Patients in a new St. Jude Children’s Research Hospital study will soon dive deep into the ocean for a marine experience alongside tropical fish, friendly seals and curious dolphins. While launching multi-colored bubbles at a variety of aquatic life, they’ll navigate an underwater terrain of sunken ruins and stone columns.
Swimsuits, scuba gear and beach towels won’t be necessary—the underwater journey is part of a new virtual reality experience designed to distract children with sickle cell disease who have acute pain crises.
People with sickle cell disease have red blood cells that are sickle-shaped and hard, making it difficult for their cells to move through blood vessels and deliver oxygen to body tissues. Pain crises are the recurring episodes that occur when normal blood flow is disrupted.
The pain is different for each individual. Some children get complete relief from routine pain medicines while others need more time or increased dosage before the pain subsides.
Three years ago, Doralina Anghelescu, MD, director of the hospital’s Pain Management Service, began a clinical trial to see if adding the drug gabapentin to the standard regimen would lessen acute pain from sickle cell crises more quickly or completely. The study is ongoing, but when presented with the opportunity of including virtual reality technology as a distraction tool, the researchers decided to try it.
The virtual reality project will include 76 patients—half will receive virtual reality sessions and the other half will receive standard treatment. St. Jude is partnering with the Memphis-based Methodist Comprehensive Sickle Cell Center on the clinical trial. This is the first study at St. Jude to use virtual reality, helping further position the institution as a leader in pain management for pediatric patients.
“I think St. Jude can be on the front line and be a champion for this new concept of integrative medicine—a combination of pain medications, working with psychologists, using relaxation techniques and technology-based approaches such as virtual reality,” Anghelescu says.
Under the sea
Children and teens in the study’s virtual reality arm will slip on a headset and headphones and grasp a video controller before they are launched into the 15-minute undersea experience. While receiving IV medications, participants dive into the water from a virtual boat and either navigate through the ocean or sit back and enjoy an automated ride.
Entering a 360-degree underwater world, patients can launch an unlimited arsenal of multi-colored orbs at passing marine life and strategically placed objects such as genie lamps, treasure chests and shimmering targets. Sea creatures such as jellyfish, orca whales and sea turtles glow brightly when the bubbles make contact, a harmless game of target practice that cumulates in a score posted at the end of the session.
Patients will meet a baby seal eye-to-eye at the journey’s halfway point. With relaxing music as a backdrop, the seal swims away to reveal an underwater castle of columns and archways.
“Overall, it’s a soothing experience, and it really does immerse you virtually,” says Latika Puri, MD, of St. Jude Hematology, the study’s principal investigator. “I thought 15 minutes might be a long time at first, but every few minutes you see something different, which makes you curious about what is going to happen next.”
St. Jude Hematology clinical research associates and nurses observe the session and help participants complete a short satisfaction survey. Participation in the study is a one-time occurrence.
A broader scale
Virtual reality has been used as a distraction technique for burn patients undergoing painful dressing changes, but St. Jude is one of the first institutions to use it for sickle cell crises in a study.
While virtual reality is a newly explored form of distraction, patients and families are already adept at using technology to alleviate pain or nervousness prior to medical procedures. It could be as simple as a child playing a game on a smart phone when receiving chemotherapy.
“Patients and families instinctively use distraction tools. This is just a bit more advanced intervention,” Anghelescu says.
The technology could potentially be used at St. Jude to help an even wider range of patients.
“It’s great because virtual reality as a distraction tool has broader applicability than just for pain, especially in oncology patients with port access and routine needle sticks,” Puri says. “At St. Jude, there is a real interest in making advancements by integrating cutting-edge science and technology with clinical medicine.”
From Promise, Spring 2018