Gaming tech could ease pain during surgery — here’s how

It turns out that VR headsets can heighten gaming experiences, immerse people in museums and art galleries, and liven up the classroom, among other creative uses. Now, they could make surgery a bit less painful.

A VR headset worn during hand surgery helps distract and relax patients — and can even manage pain on lower drug doses, according to a new article published in the journal PLOS One.

If the idea pans out, VR could help doctors rely less on anxiety- and pain-relieving medications that can result in major side effects.

Here’s the background — Hand and wrist surgery are highly common in the U.S. and U.K. And they’re about to get even more prevalent.

“There's a projected increase of as much as 75 percent for common hand elective procedures [by 2030],” says Adeel Faruki, a lead study author and assistant professor of anesthesiology at the University of Colorado, quoting a 2014 study. Trigger finger release, cyst removals, and carpal tunnel operations are among the most frequent surgeries.

Doctors usually give the patient regional anesthesia before they go into the operating room, which blocks out pain in a specific area. In this study, they provided “brachial plexus nerve block.”

This is done by injecting a nerve in the neck that’s responsible for sensitivity in the arm and hand. Then, they subminister a sedative or anxiolytic to relax the patient during the surgery, such as a mixture of fentanyl and propofol.

But these pharmacological sedatives can cause hypotension, apnea, or even post-operation cognitive disorders in too high a dosage, which is why scientists are looking into alternatives, Faruki says. These drugs can also be highly addictive, as is the case with fentanyl.

What’s new — Past research has found that the futuristic gaming tech can help patients chill out in certain situations, like during an endoscopy or when changing burn injury dressing. With their new study, Faruki’s team has shown that it could work for hand surgery, too.

People don’t necessarily have to be sedated to feel comfortable, Faruk explains. When offered both regional anesthesia and a distraction like VR, subjects said they felt like their pain was in control even though they were fully aware and awake. “They were relaxed,” he says. “They didn't feel anxious and they didn't require more sedation.”

What they did — The team observed how 30 patients fared through hand surgery — while all of them received local anesthesia before the operation, only half of them were sedated during it.

Instead, the non-sedated group immersed themselves in a relaxing environment on the Oculus Go VR headset. Imagine a 360-degree view of a peaceful meadow, enchanting forest, or majestic mountaintop. To enhance the zen feeling, they could also pick out a guided meditation.

All of the subjects could ask for more local anesthesia and sedatives if needed. Afterward, they filled out a survey describing any pain and anxiety. The researchers also compared how long patients stayed in the hospital after their operation.

As a result, only four out of 17 patients with the VR headset were administered the sedative propofol. And even when headset users had the anxiolytic, they needed significantly smaller amounts than the people who weren’t vibing in VR — 260mg less, to be exact.

Still, it’s important to note that this group received supplemental local numbing in seven out of 17 cases. “That is likely more correlated with the fact that they were awake and aware during the procedure and if they experienced pain, the surgeon was quicker to give supplemental local anesthetic,” Faruki explains.

Why it matters — Eventually, VR could be widely deployed in hospitals as a drug-free supplement, Faruki says.

What’s more, VR headsets could help streamline procedures and ease crowding in surgery units. In this experiment, people in the VR headset group were discharged from the PACU 22 minutes earlier on average than the other subjects.

In fact, the headset wearers said they didn’t feel like they had a worse operation experience, but they did say that they remembered being highly aware of how they felt while in the operating room.

Of course, there are some caveats. For example, patients using the VR headset knew they could potentially receive a lower amount of sedatives than in usual cases, so they may have been biased and less likely to ask for sedatives in the first place.

And the anesthetists knew which patients were using VR and which weren’t, which could add additional bias.

To solve this problem, the researchers could’ve asked some patients to wear headsets and headphones without any inputs, says Tomoki Arichi, a senior clinical lecturer at King's College London who was not involved in the study. Arichi recently researched how virtual reality can make MRI scans more pleasant for children and people with claustrophobia or anxiety.

“So [these findings don’t] really give a definitive understanding of [whether] it was the VR specifically that made the difference,” he says.

Scientists should try to determine what specific kind of virtual stimulus is best for each context, Arichi adds. A tailored VR experience that encourages the participant to stay still could be even more effective.

What’s next — Future research should dig into whether this concept can work with other types of surgery, according to Arichi. And this technique could theoretically be deployed immediately — the researchers used commercially available VR and headphone systems.

While this was just a pilot study, Faruki’s team is already working on larger clinical trials to see if VR can reduce the dose of sedatives needed for patients undergoing major operations, like hip and joint replacements.

“There is a growing body of evidence that is in support of virtual reality as a distraction method for patients that are in the intensive care unit or pediatric patients undergoing IV placements or lumbar punctures, and this is going to continue to be studied,” Faruki says.