Virtual Reality als Baustein in der Behandlung akuter und chronischer Schmerzen

Zusammenfassung

Schmerzbehandlung zählt zu den täglichen Routinen klinischer Anästhesisten. Im Rahmen eines wohlüberlegten Einsatzes von Schmerzmedikamenten sind Alternativen zur medikamentösen Schmerztherapie notwendig. Virtual Reality (VR) konnte sich in den letzten Jahren durch immer kostengünstigere und bessere Technologien als realistische Ergänzung etablieren. Möglichkeiten der VR sowie Indikationen und Kontraindikationen werden aufgezeigt.

Abstract

Future or reality? Treating acute and chronic pain is a part of the daily routine of clinical anesthesiologists. Commonly used analgesics have unwanted side effects or may even be insufficient as in chronic pain treatment. Virtual Reality (VR) could be a promising new approach which offers noninvasive therapy options for the treatment of pain. In case of the opioid misuse the adjunctive treatment is mandatory. Various phenomena occur in VR, such as immersion, presence, embodiment and Proteus effect, which can cause a change in body awareness and behavior. Experimental and clinical studies already yielded some promising results for analgesic effects for acute and chronic pain conditions using VR simulation. Potential analgesic mechanisms include distraction, cognitive behavioral change, and distance from reality, leading to neurophysiological changes at the cortical level. The quality of the virtual environment, personalized avatars, as well as the possibility of interaction and multisensory input can increase immersion, which leads to a state of presence, and thus effective VR. VR can be used as an immersive extension or alternative to mirror therapy, especially for pain disorders such as complex regional pain syndrome (CRPS) or phantom limb pain. VR can be supplemented by gamification, which increases intrinsic motivation, well-being and adherence to therapy. In summary, VR could be an effective and realistic therapy option for acute and chronic pain in clinical and home settings in the future.

Kernaussagen

• In der VR treten verschiedene Phänomene wie Immersion, Presence, Embodiment, (Virtual) Body Ownership und Proteus-Effekt auf, die eine Veränderung der Körperwahrnehmung und des Verhaltens bewirken können.

• Die Qualität der virtuellen Umgebung, personalisierte Avatare, die Möglichkeit einer Interaktion sowie multisensorische Inputs verstärken die Immersion und damit die analgetische Wirksamkeit der VR.

• Als wirksame Mechanismen der VR auf Schmerz werden Ablenkung, kognitive Verhaltensveränderung und die Distanz von der Realität in Betracht gezogen, die zu neurophysiologischen Veränderungen auf kortikaler Ebene führen.

• Gamification steigert die intrinsische Motivation sowie das Wohlbefinden und erhöht die Adhärenz zur Therapie.

• Es gibt gute Evidenz, dass akuter Schmerz, vor allem experimentell und bei der Wundversorgung bei Verbrennungsopfern, durch VR-Simulationen positiv beeinflusst wird.

• Es gibt moderate Hinweise, dass chronischer Schmerz durch VR-Simulationen positiv beeinflusst werden kann, wobei individuelle Konzepte wahrscheinlich wirksamer sind und in den verschiedenen Schmerzerkrankungen noch untersucht werden müssen.

• VR kann als immersive Erweiterung oder Alternative zur Spiegeltherapie insbesondere bei verschiedenen Schmerzerkrankungen wie CRPS oder Phantomschmerz analgetisch eingesetzt werden.

Schlüsselwörter

Virtuelle Realität - chronischer Schmerz - Phantomschmerz - CRPS - Gamification

Key words

Virtual Reality - chronic pain - phantom limb pain - CRPS - gamification

Publikationsverlauf

Artikel online veröffentlicht:
11. September 2020

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