A child loves to ride a roller coaster in a theme park. A retiree watches the rock band Queen play Bohemian Rhapsody before his very eyes. But all the time, they’re actually on a surgeon’s table.
They wear virtual reality headsets that effectively distract them from surgery – using a technology that could soon mean millions of Britons will have to be heavily sedated or dependent on potentially addictive painkillers.
Virtual reality (or VR) has been around since the 1960s, when it was introduced primarily for military use to train pilots.
The glasses-like device uses screens and motion sensors to create a 3D, computer-generated environment for humans to interact with. It was subsequently adopted by the gaming world in the 1990s.
Now doctors are discovering the potential of VR as a non-drug way to treat patients – from an alternative to general anesthetics, to a cure for phobias and a potential life changer for people with chronic pain.
In hospitals, hospices and care homes in the UK, patients are already starting to benefit.
Now doctors are discovering the potential of VR as a non-drug way to treat patients – from an alternative to general anesthetics to a cure for phobias and a potential life changer for people with chronic pain (File image)
Ian McDonough, 74, from Northumberland, wore a VR headset during knee replacement surgery at Northumbria Healthcare NHS Foundation Trust in 2020.
He chose to watch a “live” VR performance of the song Bohemian Rhapsody, which was so effective at distracting his mind from the surgery that he was given a nerve block instead of a general anaesthetic.
“It did distract me from everything,” he said. “I was aware of some pulling, but I would definitely recommend it as an alternative to a general anaesthetic.”
He had undergone knee replacement surgery on his other leg five years earlier and said the virtual reality approach was “much nicer and much quicker to recover from.”
General anesthesia can disorient patients, with common physical side effects such as vomiting and chills.
General anesthesia can cause patients to become disoriented, with common physical side effects such as vomiting and chills (file image)
There may also be long-term effects, including memory problems or cognitive impairment such as confusion — a condition called postoperative cognitive dysfunction, which is believed to be caused by anesthetic chemicals that damage nerve cells.
This seems to mainly affect the elderly. A 2014 study in the journal Deutsches Arzteblatt International found that 12 percent of patients over the age of 60 had postoperative cognitive dysfunction three months after surgery.
The VR technology used in Northumbria offers a choice of experiences, including sitting in a virtual forest or on the plains of Africa, watching wildlife – with a focus on breathing and mindfulness. Movies and concerts are also available.
“We started using VR headsets for elective orthopedic procedures such as knee replacements, but we soon discovered that there was so much positive feedback that we have now expanded this,” Dan Lawrance, an anesthesiologist at Northumbria Health Trust, told Good Health .
“We’ve found that the headsets not only reduce anxiety, but also the side effects they may have had with a general anaesthetic.
‘VR has reduced other hospital costs, such as the need for an overnight stay after a general anaesthetic.’
The hospital has expanded its VR headsets from two to eight: ‘We use them alongside regional and local anesthetics and help up to 2,000 patients a year,’ says Mr Lawrance.
There are plans to expand this further: ‘For example, when putting together packages that reassure patients what to expect before their treatment,’ he says.
At Birmingham Children’s Hospital, they are using VR to reduce young patients’ fear of invasive treatments.
The hospital reports that VR simulation also helps children stay still during challenging procedures, such as lumbar punctures — in which a needle is inserted between the bones in their lower back to collect fluid for testing.
dr. Ben O’Sullivan, a pediatric anesthetist at the hospital, told Good Health: “Being in the hospital is a scary time for children, so it’s important to ensure a level of comfort is maintained. We have found that the roller coaster games are the most popular for our kids.”
Separately, a study by the Evelina Children’s Hospital in London found that using a VR device significantly reduced anxiety in two-thirds of children who had procedures such as taking blood.
Further support for VR has been provided by a 2020 Health Technology Wales review of the available scientific evidence from clinical trials – it concluded that VR reduces pain more effectively than standard care (such as painkillers) during and immediately after procedures. The only side effect is ‘rare and mild’ nausea.
Why is VR so effective? dr. Jordan Tsigarides, an academic fellow in rheumatology at the University of East Anglia who has trialed VR for patients with chronic pain, explains: ‘VR is immersive. It floods the brain with audiovisual cues, excites the senses and distracts the brain’s attention from processing pain signals. It can break the cycle of thought in people with chronic pain.
‘By placing someone in a situation outside their normal environment, VR can have a relaxing effect. And if you add an exciting task like a game to that, it’s not difficult to get their full attention.’
dr. Jordan Tsigarides, an academic fellow in rheumatology at the University of East Anglia who has trialed VR for patients with chronic pain, explains: ‘VR is immersive. It can break the cycle of thoughts in people with chronic pain’
This immersive power is now widely used in healthcare across the UK, thanks to a clinic-friendly kit developed by Rescape, a Cardiff-based company.
The kit, called DR VR, is used in more than 40 hospitals, care homes and hospices, in settings such as oncology and palliative care.
Chief executive Matt Wordley says the kit is primarily a distraction and relaxation tool, but can have deeper effects.
“A Marie Curie nurse told me how a bedridden patient with motor neuron disease who had been a recreational diver got a VR experience of swimming with fish.
“When he took off the headphones, he had tears of joy in his eyes and gave the diver’s hand signal for ‘It’s okay’. VR allowed him to reconnect with the joy of his life.’
Another pioneering British technology company, Oxford VR, is developing virtual reality as a treatment for mental health problems.
It had successfully trialled a VR headset to treat phobias in 100 patients with vertigo. The study, published in Lancet Psychiatry in 2018, found that those who received the therapy reported a major reduction in their phobia, averaging 68 percent.
The treatment was later rolled out on the NHS for vertigo in some areas, including Oxfordshire, Buckinghamshire and Berkshire.
Oxford VR’s latest device, gameChange, aims to reduce anxiety in people with psychosis – estimated to affect nearly 1 percent of Brits, causing confused thoughts (due to conditions such as bipolar disorder).
Often, these patients feel so scared that they cannot leave their own homes, severely disrupting their relationships and lives.
During the gameChange experience, patients are guided by a virtual therapist who guides them through the exploration of simulations of everyday situations, such as in a cafe or on a bus.
The results of a trial involving approximately 340 patients across nine NHS Trusts showed that the therapy (given in weekly 30-minute sessions over six weeks) quadrupled patients’ distress and made them more likely to leave their homes. abandoned, the Lancet reported in April.
Daniel Freeman, a professor of psychiatry and science co-founder Oxford VR, who led the study, told Good Health: “We think it will transform the digital delivery of psychological care.”
At the moment, VR is mainly used to distract people from short-term pain, but it also shows promise for chronic pain.
As Dr. Tsigarides explains, ‘These patients have persistent pain sensations, perhaps after a previous injury, even though there is no physical cause. This is thought to be due to maladaptive pathways in the brain that control pain.
“People with chronic pain often get ‘pain interference,’ where pain-related thoughts invade their lives, affect their function, and cause fears about the pain making it worse.”
This can also affect sleep. “Fatigue makes them feel more pain,” adds Dr. Tsigarides. “It’s a vicious circle.”
In an unpublished study of 27 patients, Dr. Tsigarides that after using VR for just five minutes, patients reported a significant reduction in their pain.
“VR is potentially a huge help for people with chronic pain because we know that doctors often have few effective options, leading to the prescription of powerful painkillers such as opioids that carry an addiction risk,” says Dr. Tsigarides.
And there’s another reason VR deserves a chance: value.
Commercial estimates suggest using VR equipment could cost the NHS as little as £10 a day. So if used on ten patients a day, it’s only £1 at a time. Even in the real world, that’s a virtual snap.