R., & Moore, T. (2018). A Pilot Study of the Impact of Repeated Sessions of Virtual Reality on Chronic Neuropathic Pain. International Journal of Virtual Reality, 18(1), 19–34. https://doi.org/10.20870/ijvr.2018.18.1.2901
McGrath, P. A. (1994). Psychological aspects of pain perception. Archives of Oral Biology, 39, S55–S62. https://doi.org/10.1016/0003-9969(94)90189-9
McSherry, T., Atterbury, M., Gartner, S., Helmold, E., Searles, D. M., & Schulman, C. (2017). Randomized, Crossover Study of Immersive Virtual Reality to Decrease Opioid Use During Painful Wound Care Procedures in Adults. Journal of Burn Care & Research, 1. https://doi.org/10.1097/bcr.0000000000000589
Melzack, R., & Wall, P. D. (1965). Pain Mechanisms: A New Theory. Science, 150(3699), 971–978. https://doi.org/10.1126/science.150.3699.971
Uma, B., & Clement, D. I. (2020). GATE CONTROL THEORY OF PAIN. IDC International Journal, 7(3), 54–57. https://doi.org/10.47211/idcij.2020.v07i03.014
Williams, R. C. W. B. (2012, October 24). Groundbreaking experiment in virtual reality uses video game to treat pain. NBC News. https://www.nbcnews.com/nightly-news/groundbreaking-experiment-virtual-reality-uses-video-game-treat-pain-flna1C6647252
VIrtual Reality, the Opioid Crisis, and Pain. (2017, October 15). [Video]. YouTube. https://www.youtube.com/watch?v=UDjxYfS567U&t=193s
Volkow, N. D., & Blanco, C. (2020). The changing opioid crisis: development, challenges and opportunities. Molecular Psychiatry, 26(1), 218–233. https://doi.org/10.1038/s41380-020-0661-4