Vital Times 2019 - 95

appears poised for wide adoption, there is still a need for
additional research that yields further objective evidence
of improved patient outcomes.

Intensive Care Unit (ICU)
Anesthesiology-trained ICU physicians often use their
perioperative expertise to design innovative analgesic
strategies for patients in extremis. Multiple recent studies
have shown efficacy for VRT during painful procedures
such as wound debridement and limb-mobilization for
burn patients.1 McSherry et. al. reported a 39% reduction
in fentanyl requirements for patients randomized to
receive immersive VRT during their procedures.4 Multiple
case reports have also commented on the positive results
after combining VRT with ketamine infusions for acutely
painful procedures in the ICU.5 Even in its most serene
moments, the ICU is a trove of anxiety-provoking sights
and sounds. The mindfulness training and sensory
immersion offered by modern VRT may be instrumental
in lowering the incidence of ICU delirium and other
troubling psychological effects of intensive care.

Conclusions
As the medical and legal implications of traditional care
paradigms evolve, it remains critical for anesthesiologists
to incorporate multi-modal strategies in their practices.
The opioid epidemic continues to dominate the news
cycle and physicians are often implicated in the overprescription of opioids for pain control. While modalities
such as distraction and cognitive behavioral therapy have
been efficacious in the setting of chronic pain, few similar
strategies have been readily available for practitioners to
manage acute pain and anxiety. VRT offers a dynamic,
portable, and adaptable technology with the potential for a
reduction in opioid use, cost-savings, and improved patient
satisfaction. While previous studies have highlighted the
utility of VRT, provider impetus and clinical translation
has remained somewhat stagnant. Given these realities, it
is important for anesthesiologists to advocate for targeted
implementation of VRT in any space where patient
outcomes can be further optimized. Exciting research is on
the horizon and evidence-based protocols for widespread
VRT adoption should be forthcoming.

Pain Management
Current literature and publication trends suggest that pain
medicine physicians are at the forefront of innovation
and implementation of VRT. While results have been
promising for acute pain settings, data supporting longterm benefits in chronic pain patients have been more
elusive. In a recent meta-analysis, Mallari et. al. concluded
that "although VR may effectively reduce chronic pain
intensity during and possibly immediately after the VR
exposure, there is unlikely to be a lasting analgesic effect in
patients with chronic pain conditions with the treatment
protocols tested to date."1 Regardless of any dampened
expectations, several exciting applications of VRT have
been described, including behavioral biofeedback methods
to combat longitudinal conditions such as chronic
lumbago/cervicalgia, neuropathic pain, sickle cell anemia,
fibromyalgia, headache, and pancreatitis.1 Future studies
with home-based VRT regimens will hopefully show
benefits in terms of opioid dose reduction, decreased
morbidity, and enhanced patient functionality.

References
1 Mallari B, Spaeth E, Goh H, Boyd B. Virtual reality as an

analgesic for acute and chronic pain in adults: a systemic
review and meta-analysis. Journal of pain research 2019; 12:
2053-2085.

2 Delshad, S.D., Almario, C.V., Fuller, G. et al. Economic

analysis of implementing virtual reality therapy for pain
among hospitalized patients. npj Digital Med 1, 22 (2018).

3 Ryu JH, Park SJ, Park JW, Kim JW, Yoo HJ, Kim TW, et al.

Randomized clinical trial of immersive virtual reality tour of
the operating theatre in children before anaesthesia. Br J Surg.
2017;104(12):1628-33.

4 McSherry T, Atterbury M, Gartner S, Helmold E,

Searles DM, Schulman C. Randomized, crossover study
of immersive virtual veality to decrease opioid use during
painful wound care procedures in adults. J Burn Care Res.
2018;39(2):278-285.

5 Maani C, Hoffman H, Fowler M, Maiers A, Gaylord K,

Desocia P. Combining ketamine and virtual reality pain
control during severe burn wound care: one military and one
civilian patient. Pain Medicine 2011; 12 (4): 673-678.

Annual Publication 2019 | 95

Vital Times 2019

Table of Contents for the Digital Edition of Vital Times 2019