The journal of pain : official journal of the American Pain Society
-
Randomized Controlled Trial
Virtual reality helmet display quality influences the magnitude of virtual reality analgesia.
Immersive Virtual Reality (VR) distraction can be used in addition to traditional opioids to reduce procedural pain. The current study explored whether a High-Tech-VR helmet (ie, a 60-degree field-of-view head-mounted display) reduces pain more effectively than a Low-Tech-VR helmet (a 35-degree field-of-view head-mounted display). Using a double-blind between-groups design, 77 healthy volunteers (no patients) aged 18-23 were randomly assigned to 1 of 3 groups. Each subject received a brief baseline thermal pain stimulus, and the same stimulus again minutes later while in SnowWorld using a Low-Tech-VR helmet (Group 1), using a High-Tech-VR helmet (Group 2), or receiving no distraction (Group 3, control group). Each participant provided subjective 0-10 ratings of cognitive, sensory, and affective components of pain, and amount of fun during the pain stimulus. Compared to the Low-Tech-VR helmet group, subjects in the High-Tech-VR helmet group reported 34% more reduction in worst pain (P < .05), 46% more reduction in pain unpleasantness (P = .001), 29% more reduction in "time spent thinking about pain" (P < .05), and 32% more fun during the pain stimulus in VR (P < .05). Only 29% of participants in the Low-Tech helmet group, as opposed to 65% of participants in the High-Tech-VR helmet group, showed a clinically significant reduction in pain intensity during virtual reality. These results highlight the importance of using an appropriately designed VR helmet to achieve effective VR analgesia (see ). ⋯ Pain during medical procedures (eg, burn wound care) is often excessive. Adjunctive virtual reality distraction can substantially reduce procedural pain. The results of the present study show that a higher quality VR helmet was more effective at reducing pain than a lower quality VR helmet.
-
Randomized Controlled Trial
Use of the chronic pain coping inventory to assess older adults' pain coping strategies.
Little is known about the strategies that older adults use to cope with persistent pain. The purpose of this study was to describe strategies used by older, retirement community-dwelling adults to cope with persistent, noncancer pain, as assessed by the Chronic Pain Coping Inventory (CPCI), to examine the associations of these strategies with disability and depression, and to compare the 65-item and 42-item versions of the CPCI in this population. Two hundred fifty residents of 43 retirement communities in the Pacific Northwest completed baseline measures for a randomized controlled trial of a pain self-management intervention, including the CPCI and measures of demographics, comorbidity, pain-related disability, and depression. The most frequently reported strategies, as assessed by the CPCI, were Task Persistence, Pacing, and Coping Self-Statements. The least frequently used strategies were Asking for Assistance and Relaxation. Regression analyses demonstrated that coping strategies explained 26%, 19%, and 18% additional variance in physical disability, depression, and pain-related interference, respectively, after controlling for age, gender, comorbidity, and pain intensity. Internal consistency for most CPCI-65 and CPCI-42 subscales was adequate. This study clarifies strategies used by older adults to cope with persistent pain and provides preliminary validation of the CPCI in this population. ⋯ Findings from this study on pain coping strategies in older adults might suggest potentially useful coping strategies clinicians could explore with individual patients. Investigators can use study findings to design trials of interventions to help older adults cope more effectively with pain.
-
The activation of spinal cord microglia and astrocytes after peripheral nerve injury or inflammation contributes to behavioral hypersensitivity. The contribution of spinal cord glia to mechanical hypersensitivity after hind paw incision has not been investigated previously. Male Sprague-Dawley rats underwent a unilateral plantar hind paw incision, and the development of mechanical hypersensitivity was assessed by using von Frey filaments. The activation of spinal cord microglia and astrocytes was measured 1, 2, 3, and 5 days after hind paw incision by using immunohistochemistry. The glial activation inhibitor, fluorocitrate, was administered intrathecally 24 hours after hind paw incision to determine glial involvement in mechanical hypersensitivity. Hind paw incision induced an activation of spinal astrocytes ipsilateral to incision within 24 hours. Both microglia and astrocytes reached a maximum activation 3 days after hind paw incision. Fluorocitrate produced a dose-dependent reduction in mechanical hypersensitivity when administered 24 hours after hind paw incision. Spinal cord glial activation contributes to the mechanical hypersensitivity that develops after hind paw incision. ⋯ Hind paw incision produces mechanical hypersensitivity that can be alleviated with the inhibition of spinal cord glia. Our results suggest that the activation of spinal cord astrocytes within 24 hours of incision contributes to mechanical hypersensitivity. Therefore, spinal cord astrocytes might represent a novel target for the treatment of postoperative pain.