Virtual reality as a Non-Drug Intervention (NMI)

Context and challenges of non-drug interventions (NMIs)

‍

Drug sobriety, or the rational use of medications, has become a major challenge for modern health systems. In terms of public health, reducing drug consumption reduces side effects and the risks of complications associated with drug interactions. Economically, this sobriety makes it possible to reduce the costs associated with medications and their storage. In some care pathways, medication sobriety promotes faster patient recovery, freeing up beds more quickly to improve the performance of services. In addition, drug sobriety meets environmental concerns by reducing the ecological footprint linked to pharmaceutical products themselves, but also to their production and the management of the waste they generate.

‍

In order to limit the excessive consumption of drugs, more and more learned societies and public interest organizations such as the NPIS (Non-Pharmacological Intervention Society), the SFAR (Société Française d'Anesthétique et de Réanimation) and the Médéric Alzheimer Foundation are interested in the development of Non-Drug Interventions (NMIs) [1] [2] and the Médéric Alzheimer Foundation are interested in the development of Non-Drug Interventions (NMIs) [1] [2]. In addition, the Médéric Alzheimer Foundation recently integrated virtual reality into its INM Guide for Alzheimer's disease published in 2024 [1].

‍

In this article, we will explore how integrating virtual reality as a non-drug intervention can contribute to medication sobriety in a variety of clinical settings. We will rely on several concrete cases to illustrate the impact of this new technology.

Virtual reality as a non-drug intervention: concrete clinical cases

‍

In the operating room

Before an operation, the use of immersive virtual reality makes it possible to reduce anxiety levels preoperative of a patient [3], [4], [5]. A study carried out in 40 patients who had to undergo rhinoplasty was shown that virtual reality allowed a significant reduction in preoperative anxiety [3]. A case study conducted on a patient undergoing gallbladder surgery showed a 67% decrease in preoperative anxiety levels thanks to virtual reality [4]. Patients who are less anxious are more likely to follow the instructions given by the surgeon, which promotes the fluidity of procedures and reduces surgery time. It will also allow limit the use of anxiolytics (before surgery) and painkillers (after surgery) and to avoid the risks associated with these medications. All of this contributes to better surgical outcomes, better post-operative recovery and thus helps to reduce overall health care costs.

‍

Immersive virtual reality is also useful During an operation. A literature review has shown that in various clinical contexts (venipuncture, dental care, dental care, colonoscopy, burn care, nasal endoscopy, etc.), virtual reality combined with local anesthesia, makes it possible to reduce the use of sedation and to avoid general anesthesia [6]. This method of multimodal pain management, recommended by the SFAR, makes it possible in particular to reduce the consumption of anesthetic gases [7], [8]. These gases, pollutants and bad for health, are poorly metabolized by humans and will therefore be mostly eliminated in the atmosphere [9], [10], [11]. By limiting the use of anesthetic gas in the operating room, virtual reality makes it possible to limit the negative impact of these on the environment, and to preserve the health of caregivers.

‍

During the treatments

As we could see in a Previous article, the Immersive virtual reality is effective in reducing acute pain, especially in cases of wound and burn treatments and needle/catheter insertions. This will have a positive impact on the consumption of painkillers (opiates). Indeed, studies carried out during burn treatments [12] or in women with breast cancer [13] have shown that, used as a complement usual pharmacological treatments, virtual reality allowed a reduction in the consumption of strong opiates (up to 40% off at [12]). The abuse of strong opiates is a public health and economic problem because it can lead to reliance in the patient, affecting its quality of life and requiring long-term additional care, which represents a cost for the health system [14]. The use of non-drug interventions, such as virtual reality, as soon as the first pains appear, will have a positive impact on the consumption of these opiates and on the associated costs. By reducing the risk of addiction, this technology makes it possible to limit the costs associated with long-term care for dependent people.

‍

In health and social institutions

Beyond the health field, virtual reality is also beneficial in medico-social institutions welcoming seniors or Handicapped. Many caregivers using Lumeen in the field have seen a reduction in the consumption of anxiolytics and painkillers among elderly residents, in particular during painful treatments such as bedsores bandages (as shown by the testimony of a caregiver published in “L'Éveil Normand”, Figure 1). Reducing anxiety and pain during care reduces the need for pharmacological treatments, which in turn limits the undesirable side effects of these medications, which are often significant in elderly and frail people.

‍

Excerpt from the article: “The caregivers were able to see that after these sessions, some people in a state of anxiety, and for whom it is usually necessary to administer an anxiolytic to relieve themselves, did not need it after the virtual helmet session.”

*Figure 1: Excerpt from an article published in the newspaper L'Éveil Normand on June 5, 2024.*

‍

Virtual reality can also be used to reduce mood disorders whose apathy. Indeed, although still few, studies show encouraging results concerning the use of this technology in the management of the behavioral and psychological symptoms of dementia, in particular with decreased apathy scores during virtual reality sessions [15], [16]. Apathy can lead to increased use of medications, such as antidepressants, anxiolytics, and hypnotics, as clinicians may mistake it for depression or anxiety. By stimulating patient engagement and interest, virtual reality will have a positive and significant impact on medication sobriety, thus helping to improve the wellness General and the quality of life patients.

‍

The take-home message

By promoting the development of non-drug interventions such as virtual reality and by adopting a more responsible and sustainable approach to drug consumption, we can improve the quality of care, save money and contribute to the preservation of the environment.

‍

Lumeen is committed to promoting medication sobriety and helping the health system. Recently, Corentin Metgy, co-founder and president, was able to speak on this subject at the annual forum of the Agency for the Good Use of Medicines (ABUM). You can find his speech below:

‍

To go further

‍

References

[1] Y. Mederic Alzheimer Foundation, “Non-drug interventions and Alzheimer's disease”, 2024. Accessed on: June 7, 2024. [On line]. Available at: https://www.fondation-mederic-alzheimer.org/wp-content/uploads/2024/03/guide-inm_edition-2024_francais.pdf

[2] N. Stoicea, A. Costa, L. Periel, L. Periel, A. Periel, A., A., A., A., A., Periel,, A.,, A.,, A.,,,,,,,,,,,,, A., Uribe, T. Weaver, and S. D. Bergese, “Current perspectives on the opioid crisis in the US healthcare system: A comprehensive literature review,” Medicine (Baltimore), vol. 98, n.^O 20, p. e15425, May 2019, doi: 10.1097/MD.0000000000015425.

[3] A. D. Baytar and K. Bollucuoglu, “Effect of virtual reality on preoperative anxiety in patients undergoing septorhinoplasty”, Braz. J. Anesthesiol. Engl. Ed., vol. 73, n^O 2, pp. 159-164, March 2023, doi: 10.1016/j.bjane.2021.08.014.

[4] A. Flores et al., “Using Immersive Virtual Reality Distraction to Reduce Fear and Anxiety before Surgery,” Healthcare, vol. 11, n.^O 19, p. 2697, Oct. 2023, doi: 10.3390/healthcare11192697.

[5] L. Ganry, B. Hersant, M. Sidahmed-Mezi, M. Sidahmed-Mezi, G. Donneur, and J. P. Meningaud, “Using virtual reality to control preoperative anxiety in ambulatory surgery patients: A pilot study in maxillofacial and plastic surgery”, J. Stomatol. Oral Maxillofaca. Surg., vol. 119, n.^O 4, p. 257‑261, Sep 2018, doi: 10.1016/j.jormas.2017.12.010.

[6] R. Hitching et al., “The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review,” J. Clin. Med., vol. 12, n.^O 3, p. 843, Jan. 2023, doi: 10.3390/jcm12030843.

[7] L. Bonnet, J. Muret, and J.-C. Pauchard, “Reducing pollution by inhaled anesthetic gases”.

[8] E. M. Hafiani, J.-C. Pauchard, J. Muret, J. Muret, M. Bruyere, and L. Bonnet, “Reduce/Eliminate the Use of Nitrous Oxide”.

[9] Mr. K. Vollmer et al., “Modern Inhalation Anesthetics: Potent Greenhouse Gases in the Global Atmosphere,” Geophys. Res. Lett., vol. 42, n^O 5, p. 1606‑1611, March 2015, March 2015, doi: 10.1002/2014GL062785.

[10] J.F. Boivin, “Risk of spontaneous abortion in women occupationally exposed to anaesthetic gases: a meta-analysis.”, Occupy. Approximately. Med., vol. 54, n.^O 8, p. 541-548, August 1997, August 1997, doi: 10.1136/oem.54.8.541.

[11] Mr. Teschke et al., “Exposure to anesthetic gases and congenital anomalies in offspring of female registered nurses”, Am. J. Ind. Med., vol. 54, n.^O 2, pp. 118—127, Feb. 2011, doi: 10.1002/ajim.20875.

[12] T. McSherry, M. Atterbury, S. Gartner, S. Gartner, E. Helmold, E. Helmold, D. M. Searles, and C. Schulman, “Randomized, Crossover Study of Immersive Virtual Reality to Decrease Opioid to Decrease Opioid Use During Painful Wound Care Procedures in Adults”:, J. Burn Care Res., p. 1, May 2017, doi: 10.1097/BCR.0000000000000589.

[13] Mr. Ahmad, E. Bani Mohammad, E. Tayyem, E. Tayyem, E. Al Gamal, and Mr. Atout, “Pain and anxiety in patients with breast cancer treated with morphine versus tramal with virtual reality”, Health Care Women Int., vol. 45, n.^O 7, p. 782-795, July 2024, doi: 10.1080/07399332.2023.2257627.

[14] A. M. Dydyk, N. K. Jain, and M. Gupta, “Opioid Use Disorder”, in StatPearls, Treasure Island (FL): StatPearls Publishing, 2024. Accessed on: June 5, 2024. [On line]. Available at: http://www.ncbi.nlm.nih.gov/books/NBK553166/

[15] R. E. Brimelow, B. Dawe, and N. Dissanayaka, “Preliminary Research: Virtual Reality in Residential Aged Care to Reduce Apathy and Improve Mood,” Cyberpsychology Behav. Soc. Netw., vol. 23, n.^O 3, pp. 165-170, March 2020, doi: 10.1089/cyber.2019.0286.

[16] D. Saredakis, H. A. Keage, M. Keage, M. Corlis, and T. Corlis, and T. Loetscher, “Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study,” J.Med. Internet Res., vol. 22, n.^O 6, p. e17632, June 2020, doi: 10.2196/17632.

‍

Photo credit: Coline Bachelier