Virtual reality for management of pain in hospitalized patients: A randomized comparative effectiveness trial

Brennan Spiegel, Garth Fuller, Mayra Lopez, Taylor Dupuy, Benjamin Noah, Amber Howard, Michael Albert, Vartan Tashjian, Richard Lam, Joseph Ahn, Francis Dailey, Bradley T Rosen, Mark Vrahas, Milton Little, John Garlich, Eldin Dzubur, Waguih IsHak, Itai Danovitch, Brennan Spiegel, Garth Fuller, Mayra Lopez, Taylor Dupuy, Benjamin Noah, Amber Howard, Michael Albert, Vartan Tashjian, Richard Lam, Joseph Ahn, Francis Dailey, Bradley T Rosen, Mark Vrahas, Milton Little, John Garlich, Eldin Dzubur, Waguih IsHak, Itai Danovitch

Abstract

Objectives: Therapeutic virtual reality (VR) has emerged as an effective, drug-free tool for pain management, but there is a lack of randomized, controlled data evaluating its effectiveness in hospitalized patients. We sought to measure the impact of on-demand VR versus "health and wellness" television programming for pain in hospitalized patients.

Methods: We performed a prospective, randomized, comparative effectiveness trial in hospitalized patients with an average pain score of ≥3 out of 10 points. Patients in the experimental group received a library of 21 VR experiences administered using the Samsung Gear Oculus headset; control patients viewed specialized television programming to promote health and wellness. Clinical staff followed usual care; study interventions were not protocolized. The primary outcome was patient-reported pain using a numeric rating scale, as recorded by nursing staff during usual care. Pre- and post-intervention pain scores were compared immediately after initial treatment and after 48- and 72-hours.

Results: There were 120 subjects (61 VR; 59 control). The mean within-subject difference in immediate pre- and post-intervention pain scores was larger in the VR group (-1.72 points; SD 3.56) than in the control group (-0.46 points; SD 3.01); this difference was significant in favor of VR (P < .04). When limited to the subgroup of patients with severe baseline pain (≥7 points), the effect of VR was more pronounced vs. control (-3.04, SD 3.75 vs. -0.93, SD 2.16 points; P = .02). In regression analyses adjusting for pre-intervention pain, time, age, gender, and type of pain, VR yielded a .59 (P = .03) and .56 (P = .04) point incremental reduction in pain versus control during the 48- and 72-hour post-intervention periods, respectively.

Conclusions: VR significantly reduces pain versus an active control condition in hospitalized patients. VR is most effective for severe pain. Future trials should evaluate standardized order sets that interpose VR as an early non-drug option for analgesia.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Samsung gear virtual realty headset.
Fig 1. Samsung gear virtual realty headset.
Fig 2. CONSORT diagram describing patient flow…
Fig 2. CONSORT diagram describing patient flow through the study.
Fig 3. Titles, descriptions, and screenshots of…
Fig 3. Titles, descriptions, and screenshots of VR experiences available to patients in the experimental group.
Complete list of content provided in supplemental materials (S1 Fig). Republished under a CC BY license, with permission from AppliedVR, original copyright 2016.
Fig 4. Mean pain-scores for each group…
Fig 4. Mean pain-scores for each group at 12-hour intervals during 72-hours before and after the intervention.

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