留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

虚拟现实技术在疼痛治疗领域的研究进展

吴辰 张丽 马超 刘红菊 刘栩铭 张珂浦 王腾悌

吴辰, 张丽, 马超, 刘红菊, 刘栩铭, 张珂浦, 王腾悌. 虚拟现实技术在疼痛治疗领域的研究进展[J]. 协和医学杂志, 2024, 15(2): 272-278. doi: 10.12290/xhyxzz.2023-0519
引用本文: 吴辰, 张丽, 马超, 刘红菊, 刘栩铭, 张珂浦, 王腾悌. 虚拟现实技术在疼痛治疗领域的研究进展[J]. 协和医学杂志, 2024, 15(2): 272-278. doi: 10.12290/xhyxzz.2023-0519
WU Chen, ZHANG Li, MA Chao, LIU Hongju, LIU Xuming, ZHANG Kepu, WANG Tengti. Advances of Virtual Reality in the Field of Pain Treatment[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 272-278. doi: 10.12290/xhyxzz.2023-0519
Citation: WU Chen, ZHANG Li, MA Chao, LIU Hongju, LIU Xuming, ZHANG Kepu, WANG Tengti. Advances of Virtual Reality in the Field of Pain Treatment[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 272-278. doi: 10.12290/xhyxzz.2023-0519

虚拟现实技术在疼痛治疗领域的研究进展

doi: 10.12290/xhyxzz.2023-0519
详细信息
    通讯作者:

    张丽, E-mail:zhangli8828@163.com

  • 中图分类号: R614;R441.1

Advances of Virtual Reality in the Field of Pain Treatment

More Information
  • 摘要: 疼痛问题不仅影响个人的身心健康,更对社会造成巨大负担。传统的疼痛治疗措施种类繁多,但各具有其局限性。目前,数字疗法正蓬勃发展,其中虚拟现实技术得到了广泛应用,尤其在疼痛治疗领域展现出较大潜力。虚拟现实技术借助头戴式设备等辅助工具,为使用者构建一个视觉、听觉、嗅觉等多感官参与的三维虚拟世界,从而让使用者产生一种身临其境的感觉。本文围绕虚拟现实技术在疼痛治疗领域的应用及其作用机制进行阐述,以期提高临床医护人员的认识,为疼痛治疗提供新选择。
    作者贡献:吴辰负责查阅文献、撰写论文;刘栩铭、张珂浦、王腾悌负责整理资料;张丽、马超、刘红菊负责提供指导、修订论文。
    利益冲突:所有作者均声明不存在利益冲突
  • 表  1  数字疗法在疼痛领域的应用实例

    Table  1.   Examples of digital therapeutics in the field of pain

    产品名称 企业名称 美国FDA批准年份 应用实例
    EaseVRx AppliedVR 2021 基于认知行为疗法的VR设备,通过深度放松、注意力转移、内感受意识、换位思考、分心、沉浸式享受等方法,利用“呼吸放大器”进行深呼吸练习,帮助慢性腰痛患者(≥18岁)减轻疼痛
    Nerivio,FGD000075-4.7 Theranica 2021 通过智能手机控制电脉冲的释放,抑制神经信号传递,从而缓解疼痛,为成人和青少年偏头痛的急性和预防性治疗提供选择
    Nervio Migra 2019
    SPRINT SPR Therapeutics 2018 作为可穿戴疼痛管理设备,应用外周神经刺激系统缓解急性和慢性疼痛
    Intellis Medtronic 2017 植入式可充电脊髓电刺激系统,通过刺激脊髓神经以治疗慢性疼痛
    Quell Neurometrix 2016 作为一款经皮神经刺激仪,采用安全、精确的电脉冲刺激感觉神经,以触发自然的疼痛缓解反应
    FDA(Food and Drug Administration):食品药品监督管理局;VR(virtual reality):虚拟现实
    下载: 导出CSV

    表  2  VR在疼痛领域的应用研究

    Table  2.   Study on application effect of virtual reality in the field of pain

    文献 设计原则 样本量(n) 试验设计 结论
    Tejera[23] 单盲、随机试验 44 将受试者分为两组,一组通过“Fulldive VR”(通过颈部的倾斜来改变取景器中的图像)和“VR Ocean Aquarium 3D”(增加了颈部屈伸和旋转动作,使沉浸在虚拟海洋环境中的患者观察不同的海洋动物)两款应用进行颈部锻炼;另一组接受固定的物理功能锻炼 VR可减少慢性非特异性颈部疼痛患者的疼痛相关运动恐惧
    Garcia[24] 双盲、单队列研究 179 将受试者分为两组,一组使用EaseVRx(沉浸式疼痛缓解VR程序);另一组使用头戴式显示器,提供2D自然内容的VR程序 VR在疼痛治疗方面发挥出色的治疗效果
    Deo[25] 前瞻性、随机对照试验 40 将受试者分为两组,一组接受虚拟现实干预(引导式放松体验为观看一段名为“宁静之林”的8 min的视频,该程序模拟了1个宁静的雨林和1个湖泊环境,湖泊里有栩栩如生的野生动物,可使用头戴式追踪器进行探索);另一组接受标准护理 VR可有效减少门诊宫腔镜检查过程中患者的疼痛和焦虑
    Weynants[26] 前瞻性、随机对照试验 166 将受试者分为两组,一组接受VR镇痛;另一组不接受VR镇痛治疗 VR在体外冲击波碎石中可发挥出色的镇痛作用
    Merlot[27] 双盲、随机试验 102 将受试者分为两组,一组为Endocare(该程序共20 min,结合了三维VR环境中的听觉和视觉刺激治疗,包括双耳节拍、口头催眠指令、模拟自然声音、注意力分散等)干预组,接受VR治疗;另一组为对照组,使用相同VR设备但无Endocare刺激 对于患有中重度盆腔疼痛的子宫内膜异位症患者,VR是一种有效且安全的方法。此外,还有助于减少患者对止痛药物的依赖程度
    Gold[28] 随机对照试验 107 将受试者分为两组,一组为VR干预组(一款虚拟游戏,患者在其中沿着预设的路径穿过一个充满动画景观、建筑和云朵的三维环境,利用视线控制大炮的发射方向,以击倒泰迪熊);另一组为标准护理组 相较于对照组,VR干预组患者的焦虑和疼痛程度显著降低
    VR:同表 1
    下载: 导出CSV
  • [1] Treede R D, Rief W, Barke A, et al. A classification of chronic pain for ICD-11[J]. Pain, 2015, 156(6): 1003-1007. doi:  10.1097/j.pain.0000000000000160
    [2] Jiang Y Y, Xu T L, Mao F, et al. The prevalence and management of chronic pain in the Chinese population: findings from the China Pain Health Index (2020)[J]. Popul Health Metr, 2022, 20(1): 20. doi:  10.1186/s12963-022-00297-0
    [3] St Sauver J L, Warner D O, Yawn B P, et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population[J]. Mayo Clin Proc, 2013, 88(1): 56-67. doi:  10.1016/j.mayocp.2012.08.020
    [4] Zheng Y J, Zhang T J, Yang X Q, et al. A survey of chronic pain in China[J]. Libyan J Med, 2020, 15(1): 1730550. doi:  10.1080/19932820.2020.1730550
    [5] Digital Therapeutics Alliance. Digital therapeutics: definition and core principles[EB/OL]. [2023-09-20]. https://dtxalliance.org/wp-content/uploads/2021/01/DTA_DTx-Definition-and-Core-Principles.pdf.
    [6] Wang C, Lee C, Shin H. Digital therapeutics from bench to bedside[J]. NPJ Digit Med, 2023, 6(1): 38. doi:  10.1038/s41746-023-00777-z
    [7] 杨吉江, 雷毅, 武文杰, 等. 数字疗法发展与应用综述研究[J]. 中国卫生信息管理杂志, 2022, 19(2): 211-216. https://www.cnki.com.cn/Article/CJFDTOTAL-WSGL202202010.htm

    Yang J J, Lei Y, Wu W J, et al. A review on the development and application of digital therapy[J]. Chin J Health Inform Manag, 2022, 19(2): 211-216. https://www.cnki.com.cn/Article/CJFDTOTAL-WSGL202202010.htm
    [8] 姚恒美. 全球数字疗法发展态势研究[J]. 竞争情报, 2022, 18(2): 57-63. https://www.cnki.com.cn/Article/CJFDTOTAL-JZQB202202009.htm

    Yao H M. Research on the global development trend of digital therapeutics[J]. Competitive Intell, 2022, 18(2): 57-63. https://www.cnki.com.cn/Article/CJFDTOTAL-JZQB202202009.htm
    [9] Morris N A, Wang Y, Felix R B, et al. Adjunctive virtual reality pain relief after traumatic injury: a proof-of-concept within-person randomized trial[J]. Pain, 2023, 164(9): 2122-2129. doi:  10.1097/j.pain.0000000000002914
    [10] Szczepańska-Gieracha J, Jóźwik S, Cieślik B, et al. Immersive virtual reality therapy as a support for cardiac rehabilitation: a pilot randomized-controlled trial[J]. Cyberpsychol Behav Soc Netw, 2021, 24(8): 543-549. doi:  10.1089/cyber.2020.0297
    [11] Pittara M, Matsangidou M, Pattichis C S. Virtual reality for pulmonary rehabilitation: comprehensive review[J]. JMIR Rehabil Assist Technol, 2023, 10: e47114. doi:  10.2196/47114
    [12] Abushakra A, Faezipour M. Augmenting breath regulation using a mobile driven virtual reality therapy framework[J]. IEEE J Biomed Health Inform, 2014, 18(3): 746-752. doi:  10.1109/JBHI.2013.2281195
    [13] Feitosa J A, Casseb R F, Camargo A, et al. Graph analysis of cortical reorganization after virtual reality-based rehabilitation following stroke: a pilot randomized study[J]. Front Neurol, 2023, 14: 1241639. doi:  10.3389/fneur.2023.1241639
    [14] Ahmadpour N, Randall H, Choksi H, et al. Virtual reality interventions for acute and chronic pain management[J]. Int J Biochem Cell Biol, 2019, 114: 105568. doi:  10.1016/j.biocel.2019.105568
    [15] Hoffman H G, Patterson D R, Carrougher G J, et al. Effectiveness of virtual reality-based pain control with multiple treatments[J]. Clin J Pain, 2001, 17(3): 229-235. doi:  10.1097/00002508-200109000-00007
    [16] Hoffman H G, Patterson D R, Carrougher G J. Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study[J]. Clin J Pain, 2000, 16(3): 244-250. doi:  10.1097/00002508-200009000-00010
    [17] Schmitt Y S, Hoffman H G, Blough D K, et al. A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns[J]. Burns, 2011, 37(1): 61-68. doi:  10.1016/j.burns.2010.07.007
    [18] Carrougher G J, Hoffman H G, Nakamura D, et al. The effect of virtual reality on pain and range of motion in adults with burn injuries[J]. J Burn Care Res, 2009, 30(5): 785-791. doi:  10.1097/BCR.0b013e3181b485d3
    [19] Furman E, Jasinevicius T R, Bissada N F, et al. Virtual reality distraction for pain control during periodontal scaling and root planing procedures[J]. J Am Dent Assoc, 2009, 140(12): 1508-1516. doi:  10.14219/jada.archive.2009.0102
    [20] Magora F, Cohen S, Shochina M, et al. Virtual reality immersion method of distraction to control experimental ischemic pain[J]. Isr Med Assoc J, 2006, 8(4): 261-265.
    [21] Chirico A, Lucidi F, De Laurentiis M, et al. Virtual reality in health system: beyond entertainment. a mini-review on the efficacy of VR during cancer treatment[J]. J Cell Physiol, 2016, 231(2): 275-287. doi:  10.1002/jcp.25117
    [22] Shiri S, Feintuch U, Weiss N, et al. A virtual reality system combined with biofeedback for treating pediatric chronic headache-a pilot study[J]. Pain Med, 2013, 14(5): 621-627. doi:  10.1111/pme.12083
    [23] Tejera D M, Beltran-Alacreu H, Cano-De-La-Cuerda R, et al. Effects of virtual reality versus exercise on pain, functional, somatosensory and psychosocial outcomes in patients with non-specific chronic neck pain: a randomized clinical trial[J]. Int J Environ Res Public Health, 2020, 17(16): 5950. doi:  10.3390/ijerph17165950
    [24] Garcia L M, Birckhead B J, Krishnamurthy P, et al. An 8-week self-administered at-home behavioral skills-based virtual reality program for chronic low back pain: double-blind, randomized, placebo-controlled trial conducted during COVID-19[J]. J Med Internet Res, 2021, 23(2): e26292. doi:  10.2196/26292
    [25] Deo N, Khan K S, Mak J, et al. Virtual reality for acute pain in outpatient hysteroscopy: a randomised controlled trial[J]. BJOG, 2021, 128(1): 87-95. doi:  10.1111/1471-0528.16377
    [26] Weynants L, Chys B, D'hulst P, et al. Virtual reality for pain control during shock wave lithotripsy: a randomized controlled study[J]. World J Urol, 2023, 41(2): 589-594. doi:  10.1007/s00345-023-04280-8
    [27] Merlot B, Elie V, Périgord A, et al. Pain reduction with an immersive digital therapeutic in women living with endometriosis-related pelvic pain: at-home self-administered randomized controlled trial[J]. J Med Internet Res, 2023, 25: e47869. doi:  10.2196/47869
    [28] Gold J I, SooHoo M, Laikin A M, et al. Effect of an immersive virtual reality intervention on pain and anxiety associated with peripheral intravenous catheter placement in the pediatric setting: a randomized clinical trial[J]. JAMA Netw Open, 2021, 4(8): e2122569. doi:  10.1001/jamanetworkopen.2021.22569
    [29] Wong C L, Choi K C. Effects of an immersive virtual reality intervention on pain and anxiety among pediatric patients undergoing venipuncture: a randomized clinical trial[J]. JAMA Netw Open, 2023, 6(2): e230001. doi:  10.1001/jamanetworkopen.2023.0001
    [30] Pourmand A, Davis S, Marchak A, et al. Virtual reality as a clinical tool for pain management[J]. Curr Pain Headache Rep, 2018, 22(8): 53. doi:  10.1007/s11916-018-0708-2
    [31] Hoffman H G, Richards T L, Coda B, et al. Modulation of thermal pain-related brain activity with virtual reality: evidence from fMRI[J]. Neuroreport, 2004, 15(8): 1245-1248. doi:  10.1097/01.wnr.0000127826.73576.91
    [32] Nambi G, Abdelbasset W K, Alrawaili S M, et al. Virtual reality or isokinetic training; its effect on pain, kinesiophobia and serum stress hormones in chronic low back pain: a randomized controlled trial[J]. Technol Health Care, 2021, 29(1): 155-166. doi:  10.3233/THC-202301
    [33] Li J W, Yang H Y, Xiao Y A, et al. The analgesic effects and neural oscillatory mechanisms of virtual reality scenes based on distraction and mindfulness strategies in human volunteers[J]. Br J Anaesth, 2023, 131(6): 1082-1092. doi:  10.1016/j.bja.2023.09.001
    [34] Indovina P, Barone D, Gallo L, et al. Virtual reality as a distraction intervention to relieve pain and distress during medical procedures: a comprehensive literature review[J]. Clin J Pain, 2018, 34(9): 858-877. doi:  10.1097/AJP.0000000000000599
    [35] Melzack R, Wall P D. Pain mechanisms: a new theory[J]. Science, 1965, 150(3699): 971-979. doi:  10.1126/science.150.3699.971
    [36] Melzack R. Pain and the neuromatrix in the brain[J]. J Dent Educ, 2001, 65(12): 1378-1382. doi:  10.1002/j.0022-0337.2001.65.12.tb03497.x
    [37] Sharar S R, Alamdari A, Hoffer C, et al. Circumplex model of affect: a measure of pleasure and arousal during virtual reality distraction analgesia[J]. Games Health J, 2016, 5(3): 197-202. doi:  10.1089/g4h.2015.0046
    [38] Triberti S, Repetto C, Riva G. Psychological factors influencing the effectiveness of virtual reality-based analgesia: a systematic review[J]. Cyberpsychol Behav Soc Netw, 2014, 17(6): 335-345. doi:  10.1089/cyber.2014.0054
    [39] Bantick S J, Wise R G, Ploghaus A, et al. Imaging how attention modulates pain in humans using functional MRI[J]. Brain, 2002, 125(Pt 2): 310-319.
    [40] Hoffman H G, Richards T L, Van Oostrom T, et al. The analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments[J]. Anesth Analg, 2007, 105(6): 1776-1783. doi:  10.1213/01.ane.0000270205.45146.db
    [41] Loreto-Quijada D, Gutiérrez-Maldonado J, Nieto R, et al. Differential effects of two virtual reality interventions: distraction versus pain control[J]. Cyberpsychol Behav Soc Netw, 2014, 17(6): 353-358. doi:  10.1089/cyber.2014.0057
    [42] O'Connor S, Mayne A, Hood B. Virtual reality-based mindfulness for chronic pain management: a scoping review[J]. Pain Manag Nurs, 2022, 23(3): 359-369. doi:  10.1016/j.pmn.2022.03.013
    [43] Gupta A, Scott K, Dukewich M. Innovative technology using virtual reality in the treatment of pain: does it reduce pain via distraction, or is there more to it?[J]. Pain Med, 2018, 19(1): 151-159. doi:  10.1093/pm/pnx109
    [44] Jeffs D, Dorman D, Brown S, et al. Effect of virtual reality on adolescent pain during burn wound care[J]. J Burn Care Res, 2014, 35(5): 395-408. doi:  10.1097/BCR.0000000000000019
  • 加载中
表(2)
计量
  • 文章访问数:  1063
  • HTML全文浏览量:  23
  • PDF下载量:  29
  • 被引次数: 0
出版历程
  • 收稿日期:  2023-11-03
  • 录用日期:  2023-12-18
  • 网络出版日期:  2024-02-20
  • 刊出日期:  2024-03-30

目录

    /

    返回文章
    返回

    【温馨提醒】近日,《协和医学杂志》编辑部接到作者反映,有多名不法人员冒充期刊编辑发送见刊通知,鼓动作者添加微信,从而骗取版面费的行为。特提醒您,本刊与作者联系的方式均为邮件通知或电话,稿件进度通知邮箱为:mjpumch@126.com,编辑部电话为:010-69154261,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!