Pain, pain, go away

Come again after I'm done my VR game

Issue #14 of LFG: Learning from Games is all about reducing pain during medical procedures, using you guessed it, games. Have you had an experience where games helped reduce physical pain for you?

Hello JOMT Reader!

In a few short months, those of us living in the Northern Hemisphere will face the cold grip winter. For me, this means it’s time to head to the pharmacy for my yearly vaccines.

Needles in the arm.

I’m not too bothered by needles, but many people, including my kids, hate them. Let’s be honest, who actually enjoys being poked with something sharp? But every problem is an opportunity for a creative solution.

Researchers have been looking for ways to make being poked by a needle a bit more bearable. Some have found that simple distractions can help reduce pain during medical procedures.¹ Others have created special devices like the Buzzy, a bee-shaped gadget that vibrates and cools the skin before the needle goes in, helping to dull the pain.²

There are other interesting ways researchers have tried to reduce pain during medical procedures. Studies show that VR³ and exercise,⁴ on their own, can reduce pain. So, the researchers of the article “The acute hypoalgesic effects of active head-mounted display virtual reality games” wanted to see if VR + exercise had an even greater effect on reducing pain.

Why does this matter?

If you guessed that needles and vaccinations are a big reason why research like this exists, you guessed right! If VR and exercise together can reduce pain, a VR-based exercise game could become useful tools for healthcare providers, especially when giving needles. For people who are scared of shots but need them, a VR-based exercise game could make the experience a lot less stressful.

Another way a VR game–based treatment could be useful is for those who can’t tolerate painkillers due to allergies or other issues. VR game–based treatments could offer a non-drug alternative for pain relief.

VR game–based treatments go way beyond just uncomfortable medical procedures. If you suffer from chronic pain, a VR game specifically targeting the painful parts of your body, combined with more conventional therapies, could help. Of course, I’m not suggesting that patients strap on a VR headset to reduce pain during open heart surgery, but VR games could be useful for minor procedures or short-term pain relief.

How did the researchers answer the question?

To answer the question about whether VR combined with exercise could reduce more pain than either alone, the researchers recruited 20 university students and used the following procedure:

1. Participants were fitted with a heart rate monitor and accelerometer to track their movements.

2. Pre-warmup pain was measured by pressing a rubber-tipped stick into the biceps and thighs of participants, recording the pressure at which the pressing became painful.

3. Participants warmed up using the VR game or stationary bike for 5 min and then rested for 10 min.

4. Post-warmup pain was measured as above.

5. Participants then played the VR game or used the stationary bike for 15 min.

6. Post-activity pain was measured above.

All the participants played three different VR games and used the stationary bike on different days. The games included an archery game where players shoot at targets while dodging projectiles, a squatting game to avoid virtual obstacles, and a passive exploration game played primarily with the controller.

What the researchers found

As expected there were no differences between the pre-warmup pain and post-warmup pain measurements for both the biceps and the thighs. The 5 min warmup is too short for either the effect of VR or exercise to be seen. However, things changed after 15 min of the VR game or exercise.

For the biceps, both active and passive VR games increased the pressure at which participants felt pain, meaning they were more tolerant (felt less pain) than during the pre- or post-warmup pain measurements. Even being on the stationary bike reduced the pain that participants felt during the post-activity pain measurement.

If the researchers’ hypothesis — that VR + exercise has a greater effect to reduce pain than VR or exercise alone — is correct, you would expect that the pain reduction for the passive VR game + the pain reduction for the stationary bike should be roughly equal to the pain reduction for the active VR game. But, for the biceps, that didn’t seem to be the case as all of these activities reduced pain to a similar degree.

For the thighs, the findings were similar to the biceps, except that the squatting VR game and the stationary bike, both of which use thigh muscles, had the greatest effect of reducing pain. Again, like with the biceps, there was no added benefit to combining VR with exercise.

Interestingly, there was no difference in pain reduction between the passive and active VR games. This means that for those who can’t exercise or who have a hard time with movements, strapping on a VR headset to explore calming environments might be enough to make medical procedures like vaccinations more comfortable.

Limitations of the study

The researchers admit that it would have been easier to make an apples to apples comparison if the physical component of the VR game was exactly the same as the non-VR activity. For example, if a stationary bike was going to be used, a VR biking game would have allowed the researchers to make a better comparison.

Additionally, the study involved a small group of university students, which might not represent the general population. More studies with a diverse group of participants would help confirm these findings and make them more widely applicable.

Final remarks

I don’t think we’ll ever get to a point where VR headsets are used for every medical procedure to make them comfortable. But I do see VR games being useful for pain management, especially with the ongoing opioid misuse epidemic. If there’s a way to reduce our dependence on these effective but potentially addictive pain killers, we should be exploring them fully.

If you’re interested in the study, you can read it for free here: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0308064#pone.0308064.ref008

If you liked what you read, please consider giving this post a like and sharing it with your community! Have you ever used non-medicinal ways to reduce pain? Let me know if you are comfortable sharing your experiences!

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920573/
This article is about a system called CARD (comfort, ask, relax, distract) that the authors propose could be used during vaccinations to make the process a little bit better.

2. https://journals.lww.com/md-journal/fulltext/2024/04120/effectiveness_and_safety_of_buzzy_device_in.63.aspx
This article is a review and meta-analysis of articles published about Buzzy, concluding that Buzzy does reduce pain and anxiety during vaccinations.

3. https://www.nature.com/articles/s41598-021-89526-4
This article showed that interacting with objects in a VR environment reduced experimentally induced pain.

4. https://www.jpain.org/article/S1526-5900(12)00808-5/fulltext
This article is a review and meta-analysis of studies showing that exercise has pain reducing effects.