Abstract
Chronic pain affects many people worldwide with significant individual impact and societal cost. One such area involves the psychiatric co-morbidities associated with chronic pain. Despite its prevalence, the underlying mechanism of chronic pain is not fully understood although evidence suggests the importance of biologic, psychologic, and social factors in the perception of pain. Virtual reality has the potential to be a powerful therapeutic option for chronic pain. This may be due to its impact on attention, emotion, and potentially central nervous system plasticity. Virtual reality therapy has been used successfully for a variety of chronic pain conditions showing its potential. It has also been safely used in pediatric populations. However, the major current limitation is quality of evidence; therefore, future studies should aim to address this issue.
TopBackground
While acute pain has an intuitive role in human adaptation, the role of chronic pain is ill-defined and maladaptive. Initially, biologically-driven theories of chronic pain, such as the gate-control theory, were used to explain chronic pain (Ehde, Dillworth, & Turner, 2014; Melzack & Wall, 1965). Shortly thereafter, researchers began to realize the complexity and multi-faceted issues involved with chronic pain. Observations of the psychologic and social effects of chronic pain became apparent. This led psychologists to apply behavioral and cognitive therapy to these patients (Ehde et al., 2014; Fordyce & Company, 1977). With the success of these therapies, recognition of chronic pain has evolved to encompass the variety of areas it can impact patients’ lives. One way to capture this complexity is describing chronic pain as a perceptual phenomenon, therefore encompassing the biologic, psychologic, and social influences and impacts (Songer, 2005).
Before the next section discusses the biologic component, the following will touch on the equally important psychologic and social aspects. Chronic pain is highly correlated with negative emotions such as depression, anxiety, anger, isolation, and demoralization (Gatchel, Peng, Peters, Fuchs, & Turk, 2007). This can lead to the psychologic impacts described later but can also impact the relationship between patient and healthcare system. These negative emotions impact motivation for treatment and compliance with therapies (Gatchel et al., 2007). Furthermore, patients suffering from chronic pain often deal with repeated failures of treatment, which can lead to frustration and irritation with the healthcare system (Gatchel et al., 2007). This emotional distress is compounded by rejection from the medical system as healthcare providers may label these patients as “complainers” or “symptom magnifiers” (Gatchel et al., 2007). Therefore, the psychosocial components of chronic pain described below should be viewed holistically, keeping mindful of their interconnected relationships.
Key Terms in this Chapter
Neuroplasticity: The ability of the brain to adapt to the environment.
Immersive Virtual Reality: A type of virtual reality where the user is fully immersed in the virtual environment, most often achieved using a head-mounted display.
Sensation: The physiologic detection of a stimuli through peripheral receptors.
Perception: The conscious result of the brain’s interpretation of sensory information.
Chronic Pain: Persistent pain, typically lasting three or more months.
Cortical Reorganization: A change in the original mapping pattern of the brain so that stimuli activate different parts of the cortex.
Biopsychosocial: A model or approach that recognizes biologic, psychologic, and social effects.