{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T02:35:46Z","timestamp":1781404546135,"version":"3.54.1"},"reference-count":49,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T00:00:00Z","timestamp":1638144000000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                        <jats:title>Introduction<\/jats:title>\n                        <jats:p>The annual mortality and national expense of the opioid crisis\n                            continue to rise in the USA (130 deaths\/day, $50\u2009billion\/year). Opioid\n                            use disorder usually starts with the prescription of opioids for a\n                            medical condition. Its risk is associated with greater pain intensity\n                            and coping strategies characterised by pain catastrophising.\n                            Non-pharmacological analgesics in the hospital setting are critical to\n                            abate the opioid epidemic. One promising intervention is virtual reality\n                            (VR) therapy. It has performed well as a distraction tool and pain\n                            modifier during medical procedures; however, little is known about VR in\n                            the acute pain setting following traumatic injury. Furthermore, no\n                            studies have investigated VR in the setting of traumatic brain injury\n                            (TBI). This study aims to establish the safety and effect of VR therapy\n                            in the inpatient setting for acute traumatic injuries, including\n                            TBI.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Methods and analysis<\/jats:title>\n                        <jats:p>In this randomised within-subjects clinical study, immersive VR\n                            therapy will be compared with two controls in patients with traumatic\n                            injury, including TBI. Affective measures including pain\n                            catastrophising, trait anxiety and depression will be captured prior to\n                            beginning sessions. Before and after each session, we will capture pain\n                            intensity and unpleasantness, additional affective measures and\n                            physiological measures associated with pain response, such as heart rate\n                            and variability, pupillometry and respiratory rate. The primary outcome\n                            is the change in pain intensity of the VR session compared with\n                            controls.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Ethics and dissemination<\/jats:title>\n                        <jats:p>Dissemination of this protocol will allow researchers and funding\n                            bodies to stay abreast in their fields through exposure to research not\n                            otherwise widely publicised. Study protocols are compliant with federal\n                            regulation and University of Maryland Baltimore\u2019s Human Research\n                            Protections and Institutional Review Board (protocol number\n                            HP-00090603). Study results will be published on completion of enrolment\n                            and analysis, and deidentified data can be shared by request to the\n                            corresponding author.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Trial registration number<\/jats:title>\n                        <jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial pre-results\" xlink:href=\"NCT04356963\">NCT04356963<\/jats:ext-link>; Pre-results.<\/jats:p>\n                    <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-056030","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T15:53:48Z","timestamp":1667577228000},"page":"e056030","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Adjunctive virtual reality pain relief following traumatic injury:\n                        protocol for a randomised within-subjects clinical trial"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct04356963","registry":"10.18810\/clinical-trials-gov","type":"preResults"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5375-1313","authenticated-orcid":false,"given":"Ryan B","family":"Felix","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aniruddha","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazhar","family":"Khalid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luana","family":"Colloca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah B","family":"Murthi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A","family":"Morris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,11,30]]},"reference":[{"key":"2022110304331283000_11.11.e056030.1","doi-asserted-by":"crossref","first-page":"202","DOI":"10.15585\/mmwr.mm7006a4","article-title":"Trends and geographic patterns in drug and synthetic opioid overdose deaths - United States, 2013-2019","volume":"70","author":"Mattson","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2022110304331283000_11.11.e056030.2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6911a4"},{"key":"2022110304331283000_11.11.e056030.3","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e3181ff04ca"},{"key":"2022110304331283000_11.11.e056030.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2016.11.003"},{"key":"2022110304331283000_11.11.e056030.5"},{"key":"2022110304331283000_11.11.e056030.6","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.jpain.2017.06.010","article-title":"Factors influencing long-term opioid use among opioid naive patients: an examination of initial prescription characteristics and pain etiologies","volume":"18","author":"Shah","year":"2017","journal-title":"J Pain"},{"key":"2022110304331283000_11.11.e056030.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2014.03.004"},{"key":"2022110304331283000_11.11.e056030.8","doi-asserted-by":"crossref","DOI":"10.1097\/AJP.0b013e318270fa77","article-title":"Days with pain and substance use disorders: is there an association?","volume":"29","author":"Edlund","year":"2013","journal-title":"Clin J Pain"},{"key":"2022110304331283000_11.11.e056030.9","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6609a1"},{"key":"2022110304331283000_11.11.e056030.10","unstructured":"National Center for Health Statistics, Centers for\n                            Disease Control and Prevention, U.S. Department of Health and Human\n                            Services . National Hospital ambulatory medical care survey: 2018\n                            emergency department summary tables, 2018. 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Impact of different immersive\n                            techniques on the perceived sense of presence measured via subjective\n                            scales. 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