2023-11-18 15:33:45
(Montreal) A virtual reality therapy developed by a young Quebec company seems able to relieve the anxiety and nervousness that can accompany a visit to the dentist, especially when it comes to children.
Posted at 10:33 a.m.
Jean-Benoit Legault The Canadian Press
Taking advantage of the most recent technological advances in this area which make less bulky headsets available, Paperplane Therapeutics has developed two applications which allow the patient to be immersed in a virtual world while the dentist provides the necessary care.
This apparently results in procedures that are more pleasant for the patient and less time-consuming for the practitioner.
“I have always been passionate regarding everything that was non-pharmacological, not just for the management of pain and anxiety, but for the management of several pathologies, so trying to maximize everything we can do without always resorting to medications,” said the co-founder of Paperplane Therapeutics, Dr. Jean-Simon Fortin, a doctor who put his career on hold to devote himself to this project full-time.
PHOTO ROBERT SKINNER, LA PRESSE ARCHIVES
Dr. Jean-Simon Fortin
Dr. Fortin makes no secret of it: the practice of emergency pediatrics can end up being draining when you deal with children who suffer on a daily basis – or who are made to suffer, even if it is ultimately for their own good.
I worked for three years at Sainte Justine, in the emergency room, and […] I found it difficult when children are sick all day long, we are always doing things to them, then they cry, they scream, they struggle, and it starts to weigh on them.
Dr Jean-Simon Fortin
This is somewhat what led him to realize that “we lack options” to relieve the pain of little ones. They can always be put to sleep, but this option is reserved for the most painful procedures due to the risks that accompany it.
“I asked myself: Would we be able to have something that is safe, that children will love and that will transform experiences where everyone is stressed? When a child starts crying, it’s not just them, it’s the parents, the professionals… everyone in the room is even more stressed. So I was thinking: is there something that might lower that intensity for everyone and that would be extremely well received? »
Gate theory
The benefits conferred by the use of the virtual reality headset go well beyond a simple distraction for the patient and arise from a phenomenon known to researchers for several decades, that of the “gate theory”.
If a nerve impulse (such as a painful or at least unpleasant sensation) arrives in the brain and it is the only impulse present at that moment, explained Dr. Fortin, the brain will devote 100% of its attention to it. But if the brain is bombarded at the same time with multiple other impulses (such as those generated by a video game), virtually all of the impulses will be downregulated.
“Or the brain will focus on certain impulses, depending on its interest or the emotional state of the patient,” explained Dr. Fortin. So if for example there is something extremely pleasant, very stimulating, happening at the same time, the brain will increase the interpretation of these stimuli and it will really lower the intensity of the other stimuli. So if the pain was one of those, then the pain is going to be downregulated. »
Magnetic resonance images even show that certain areas of the brain, during a painful stimulus, are much less active in the presence of virtual reality, he added.
Using interactive video games, instead of a passive task like looking at a screen, also has something to do with it, Dr. Fortin revealed.
When there is a cognitive task that is involved, there are descending inhibitory pathways. It is a nervous system which starts from the brain, which descends to the level of the spinal cord and which releases a substance which is identical to morphine, which sticks to the same receptors and which blocks painful impulses. When the patient is captivated on a task that requires thinking regarding something, we have seen that there is a very interesting analgesic effect.
Dr Jean-Simon Fortin
In fact, this released “natural morphine” resembles morphine so much that it is possible to block its effect by administering to the patient the same product that would be used to neutralize synthetic morphine.
“There is really a very well-documented physiological mechanism that causes the body to react in a very concrete way to these stimuli,” said Dr. Fortin.
The most obvious beneficial effect of using virtual reality, however, appears to be a reduction in patient anxiety, which will prevent the vicious cycle of “the more anxious you are, the more pain you have; the more pain we have, the more anxious we are” to engage.
A “memory of pain” ends up setting in, recalled Dr. Fortin. A patient who has undergone a procedure that caused them pain will be even more anxious if they have to undergo it once more.
“It goes from a bad experience to a worse experience, to a worse experience, and that’s what makes it more and more difficult,” he said. It’s a slippery slope, as all children who are poorly cared for will become phobic once morest healthcare environments. »
Essay
Stopping at nothing to provide our readers with top quality information, the Canadian Press representative immediately volunteered to put the system to the test.
The first step consists of calibrating the virtual reality headset to allow it to follow the user’s gaze, since only the eyes will then be called upon to move. It only takes a few seconds, following which you can take action.
The first application is a shooting game which consists of blowing up different objects by “aiming” at them with your eyes. You just have to look at the object in question, the small light point which serves as a viewfinder moves accordingly, you press the trigger… and boom, the target is pulverized. The movements of the head – when there are any – are minimal and those of the hand non-existent, and we understand without long explanations that the opposite would be unimaginable in a dentistry context.
The second game is a puzzle where the goal is to line up pipes to redirect a trickle of water into a bucket. Once once more, it is with the eyes that we aim at the targets which allow us to change the orientation of the pipes (from left to right, from right to left) to send the water to the right place.
The two applications have also been designed to impose on the user a sort of “telescopic vision”: the image disappears as soon as they turn their head to the right or left, which forces them to remain immobility. he wants to play ― allowing the dentist to work in peace.
In the field
Dr. Élise Morency, whose practice is located in Saint-Constant, is currently the only dentist to use Paperplane technology in Quebec.
She discovered the product through her partner, a long-time friend and colleague of Dr. Fortin, and quickly realized that it might be a valuable asset in her daily practice.
“I have a clientele who, in general, have a lot of anxiety, I have a lot of ADHD, autism, young children who are referred to us because things haven’t gone well elsewhere. »
Over time, my practice has become more specialized, so […] It’s perfect at this time to have several ways to be able to modulate behavior in the room, because it’s not the same recipe that will work for everyone.
Dr. Élise Morency
Virtual reality, she continues, came to “fill a need that I saw for a certain stratum (of my clientele) that I was not able to really control well”.
The dentist and her assistant follow the progress of the game in real time, on an electronic tablet, and can influence its progress according to the needs of the moment. For example, if we reach a more delicate stage of the procedure, we can increase the volume of the game sound or make new targets appear to distract the user from what is regarding to happen.
“If I know I’m going to do something a little problematic for (the patient), I signal to my assistant and she will challenge the child, she will tell him, ‘there is a box who is parachuting down, detonate it immediately,” explained Dr. Morency. We are able to interact with him and keep his attention on the game, which means he forgets a little what is happening. I can work and sometimes they don’t even realize it, and I would say regarding 95% of the children when I take off the helmet say to me, “but is it already over? ”. »
The virtual reality headset is not appropriate for all patients, she explains, but she has noticed through its use that it is particularly appreciated by young people aged 8 to 14. With this stratum of her clientele, she said, “the unicorn world is over and they have real anxiety.”
“They know what’s happening and I need something very immersive to take their mind off the stress of what’s coming,” she said. And the headset works really well. Now I wouldn’t do without it, especially for procedures that are very anxiety-inducing, such as tooth extraction. »
Even though dentists know that the procedure is not very painful, a child of this age may have difficulty distinguishing between the pressure felt during the procedure and pain, whether real or perceived.
Dr. Morency also noted that using the virtual reality headset has virtually eliminated the gag reflex that some patients may have, including when she has to move their tongue to be able to work.
The use of the helmet might be possible in adults, she believes, with the difference that adults’ anxiety is usually more focused on the injection of the anesthetic product than on the procedure, while it is the opposite. for kids. A shorter virtual immersion might therefore be sufficient.
“Of course, if I can improve their experience, it will just make me happy,” she said. When someone leaves happy with their session, there is nothing better there for a dentist. »
This is also what Dr. Fortin is ultimately looking for, who says he takes immense pride in improving the patient experience.
“I feel like I’m still doing medicine, but it’s different. It’s certain that I don’t have the action-reaction of making a move and getting immediate feedback, but I receive people’s comments, how they use it on the ground and the benefits it brings, and it gives me the same feeling as the effect I had when I might have a positive effect in the emergency room,” concluded Dr. Fortin.
A clinical study to better quantify the impact of Paperplane Therapeutics’ technology is underway in the department of dentistry at CHU Sainte-Justine, in Montreal, under the supervision of Professor Sylvie Le May, a world authority in the field of pain management, as well as dentists Marie-Ève Asselin and Wenjia Wu.
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