Virtual Reality Analgesia for Procedural Cancer Pain

描述(由申请人提供) 持续提供有效的止痛和最小的副作用是癌症治疗的主要治疗目标。然而，对于反复接受腰椎穿刺术和骨髓抽吸术等肿瘤手术的患者，尤其是儿童，这往往仍然是一个难以实现的目标。镇静和止痛的药理技术在大多数临床环境中都被使用，但它们的广泛使用受到相关经济成本和副作用(如安全风险、不适和不便)的限制。替代和补充的非药物止痛技术已经在一些癌症环境中被采用，但其机制、有效性和特定的适应症还没有完全被研究。沉浸式虚拟现实(VR)基于认知分心的一般原理，是一种创新的非药物止痛技术。我们的研究小组已经证明了它在成人和儿童急性程序性疼痛的非癌症环境中的初步疗效，并正在探索其止痛效果的机制和决定因素。例如，止痛效果似乎取决于用户在虚拟世界中感受到的“在场”(或沉浸)程度，这种感觉受到用户与环境的交互和在环境中的移动的强烈影响。在目前的提案中，我们将建立在这一知识的基础上，并在一系列临床前研究中重点介绍VR止痛在程序性癌症疼痛中的应用。该项目的广泛和长期目标是：(1)设计和制造包含多感官输入的VR硬件和软件，以最大限度地使用户在虚拟环境中(以及由此产生的止痛)中“存在”，在其中身体位置固定的受试者(例如，腰椎穿刺者)，其运动或运动受到严格限制(即，‘运动受限的虚拟现实’-MRVR)；(2)评估MRVR相对于标准临床VR(允许和鼓励运动)和2-D视频分心(一种目前可用的分心疗法)在成人和青少年受试者中的止痛效果和副作用；以及(3)收集和解释这些初步数据，以便设计未来在成人和儿童肿瘤痛苦手术中使用MRVR的对照临床试验。

DESCRIPTION (provided by applicant) The consistent provision of effective pain relief with minimal side effects is a major therapeutic goal in cancer therapy. However, it often remains an elusive goal in patients, particularly in children, undergoing repeated oncologic procedures such as lumbar puncture and bone marrow aspiration. Pharmacologic techniques of sedation and analgesia are utilized in most clinical settings, but their widespread use is limited by associated economic costs and side effects (e.g., safety risk, discomfort, and inconvenience). Alternative and complementary, non-pharmacologic analgesic techniques have been adopted in some cancer settings, but their mechanisms, efficacy, and specific indications have been incompletely investigated. Based on the general principal of cognitive distraction, immersive virtual reality (VR) is an innovative non-pharmacologic analgesic technique. Our research group has demonstrated its preliminary efficacy in non-cancer settings of acute procedural pain in adults and children, and is exploring the mechanisms and determinants of its analgesic effects. For example, analgesic efficacy appears dependent on the degree of 'presence' (or immersion) the user feels in the virtual world, a sensation that is strongly influenced by the user's interaction with, and movement within the environment. In the current proposal, we shall build on this knowledge and focus on the application of VR analgesia to procedural cancer pain in a series of preclinical studies. The broad, long-term objectives of this project are: (1) to design and fabricate VR hardware and software that incorporate multisensory input to maximize user 'presence' in the virtual environment (and hence analgesia), in subjects in whom body position is fixed (e.g., for lumbar puncture) and whose movement or motion is severely restricted (i.e., 'Movement-Restricted Virtual Reality' -- MRVR); (2) to assess the analgesic efficacy and side effects of MRVR relative to standard clinical VR (where motion is tolerated and encouraged) and to 2-D video distraction (a currently available distraction therapy) in adult and adolescent subjects experiencing controlled, analog (thermal) pain; and (3) to collect and interpret these preliminary data in order to design future controlled clinical trials of MRVR in adults and children during painful oncologic procedures.