Virtual reality hypnosis diminishes experimental cold pain and alters autonomic responses.

Immersive virtual reality (VR) is a promising tool to reduce pain in clinical setting. Digital scripts displayed by VR disposals can be enriched by several analgesic interventions, which are widely used to reduce pain. One of these techniques is hypnosis induced through the VR script (VRH) which is facilitated by immersive environment and particularly efficient even for low hypnotizable patients. The aim of this study is to assess the efficacy of a VRH script on experimentally induced cold pain perception (intensity and unpleasantness) and physiological expression. 41 healthy volunteers had been recruited in this within-subjects study. They received 9 stimulations of 20 s (3 non-nociceptive cold; 3 low nociceptive cold and 3 highly nociceptive cold) during a VRH session of 20 min (VRH condition) or without VRH (noVRH condition). Physiological monitoring during the cold pain stimulation protocol consisted of recording heart rate, heart rate variability and respiratory frequency. Maximum cold pain intensity perception, measured through the visual analog scale (VAS) on 10, was of 3.66 ± 1.84 (VAS score/10) in noVRH condition and 2.46 ± 1.54 in VRH (Wilcoxon, p < 0.0001). Considering pain unpleasantness perception, 3.68 ± 2.06 in noVRH and 2.21 ± 1.63 in VRH (Wilcoxon, p < 0.0001). Hypnotizability negatively correlated with the decrease in VAS intensity from noVRH to VRH (Spearman r = -0.45; p = 0.0038). In our sample, we found that 31/41 volunteers (75.6%) displayed a reduction of more than 10% of their VAS pain intensity and unpleasantness scores. Trait anxiety was the best predictor of the VRH responders, as well as heart rate variability. In addition, respiratory rate was diminished under VRH in every subgroup. VRH is an effective tool to reduced pain intensity and unpleasantness in a vast majority of healthy subjects. We further indicate in this study that heart rate variability parameter RMSSD (root mean square of successive differences) is a good predictor of this effect, as well as anxiety as a personality trait (but not state anxiety). Further studies are expected to determine more precisely to whom it will be the most useful to offer tailored, non-pharmacological pain management solutions to patients.

Effect of Virtual Reality Hypnosis on Pain Threshold and Neurophysiological and Autonomic Biomarkers in Healthy Volunteers: Prospective Randomized Crossover Study.

BACKGROUND: Virtual reality hypnosis (VRH) is a promising tool to reduce pain. However, the benefits of VRH on pain perception and on the physiological expression of pain require further investigation. OBJECTIVE: In this study, we characterized the effects of VRH on the heat pain threshold among adult healthy volunteers while monitoring several physiological and autonomic functions. METHODS: Sixty healthy volunteers were prospectively included to receive nociceptive stimulations. The first set of thermal stimuli consisted of 20 stimulations at 60°C (duration 500 milliseconds) to trigger contact heat evoked potentials (CHEPs). The second set of thermal stimuli consisted of ramps (1°C/second) to determine the heat pain threshold of the participants. Electrocardiogram, skin conductance responses, respiration rate, as well as the analgesia nociception index were also recorded throughout the experiment. RESULTS: Data from 58 participants were analyzed. There was a small but significant increase in pain threshold in VRH (50.19°C, SD 1.98°C) compared to that in the control condition (mean 49.45°C, SD 1.87; P<.001, Wilcoxon matched-pairs signed-rank test; Cohen d=0.38). No significant effect of VRH on CHEPs and heart rate variability parameters was observed (all P>0.5; n=22 and n=52, respectively). During VRH, participants exhibited a clear reduction in their autonomic sympathetic tone, as shown by the lower number of nonspecific skin conductance peak responses (P<.001, two-way analysis of variance; n=39) and by an increase in the analgesia nociception index (P<.001, paired t-test; n=40). CONCLUSIONS: The results obtained in this study support the idea that VRH administration is effective at increasing heat pain thresholds and impacts autonomic functions among healthy volunteers. As a nonpharmacological intervention, VRH has beneficial action on acute experimental heat pain. This beneficial action will need to be evaluated for the treatment of other types of pain, including chronic pain.

An active cardiac stabilizer based on gyroscopic effect.

Active cardiac stabilization has a role to play in the development of minimally invasive techniques for beating heart surgery. We propose here a new active cardiac stabilization device based on gyroscopic actuation. This system allows to compensate for heart motion in high frequencies and is fully independant and pluggable on conventional stabilizers. The mechanical model and design are described. The system is controlled thanks to static state feedback, taking into account gyroscope specificities. Experiments results are presented. They highlight the effectiveness of this solution with a 48% reduction of the RMS excursion.

Motion prediction for computer-assisted beating heart surgery.

Off-pump totally endoscopic coronary artery bypass grafting is a milestone for cardiac surgery, and still a technical challenge. Indeed, the fast and complex cardiac motion makes this operating method technically demanding. Therefore, several robotic systems have been designed to assist the surgeons by compensating for the cardiac motion and providing a virtually motionless operating area. In the proposed systems, the servoing schemes often take advantage of a prediction algorithm that supplies the controller with some future heart motion. This prediction enlarges the control-loop bandwidth, thus allowing a better motion compensation. Obviously, improving the prediction accuracy will lead to better motion-compensation results. Thus, a current challenge in computer-assisted cardiac surgery research is the design of efficient heart-motion-prediction algorithms. In this paper, a detailed survey of the main existing prediction approaches is given and a classification is provided. Then, a novel prediction technique based on amplitude modulation is proposed, and compared with other techniques using in vivo collected datasets. A final discussion summarizes the main features of all the proposed approaches.

Cardiolock: an active cardiac stabilizer. First in vivo experiments using a new robotized device.

Off-pump Coronary Artery Bypass Grafting (CABG) is still a technically difficult procedure. The mechanical stabilizers used for local suppression of the heart excursion have been demonstrated to exhibit significant residual motion, which could lead to a lack of accuracy in performing the surgical task, particularly when using a minimally invasive surgery (MIS) approach. We therefore propose a novel active stabilizer to compensate for the residual motion whose architecture is compatible with MIS. An experimental evaluation of a commercially available totally endoscopic stabilizer is first presented to demonstrate the unsatisfactory behavior of this device. Then, the interaction between the heart and a mechanical stabilizer is assessed in vivo using an animal model. Finally, the principle of active stabilization, based on the high-speed vision-based control of a piezo-actuated compliant mechanism, is presented, along with in vivo experimental results obtained using a prototype to demonstrate its efficiency.

Cardiolock: an active cardiac stabilizer. First in vivo experiments using a new robotized device.

Off-pump Coronary Artery Bypass Grafting (CABG) is still today a technically difficult procedure. In fact, the mechanical stabilizers used to locally suppress the heart excursion have been demonstrated to exhibit significant residual motion. We therefore propose a novel active stabilizer which is able to compensate for this residual motion. The interaction between the heart and a mechanical stabilizer is first assessed in vivo on an animal model. Then, the principle of active stabilization, based on the high speed vision-based control of a compliant mechanism, is presented. In vivo experimental results are given using a prototype which structure is compatible with a minimally invasive approach.