Report

A 63-year-old man was referred for assessment of recurrent episodes of collapse. MRI suggested raised intracranial pressure and the patient was admitted for an elective lumbar puncture to assess cerebrospinal fluid and measure opening pressures. The patient was also under the care of the adult mental health team and was being treated for somatoform disorder with severe anxiety and depression. On admission, the patient was highly anxious about his current symptoms as well as the lumbar puncture procedure. He was identified as a potential candidate that may benefit from a virtual reality (VR) device to improve tolerability and the hospital’s clinical VR team were contacted for assistance.

The VR system that was chosen was a Healthy Mind (Paris, France) Pico device with headphones. The immersive scene within the software includes a three-dimensional natural location, environment-based hypnotherapy scripts, accompanying music, relaxation features to encourage deep breathing, and distraction techniques to focus attention away from the clinical procedure. The patient was given verbal and written information about the VR device and the potential benefits it may have to him during the procedure. He was also given the opportunity to try on the VR headset and headphones before the procedure commenced and make a choice as to which immersive scene he might find the most relaxing during the procedure. The patient opted for an underwater scene (figure 1). He was informed that the clinical team would be able to communicate with him during the procedure using the text feature of the device, whereby he would receive written notifications within the immersive scene (eg, before local anaesthetic was administered). The patient was also informed that he could gain the clinical team’s attention during the procedure by raising his hand.

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Figure 1

Underwater immersive environment as seen by the patient

The lumbar puncture lasted 20 min and proceeded without complication (figure 2). The patient’s well-being was checked regularly throughout the procedure, and he remained calm throughout. Approximately 10 min into the procedure, the patient fell asleep and remained so for the duration of the procedure. Verbal feedback was obtained about the patient’s experience of the procedure using the VR device and he reported that the VR system helped him to forget what was happening and relax more.

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Figure 2

Patient in left lateral position using the virtual reality headset and headphones.

Clinical VR is a rapidly evolving sector with benefits being applied to a wide range of settings within healthcare. It is hypothesised that VR reduces pain by providing an effective distraction away from the painful stimuli that the patient would otherwise be focused on.1–5 This results in less attentional resources available to process nociceptive signals.6 In addition to a reduction of subjective pain perception, VR has also been shown to reduce pain-related brain activity on functional MRI.7 8

The case presented here demonstrates how VR technology may benefit patients undergoing invasive procedures such as lumbar puncture. VR may, therefore, offer an alternative or adjunct to sedation and analgesia and may reduce the amount of pharmacological therapy required.