Month: July 2020

Appendix

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Bibliography

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• Beck, AT, Brown, G, Epstein, N, Steer, RA (1988). An inventory to measure clinical anxiety: psychometric properties. Journal of consulting and clinical psychology, 56, 893-897.

• Bennett, M. (2001). The LANSS pain scale: the Leeds assessment of neuropathic symptoms and signs, Pain, 92, 147-157.

• Bouhassira, D., Attal, N., Alchaar, H., Boureau, F., Brochet, B., Bruxelle, J. , Cunin, G., Fermanian, J., Ginies, P., Grun-Overdyking, A., JafariSchluep, H., Lantéri-Minet, L., Laurent, B., Mick, G., Serrie, A., Valade, D., Vicaut, E. (2005). Comparison of pain syndromes associated with nerve or somatic lesions and development of a new diagnostic questionnaire for neuropathic pain (DN4). Pain, 114, 29-36. 10.1016 / j. Pain. 2004.12.010

• Brown, TA, Di Nardo, PA and Barlow, DH (1994). Interview schedule for anxiety disorders for DSM-IV (ADIS-IV). San Antonio: The Psychological Corporation.

• Cabas Hoyos, Kattia; Cárdenas López, Georgina; Gutiérrez Maldonado, José; Ruiz Esquivel, Fernanda; Torres Villalobos, Gonzalo; (2015). Clinical use of virtual reality for distraction and reduction of postoperative pain in adult patients. Tesis Psicológica, July-December, 38-50.

• Carlsson, AM (1983). Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain, 16, 87-101.

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Intervention proposal

“All the information contained in this section is for guidance only. Psious environments are therapy supporting tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user. 

Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, chip economy…) to Psious environments.”

THE PAIN DURING DIAGNOSTIC TESTS

In order to achieve a better result, it would be advisable to perform different relaxation techniques both before and after the painful diagnostic test. It is also recommended to evaluate the levels of pain and anxiety at the previous and final moments of the process, in order to analyze the changes in these levels (Cabas Hoyos, Cárdenas López, Gutiérrez Maldonado, Ruiz Esquivel, Torres Villalobos, 2015). 

BEFORE THE DIAGNOSTIC TEST

Assessment of the level of pain and anxiety (basal). Tools such as visual analogue scales (VAS) for pain and anxiety questionnaires (eg BAI).

Application of relaxation techniques: 

• Abdominal breathing through Psious virtual environments for this task (eg, diaphragmatic breathing in a meadow, diaphragmatic breathing under the sea).

• Abdominal breathing through 360o environments of relaxation (for ex.: cove), with abdominal breathing audio.

DURING DE DIAGNOSTIC TEST

Distraction Task using the Psious virtual environment. 

AFTER THE DIAGNOSTIC TEST IS DONE 

Assessment of the level of pain and anxiety using the same instruments as in the beginning. 

Imagery task through the Beach scene and/or 360o environments of Psious to consolidate the results achieved.

Evaluation

“All the information contained in this section is for guidance only. Psious environments are therapy supporting tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user.

Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, chip economy…) to Psious environments.”

OBJECTIVES 

• Determine the presence of emotional disorders.

• Determine the presence of pain behaviors and associated distorted thoughts.

• Determine the presence of anxiety and associated thoughts.

Useful tools for the evaluation of Chronic Pain and Anxiety 

Taking into account the evaluation objectives, we will list some tools that may be useful to obtain relevant information about the characteristics of your user. Remember that a good definition of the objectives, a well conducted patient characterization and intervention planning are important for the therapeutic efficiency and effectiveness, as well as for the satisfaction of your user. In the bibliography you will find the articles in which to review the characteristics of the tools proposed below:

Open or semi-structured interview

• Structured interview ADIS-IV

SELF-REPORTS

Regarding Chronic Pain, there are specific scales to measure it:

•  One-dimensional 
  1.  VAS (Visual Analogue Scales) (Carlsson, 1983) 
  2. Numeric Scale 
  3.  Facial Pain Scale 
     
• Multidimensional 
  1. McGill Pain Questionnaire, MPQ (Melzack & Torgerson, 1971) 
  2.  Lattinen Index, IL (Monsalve, Soriano and De Andrés, 2006) 
  3. Brief Pain Inventory, BPI (Badia et al, 2003) 

• Neuropathic Pain Rating Scales
  1.  The LANSS Pain Scale (Bennett, 2001) 
  2.  The Neuropathic Pain Questionnaire (NPQ) (Krause & Backonja, 2003) 
  3. Neuropathic pain in 4 questions (DN4) (Bouhassira et al, 2005) 
  4.  PainDETECT (Freynhagen et al, 2006) 

• Regarding Anxiety, there are specific measurement scales
  1. Hamilton Anxiety Rating Scale (HAM-A) (Hamilton, 1959) 
  2. The State-trait Anxiety Inventory (STAI) (Spielberger et al, 1999) 
  3. Beck Anxiety Inventory (BAI) (Beck et al, 1998) 
  4. Hospital Anxiety And Depression Scale- Anxiety (HADS-A) (Zigmond & Snaith, 1983)

Pain management
and virtual reality

Pain, despite being an unpleasant sensation, is a vital alarm system of the body since it allows the individual to recognize some stimulus harmful to the body tissue. Acute pain, because of its short duration, ends once the cause is resolved. However, chronic pain loses the alarm function to become an obstacle to achieve quality life. This pain can be caused by various conditions, and is resistant to standard treatments (Kato, J., Agalave, N. M., and Svensson, C.I., 2016). Some of the causes are burns, cancer, fibromyalgia, among others.

In relation to anxiety, it is a normal reaction to stress. It serves to help a person with a difficult situation and to enable them to deal with it. This type of anxiety is adaptive, but when it becomes excessive it can manifest itself as an anxiety disorder.

Pain Management therapeutic area includes different VR environments for patients with chronic pain, acute pain, or anxiety for medical procedures, who have to undergo processes such as hemodialysis, endoscopies, chemotherapy, visits to the dentist, magnetic resonance, etc., in order to decrease the painful sensations or anxiety by focusing the attention on the virtual environment.

There is scientific evidence that when one shifts attention from a noxious stimulus to a more pleasant one, there is a reduction in the perception and experience of pain. Melzack and Wall proposed the gate control theory, which emphasizes the relationship between the central and peripheral nervous systems, according to which only certain painful stimuli would pass to the brain. According to this theory, several Central Nervous System activities, especially attention, emotion and memories related to previous experience, play a fundamental role in sensory perception (Gold, et al, 2005).  Empirical evidence indicates that the use of virtual reality allows, in case of achieving a high immersion in the scene, the distraction of painful and anxious sensations in a very effective way (Jones, T., et al, 2016).