Whether it is the newly approved COVID-19 vaccines or school-required immunizations, many children receive their mandatory shots over summer vacation. that as many as two-thirds of children and one-fourth of adults have strong fears around needles. Despite the past few years' extensive coverage of the political and cultural objections to vaccinations, procedural anxiety and fear also act as significant barriers to getting the entire population vaccinated against newer illnesses like COVID-19 as well as older ones. Virtual reality (VR) offers an important solution for addressing fear of needles and lessening anxiety associated with these common and necessary procedures.
How does VR achieve what a mother's soothing voice cannot? It all has to do with how the brain recognizes pain. If you have ever suffered an injury but not felt the pain until you visually saw it minutes later, you have experienced this effect firsthand. In my family, this often occurs as someone is slicing vegetables for Thanksgiving dinner, while simultaneously watching football and arguing about politics. What I've observed throughout many finger-bandaging sessions, science can explain to us. Functional MRI scans of the brain that when a virtual world is substituted for the real world, activity in pain centers of the brain can be . Just like arguing politics and watching football, VR powerfully occupies an individual's thought space and "tricks" the brain into perceiving less pain.
This can be taken a step further by replacing negative, scary, real-world stimuli with positive, friendly, virtual stimuli. This technique, known as procedural choreography, aligns real world experiences with a virtual story line. A common VR experience sought by children is an underwater adventure. At the start of this type of procedure children see waves washing over their injection sight. When it is time for the vaccine to be administered, the patient watches as fish nibble at their arm. I led two large randomized studies, in the Journal of Pediatrics, which showed that this safely and effectively reduced pediatric needle pain by 60% and anxiety by 40%. conducted at Children's Hospital Los Angeles in 2021 confirm my and my co-researchers findings, showing lower mean pain and anxiety scores when VR is used during peripheral IV catheter insertion.
The use of VR produces tangible effects for healthcare providers too. Procedural choreography reduced the need for restraining pediatric patients by . In the emergency room, the child's distress level (as rated by their parents) was reduced by 75%. Results like these are supporting adoption of VR around the world. Instead of three healthcare practitioners attending to one child, only one may be needed. This frees up staff to attend to other patients and helps streamline the health system. It can also protect them from injury or exposure to blood-borne pathogens. These findings were corroborated in research conducted by Dumoulin et al., as they looked at VR related outcomes in the emergency department. Their found that compared to the groups assigned Child Life intervention, VR reduced distress, discomfort, and pain more significantly. Reducing pain and anxiety to the point where child life personnel are not needed eliminates the need for restraints in many cases.
Fear and anxiety are not unique to children. Negative childhood experiences follow children into adulthood with important consequences: avoid the influenza vaccination because of needle fear, for example. VR can assist adults in reducing pain and anxiety -- a day on the beach with waves gently lapping at their feet beats a visit to the doctor any day. That is the "" a patient could have, and it is one of many experiences offered for adolescents and adults alike.
The medical applications of VR may be in their infancy, but they are growing. As more physicians become familiar with VR, we may see this technology become more and more common. Perhaps it won't be long before you see it at your family physician's office. A growing evidence base supports the benefits of VR, and it can be a useful weapon against COVID-19, influenza, and common childhood diseases. If the opportunity arises, don't be afraid to let your pediatric patients step into the virtual world to improve their health in the real world.
Evelyn Chan, MBBS, MSc, MPH, DCH, is a pediatrician, Rhodes scholar, and founder of Smileyscope, a startup in medical VR.