A short-cut review of the available medical literature was carried out to establish whether virtual reality was an effective method for pain control during medical procedures. After abstract review, fifteen papers were found to answer this clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is insufficient high-quality research to answer this question.
- emergency care systems
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Three part question
In (adults undergoing painful procedures) does (virtual reality) (decrease acute pain perception) compared with (no distraction techniques)?
A 47-year-old woman presents to the emergency department with a 6 cm superficial laceration on her forearm. She sustained the injury while cutting wood to build an outdoor patio set. She is very anxious and complaining of severe pain making it difficult to examine the entire wound or provide local anaesthetic. You wonder how to proceed with irrigation and closure.
Distraction methods are commonly used in paediatric emergency departments to ease anxiety and reduce pain perception in children undergoing painful procedures. Can distraction methods, specifically virtual reality, be effective in decreasing pain perception in adults undergoing painful procedures?
Medline 1996–February/2020 using the OVID interface
([virtual reality.mp. or exp Virtual Reality/ or exp Computer Simulation/ or Imaging, Three-Dimensional/ or Therapy, Computer-Assisted/] or [virtual reality.ti,ab,kf.] or [enhanced reality.mp.]) AND ([exp Acute Pain/ or exp Pain Perception/ or exp Pain Management/ or exp Pain Measurement/] or [pain outcome.mp.] or [painful procedure.mp]) LIMIT to all adult (19 plus years) and english language
Three hundred and twenty-three papers of which 284 were deemed irrelevant to answering the clinical question, 16 were excluded as the participants underwent painful stimulus (heat/thermal, cold pressor, mild electric shock) and not a painful procedure, 6 were excluded as we found that undergoing a painful experience (physical therapy session in burn victims, labour) did not fit under the term ‘painful procedure’, 2 papers were excluded as they were case studies. These are presented in table 2.
All 15 studies included were experimental studies comparing pain scales of patients undergoing procedures with adjunct VR headsets or non-distraction. Eight studies showed improved pain scores with statistically significant results. Five RCTs showed no statistically significant difference between the two groups. Two studies, although in support of VR, were based on qualitative responses. The major limitation of these studies was small sample sizes, non randomisation, non blinding and use of analgesics as a confounder. Some reasons against VR include minor side effects of nausea during simulation and the fact that some adults would prefer observing the procedure or interacting with the physician/caregiver.
Clincal bottom line
Based on the presented evidence, there is no strong evidence to favour virtual reality headsets as a means to reduce acute pain perception in adults undergoing medical procedures. Further study into the topic is needed.
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