S. R. Sharar, M.D., T. Richards, Ph.D.
Painful medical procedures that do not warrant general anesthesia or deep sedation, yet require potent analgesia in awake and cooperative patients, are increasing in scope and number and exceed our specialty's resources to provide direct care. Awake patients undergoing painful procedures such as wound debridement, post-injury or post-operative physical therapy, cancer-related oncology procedures, or limited surgical procedures may benefit from the thoughtful combination of pharmacologic and non-pharmacologic analgesic techniques. Concrete evidence supporting this potentially widely applicable combined analgesic approach is lacking, but is best provided by anesthesiologists whose knowledge and training are best suited for such investigation. We propose to explore the efficacy, safety, and mechanism of one particularly promising combination -- systemic opioids + attentional distraction with immersive, interactive virtual reality (VR) — each of which alone can provide measurable analgesia for procedural pain. We propose to test the specific hypotheses: (1) that combined opioid + VR therapies act synergistically to effect clinically superior analgesia compared to either treatment alone, and (2) that functional neuroimaging of these therapies, alone and in combination, will demonstrate specific patterns of brain activation in the 'pain matrix' that explain their relative analgesic effects. Results from these studies will provide evidence for procedural analgesic strategies that maximize clinical and economic benefits, as well as provide valuable preliminary data for future clinical trials in procedural pain. Furthermore, these results will allow our specialty to positively impact conscious, procedural analgesic care outside of the operating room, whether or note we are directly involved in such patient care.