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Scared of needles or pain? Study finds Virtual Reality could help

Peer Reviewed |Case Report | People

Virtual reality (VR) could replace local anaesthesia to reduce pain and discomfort during simple medical procedures, and could help people with needle phobia, according to research published in the British Journal of Dermatology.

Minor treatments which can be administered at the bedside, such as wart destruction and cleaning of an open wound, are commonplace in medicine. A current solution for the pain associated with these practices is an injection of a local anaesthesia. However, this also causes pain and anxiety in patients as well as being associated with a risk of causing an eczema flare, light-headedness, tinnitus and occasionally systemic toxicity.

Virtual reality is a computer-generated, interactive three-dimensional (3D) environment experienced by wearing a head-mounted device, goggles and noise cancelling headphones connected to a smartphone. The simulated environment is multi-sensory often incorporating auditory, visual and touch settings.

In this study from the US, nine patients, aged between four and 70 years, were provided with VR headsets during minor procedures that would normally be painful and may require local anaesthetic. The researchers found that all participants included in the study experienced minimal pain, with half experiencing no pain at all. All participants, regardless of age, reported finding the technology simple to use.

Seven patients were undergoing wart destruction, one was having a venous leg ulcer cleaned and another having an anaesthetic injection for a skin biopsy.

The patients were cleaned and prepped as standard, and then fitted with a VR system. After a few minutes of use, the procedure was commenced. Upon completion, each patient was asked about their experience and level of pain and the provider of the procedure gave a score based upon the patients’ reactions.

The provider score of patient response to treatment was ranked between zero and four. A score of zero meant that the patient did not retract the treated limb and demonstrated no signs of pain. A score of four was given if the patient retracted the limb, demonstrated severe signs of pain and asked to stop the procedure.

Five out of the nine patients were ranked a provider score of zero, having demonstrated no pain response. The highest provider score from all of the patients studied was just two.

When asked, all patients said they experienced minimal pain, with half describing that they felt no pain at all, accompanied by surprise that the procedure was over.

VR is believed to have this positive effect on pain due to the multi-sensory, immersive nature of the simulated environment. This acts as a distraction in the brain, which interacts with how pain is perceived.

Dr. Hadar Lev-Tov of the University of Miami, one of the authors of the study, said:

“Most people will have undergone some type of minor medical procedure in their life such as wart removal, wound cleaning or injections. Although minor, these treatments are often uncomfortable and for some people, for example those with a phobia of needles, they can cause considerable anxiety.

“Virtual Reality is a relatively recent technology, and as such research into this area is new. However, distraction techniques have long been used by doctors when performing these procedures - Virtual Reality is just particularly effective at taking the patients from the here-and-now and immersing them in another experience. So effective in fact, that during our research some patients were surprised when their treatments were over.

“Especially encouraging is a new generation of VR devices which are now available, affordable and can be easily incorporated into clinical practice. At the same time, we need to expand research into the safety of using VR as it is not known for example how people with seizure disorders or vertigo respond to this immersive environment.”

Holly Barber of the British Association of Dermatologists said:

“There are a huge number of people for whom minor medical procedures, such as getting injections, or having stitches, are incredibly stressful. This leads to people putting them off for as long as possible, potentially endangering their health. This research is at a very early stage, but it suggests that VR could be a way to solve this problem. I suspect that for most people who wish to avoid these sorts of treatments, the idea is worse than the actual process.”

It is hoped that larger randomised control trials focusing on VR in bedside procedures will expand upon and confirm the results of this study.

 

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Study details:

The use of Virtual Reality for Bedside Procedures
P.A. Hirt1 and H. Lev-Tov1

1Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine.

Citation: P.A. Hirt and H. Lev-Tov (2019), The use of Virtual Reality for Bedside Procedures. Br J Dermatol. DOI 10.1111/bjd.17682.

Link to full study: https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.17682?af=R

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk

About us:

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk

The British Association of Dermatologists publishes two world-renowned dermatology journals, both published by Wiley-Blackwell. The British Journal of Dermatology is one of the top dermatology journals in the world, and publishes papers on all aspects of the biology and pathology of the skin. https://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133
 

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New research demonstrates the effectiveness of potential new eczema treatment

Peer Reviewed | Randomised Control Trial | People

A new cream being developed by scientists could greatly improve the treatment of eczema symptoms, according to new research published in the British Journal of Dermatology.

The research, conducted by dermatologists in Korea, has shown that a non-steroid containing cream, called PAC-14028, can be as effective in treating eczema symptoms as current creams on the market but with fewer side-effects.

Eczema is one of the most common skin diseases and is often linked to allergies, asthma and hay fever. One in five children is affected by eczema at some point, and the condition often continues into adulthood. It is characterised by red, itchy and sore skin which can affect the ability to sleep and generally reduce the patient’s quality of life.

Available topical (applied to the skin) treatments can be very effective in treating eczema symptoms. However, they can also cause negative side-effects such as itching and burning, which can result in patients discontinuing their treatment. Existing treatments can also lead to more serious complications in patients who rely on them for long periods, such as thinning of the skin with creams containing steroids.

The research was conducted with 194 adults with mild to moderate eczema. Participants were split into four groups and treated with either a control cream or the new treatment, PAC-14028 cream, at one of three different concentrations (0.1%, 0.3% or 1.0%). Participants applied the cream twice daily for eight weeks.

The results were primarily measured using the Investigator’s Global Assessment (IGA). This is a standardised visual scale for assessing the severity of eczema in a patient based upon typical symptoms. A score of zero represents a patient completely clear of eczema up to a score of five representing very severe eczema. Treatment success was classed as an IGA score of zero or one at the end of the trial.

After eight weeks, 57.5 percent of patients in the group who received the highest concentration PAC-14028 cream, had an IGA score of zero or one. Symptoms of eczema were therefore completely eradicated or reduced to an almost-clear level in a significant number.

IGA success rates at week eight were 15 percent for the control cream, compared to 43 percent for PAC-14028 cream at 0.1%, 38 percent for 0.3% and 57 percent 1.0%.

Those treated with the control cream showed relatively little improvement, with just 4.2 percent of patients having a two-grade IGA score improvement from the start of the trial, compared to 38.3 percent in the 1.0% cream.

Safety of the creams was also monitored as part of this study. The highest concentration PAC-14028 cream, 1.0%, had a favourable safety profile. Between treatment groups, there was no significant difference in the number of negative side-effects noted. Side-effects which were noted were all considered mild to moderate in severity, with no serious complications in any treatment group.

The efficacy of PAC-14028 cream was similar to a commonly used non-steroidal cream called pimecrolimus but with a far lower incidence of unwanted side-effects.

PAC-14028 cream works by inhibiting the impact of TRPV1, a protein which plays a role in the pain, inflammation and itching of eczema.

Holly Barber of the British Association of Dermatologists said: “The symptoms of eczema can have a huge impact on the day-to-day lives of patients. This study is exciting as potential new topical treatments for eczema flares are rare. However, further trials are required to confirm these findings after long periods of application.”

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Notes to Editors:

The British Association of Dermatologists’ Patient Information Leaflet on eczema is available here.

Study details:

Efficacy and safety of PAC-14028 cream, a novel, topical, nonsteroidal, selective TRPV1 antagonist in patients with mild to moderate atopic dermatitis: a phase IIb randomized trial
Y.W. Lee,1 C.-H. Won,2 K. Jung,3 H.-J. Nam,3 G. Choi,3 Y.-H. Park,3 M. Park3 and B. Kim4

1Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea, 2Department of Dermatology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Republic of Korea, 3Vital Beautie Research Institute, AmorePacific Corporation R&D Center, Yongin, Republic of Korea, 4Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Republic of Korea

Citation: Y.W. Lee, C.-H. Won, K. Jung, H.-J. Nam, G. Choi, Y.-H. Park, M. Park and B. Kim (2018), Efficacy and safety of PAC-14028 cream, a novel, topical, nonsteroidal, selective TRPV1 antagonist in patients with mild to moderate atopic dermatitis: a phase IIb randomized trial. Br J Dermatol. DOI 10.1111/bjd.17455.

Link to full study: https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.17455

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk
 

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