Reducing opioid use during PRM care with virtual reality

During rehabilitation, pain management is a major challenge for patients and healthcare professionals. Opioids, drugs that act on the areas of the brain responsible for pain control, are often prescribed in PRM care to help control pain. However, their excessive use can lead to undesirable side effects or addiction. Thus, virtual reality is emerging as an innovative solution to help reduce the use of opioids in adults suffering from chronic and acute pain.

Virtual reality: an alternative to opioid use

PRM (Physical and Rehabilitation Medicine) is a medical specialty that focuses on the restoration of physical function. The administration of treatments and manipulations during PRM consultations can be painful, leading to the prescription of opioids.

The Centers for Disease Control and Prevention (CDC) has reported an increase in opioid prescribing and related deaths in recent years (1). Indeed, the number of deaths has increased from 3,442 in 1999 to 16,706 in 2021, an increase of approximately 385%. This has led healthcare professionals to look for new solutions for pain management. Thus, virtual reality appears as an answer to this problem.

VR can be used as an integral part of PRM care to reduce pain and therefore, potentially, opioid use. Indeed, thanks to the immersion it allows, the patient's attention and concentration will be focused on the virtual experience and not on the pain he or she is experiencing. VR is a non-invasive method with no undesirable side effects, which reduces the health risks for the patient. In addition, it can be used to treat different types of pain such as chronic, acute, or anxiety-related pain, making it a versatile solution for patients suffering from various conditions.

According to a 2018 study (2 ) of hospitalized patients requiring recurrent painful wound procedures, it was concluded that RV significantly reduced (39%) the amount of opioids administered during painful procedures and appears to be a true distraction therapy for patients.

Future prospects for virtual reality in pain management

VR is an ever-evolving technology and its applications in pain management are being thoroughly explored. New studies are underway to evaluate the effectiveness of VR in pain management. In addition, VR can be combined with other non-drug therapies, such as cognitive behavioral therapy and physical therapy, to provide a comprehensive approach to pain management.

According to a 2019 study published in the journal Pain Medicine (2), virtual reality was effective in alleviating postoperative pain in patients undergoing knee surgery and painful wound care. In addition, a 2020 study published in the European Journal of Physical and Rehabilitation Medicine (3) showed that virtual reality can be effective in reducing pain and improving function in patients with fibromyalgia (a chronic condition characterized by persistent diffuse pain and pressure sensitivity). These promising results indicate that virtual reality could be an effective adjunct to conventional pain treatments in rehabilitation.

With this in mind, H'ability now offers immersive 360-degree videos to reduce patient anxiety and pain during PRM care (e.g., during botulinum toxin injection) or painful mobilizations. Indeed, according to a study conducted in 2021 and published in the Journal of Advanced Nursing (5), the use of virtual reality was effective in reducing the pain associated with intramuscular injection of benzathine penicillin in adults. This is particularly enabled by the distraction provided by 360 virtual reality videos.

In addition, some of our rehabilitation exercises such as "Enchanted Forest" also immerse patients in a soft universe and allow a double task: work of the upper limbs during a painful passive mobilization. The virtual immersion allows the patient's attention to be diverted.

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(1 ) Centers for Disease Control and Prevention. (2021, March 3). Opioid Overdose. Understanding the Epidemic. Retrieved April 24, 2023, from https://www.cdc.gov/drugoverdose/epidemic/index.html

(1) National Institute on Drug Abuse (2022, March 25). Overdose Death Rates. Retrieved April 24, 2023, from https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates

(2) (McSherry, T et al. (2019). Randomized, Crossover Study of Immersive Virtual Reality to Decrease Opioid Use During Painful Wound Care Procedures in Adults. Journal of burn care & research : official publication of the American Burn Association, 40(6), 874-879. doi:10.1093/jbcr/irz122)

(3) Leplège, A., Ravaud, J.-F., Boutron, I., & Arnould, B. (2019). Effectiveness of Immersive Virtual Reality in Decreasing Pain and Anxiety in Patients Undergoing Postoperative Rehabilitation: A Randomized Controlled Trial. Pain Medicine, 20(10), 1955-1964. https://doi.org/10.1093/pm/pny265

(4) Miguez, S., Riva, G., Lorenzo-Seva, U., Espejo-Antunez, L., Rodriguez-Gomez, J., & Rubio-Rodriguez, J. (2020). Efficacy of Virtual Reality for Treating Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. European Journal of Physical and Rehabilitation Medicine, 56(4), 544-553. https://doi.org/10.23736/S1973-9087.20.05998-9

(5) Basak T, Demirtas A, Yorubulut SM. Virtual reality and distraction cards to reduce pain during intramuscular benzathine penicillin injection procedure in adults: A randomized controlled trial. J Adv Nurs. 2021;77(5):2511-2518. doi:10.1111/jan.14782

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