Virtual Reality Therapy for Pain

Yes you heard that correctly! I bet you didn’t know that a simple virtual reality video game can help a burn patient get through the pain they experience during wound care, did you? Burn patients immersed in virtual reality called Snow-World during wound care experience strong non-pharmacologic “virtual reality analgesia.” Wound care is said to be more painful than getting the actual burn itself, so to be able to apply a simple non-pharmacological technique to reduce the pain for patients is a way to avoid high doses of opioids. In fact, the virtual reality game Snow-World has been shown to work better than morphine.

Snow-World was developed at the University of Washington by two psychologists, Drs. David Patterson and Hunter Hoffman. Using an fMRI brain scan the scientist measured the power of virtual reality to control pain. Significant reduction in pain-specific brain signals where seen when the patient was engaged in using virtual reality. The patients also reported a reduction in the amount of pain experienced when using VR, which supports the fMRI results. The scientist are also seeing that the greater the engagement/immersion the lower the reported pain.

Immersive virtual reality appears to display a non-pharmacologic dose-response relationship where more immersive virtual reality systems (presumed to be more attention grabbing) decrease pain more effectively than less immersive virtual reality systems. Interactivity increased the objective immersion of the virtual system, and increased the analgesic effectiveness of immersive virtual reality.

So from the study conclusions it appears that the mechanism of blocking the pain signals may in part be related to:

  1. Distraction

  2. Diverting the brains attention

  3. Increased overload of other stimuli (not focusing on pain)

  4. Immersion

Here is the video of how the virtual reality game works on Rock Center NBC News.

http://rockcenter.nbcnews.com/_news/2012/10/24/14648057-groundbreaking-experiment-in-virtual-reality-uses-video-game-to-treat-pain?lite

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Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. She developed her interest in the treatment of pain during her fellowship at the University of Washington where she worked at the burn center at Harborview Medical Center. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.


REFERENCES

Hoffman, HG, Chambers, GT, Meyer, WJ, Arceneaux, LL, Russell, WJ, Seibel, EJ, Richards, RL, Sharar, SR, Patterson, DR. Virtual Reality as an Adjunctive Non-pharmacologic Analgesic for Acute Burn Pain During Medical Procedures. Annals of Behavioral Medicine. 2011, 41 (2); 183-191

Hoffman HG, Garcia-Palacios A, Kapa VA, Beecher J, Sharar SR: Immersive virtual reality for reducing experimental ischemic pain. International Journal of Human-Computer Interaction. 2003, 15:469–486.

Hoffman HG: Virtual Reality Therapy. Scientific American. 2004, 291:58–65.

Navigating the Disorientation of a Cancer Diagnosis

When patients come to see me after a cancer diagnosis, we often spend time talking first about how disorienting a cancer diagnosis can be. What many find is that they were going along in their life on a particular path with some idea about what would be coming next and suddenly they find that life has taken a left-hand turn somewhere and they are now on a new path, not of their choosing. With this change in direction comes a range of emotions including fear, sadness, guilt, grief and anger. One of the predominant statements that patients make around the time of diagnosis is that they feel that they are traveling this new path in a way that feels out-of-control. One of the reasons for this out-of-control feeling is that there is simply so much new information to take in. There are a few things that you can do throughout treatment that can help manage this flow of information. 

1. Get a small notebook and write down your questions. This strategy will help you ensure that you don’t forget any questions and also that you have a place to put those questions or concerns (both literally and metaphorically) when you don’t have your doctor in front of you to answer them.

 2. Find some reliable resources that allow you to do some basic research on questions you may have. Stay away from general internet searches. There is a lot of bad information out there that can hurt more than it helps so try to stick with your doctor and well-respected sites for reliable information. Here is a list of resources that a trusted oncologist gave to me along with a few I have also found helpful:

–       American Cancer Society www.cancer.org
–       National Cancer Institute www.cancer.gov
–       Tower Hematology Oncology Medical Group www.toweroncology.com
–       MD Anderson Cancer Center www.mdanderson.org
–       Leukemia and Lymphoma Society www.lls.org

3. Bring someone to appointments with you. Studies have shown that when you are experiencing high levels of stress and anxiety it can be difficult to process information. Because the initial appointments you have with your oncologist often happen when you are experiencing high levels of stress and cover material that is absolutely novel to most people, it can be extremely useful to have someone else who can help you to process the facts you have heard. Asking the person who comes with you to take notes on the appointment can be extremely helpful.

4. Start a cancer file. You will get a lot of written information. The best way to stay organized is to start a file that contains copies of all of your reports and scans. This will make it much easier to move this information from between different doctors and facilities.

5. Use other survivors, if that helps you to gain perspective on the journey. For many finding others who have walked a similar path is incredibly helpful and is a great way to find someone whose experience can be a useful resource in sorting all that you are learning about cancer. The most important thing to keep in mind any time you talk with others is that every person’s situation is different so try to avoid getting lost in places like internet discussions with others who may try to make general statements based on their own unique experience and can provide unhelpful information.  Support groups can be a wonderful resource for helping you find other survivors and connect with them in a meaningful way. The support groups are often run by a professional therapist that can help keep the discussion on topic and focused on useful subjects. There are also organizations that can link you with survivors who have had a similar diagnosis.

Here are some resources:

–       The Cancer Support Community www.cancersupportcommunity.org
–       Livestrong www.livestrong.org
–       Imerman Angels www.imermanangels.org
–       American Cancer Society www.cancer.org

6. If you find yourself feeling so overwhelmed that you are having difficulty making decisions, your distress is so high that it is impacting your ability to stay engaged in the treatment process or you simply need someone outside of your friends and family to help you process your diagnosis, it is time to get some help. Find a professional therapist who is experienced in working with cancer patients. This therapist can help you to decrease your level of distress and can be a wonderful sounding board as you process the new information you are learning about your own diagnosis and treatment course. 

As you move along in your cancer journey, you will find that it gets easier to take in all of the medical terminology and the large number of facts being presented to you. Although you did not plan to become an expert in cancer, you will find that you will develop a new knowledge base about your diagnosis and treatment protocol over time that will make it easier to navigate discussions with your providers. For now, it is important to keep in mind that this information is brand new and it is perfectly normal to feel overwhelmed, numb, angry, confused and frightened. Try using the strategies and resources presented in this post and do not be afraid to ask questions as many times as you need to in order to understand your options.  

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Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

The Grief and Loss of a Chemical Pregnancy

Few things are as devastating as a chemical pregnancy. A pregnancy is termed a “chemical pregnancy” when a woman has a positive pregnancy test but miscarries before anything can be seen in the uterus. For couples in the midst of the physically and emotionally demanding process of infertility treatment, a chemical pregnancy can trigger intense feelings of loss, hopelessness and sometimes depression. After rejoicing in the news of a positive pregnancy test, a couple is told mere days later that they are no longer expecting. Unfortunately, there is often little space given for grieving as couples are asked to make more complex medical decisions. Sadly, even the term “chemical pregnancy” seems reductionistic for what is often a profound loss.      

Depression and anxiety are quite common in both men and women facing infertility (Fassino, Piero, Boggio, Piccioni, & Garzaro, 2002). Many couples report that infertility is one of the most stressful events in their lives, equivalent to the death of child or spouse (Kedem et al., 1990). It is quite common for people who are undergoing treatment for infertility to feel as though they are on a roller coaster of hope and despair and a “chemical pregnancy” typifies this experience. The psychological stress of a failed cycle is one of the main reasons that couples drop out of infertility treatment (Domar, 2004).

When a couple experiences a “chemical pregnancy” it is common to suffer intense grief as a result. Often couples have developed strong feelings and vivid fantasies while waiting to hear the results of the pregnancy test which only increase with a positive test result. Intensifying the grief of the pregnancy loss is the knowledge that getting pregnant again is likely to be difficult. Unfortunately, the grief associated with a “chemical pregnancy” can be overlooked. In many instances of infertility, particularly with older couples, time is of the essence and there is little room for a lengthy mourning process.

In addition to feelings of grief, it is not uncommon for emotional reactions such as anger, blame and shame to emerge. Some couples may report anger for their unlucky fate. Other potential targets of anger are healthcare providers, particularly in instances when their is no identifiable explanation for the couple’s infertility, which occurs in approximately 10-20% of cases. It is also quite common for couples to place blame on one another, especially if one member carries the infertility factor. Feelings of shame and defectiveness are often reported by women following a “chemical pregnancy” or treatment failure.

Rituals can be very helpful for allowing couples to grieve after experiencing a “chemical pregnancy”. Rituals bring formality and solemnity to the passages of life. They play a critical role in the process of grief and mourning and can provide the opportunity for a couple to empathize and support one another. Both partners should take an active role in planning the ritual and agree on the various elements that will be included. It is sometimes helpful to include special items such as baby clothes or a memorial object. Some couples planted trees or gardens to represent their lost child. Questions to consider when creating a meaningful situation include:

  • What do you need to say to your child?

  • What preparation is needed?

  • Who would you like to include in the ritual?

  • Is there a location where you can hold the ritual that has meaning for both of you?

 In some cases, the cumulative losses and stressors associated with infertility become too much to bear and many women and couples find the support of a couple or individual therapist or infertility group very beneficial. Signs that you may have depression and need to seek professional support include:        

  • Daily tearfulness

  • Not enjoying things as much as you used to

  • Difficulty sleeping and/or eating

  • Feeling guilty, hopeless or irritable

  • Having difficulty concentrating or making decisions

  • Worry or feelings of anxiety that are interfering with daily life

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Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

REFERENCES

Fassino, S., Pierò, A., Boggio , S., Piccioni, V.,  & Garzaro, L. (2002). Anxiety, depression and anger suppression in infertile couples: A controlled study. Human Reproduction 17(11), 2986-2994.

 Kedem, P., Mikulincer, M., Nathanson, Y. E., & Bartov, B. (1990). Psychological aspects of male infertility. British Journal of Medical Psychology 63, 73-80.

 Domar, A., Seibel, M., & Benson, H. (1990). The mind/body program for infertility: A new behavioral treatment approach for women with infertility. Fertility and Sterility, 49, 246-249.

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