Virtual reality for acute pain in outpatient hysteroscopy: a randomised controlled trial

N Deo, K S Khan, J Mak, J Allotey, F J Gonzalez Carreras, G Fusari, J Benn, N Deo, K S Khan, J Mak, J Allotey, F J Gonzalez Carreras, G Fusari, J Benn

Abstract

Objective: To evaluate the effectiveness of virtual reality as a distraction technique in the management of acute pain and anxiety during outpatient hysteroscopy.

Design: Parallel group, prospective randomised controlled trial.

Setting: UK University Hospital.

Methods: Forty consenting, eligible women were randomised to virtual reality intervention (immersive video content as a distraction method) or standard care during outpatient hysteroscopy from August to October 2018.

Main outcome measures: Pain and anxiety outcomes were measured as a numeric rating score (scale 0-10).

Results: Compared with standard care, women with virtual reality intervention experienced less average pain (score 6.0 versus 3.7, mean difference 2.3, 95% CI 0.61-3.99, P = 0.009) and anxiety (score 5.45 versus 3.3, mean difference 2.15, 95% CI 0.38-3.92, P = 0.02).

Conclusion: Virtual reality was effective in reducing pain and anxiety during outpatient hysteroscopy in a mixed-methods randomised control trial. Its wide potential role in ambulatory gynaecological procedures needs further evaluation.

Tweetable abstract: Virtual reality can be used as a part of a multimodal strategy to reduce acute pain and anxiety in patients undergoing outpatient hysteroscopy.

Keywords: Anxiety; outpatient hysteroscopy; pain; randomised controlled trial; virtual reality.

© 2020 Royal College of Obstetricians and Gynaecologists.

References

    1. RCOG. Standards for Gynaecology. London: RCOG Press; 2008.
    1. Finikiotis G. Outpatient hysteroscopy: pain assessment by visual analogue scale. Aust N Z J Obstet Gynaecol 1990;30:89-90.
    1. Cooper NAM, Khan KS, Clark TJ. Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis. BMJ 2010;340:c1130.
    1. Zupi E, Luciano AA, Valli E, Marconi D, Maneschi F, Romanini C. The use of topical anesthesia in diagnostic hysteroscopy and endometrial biopsy. Presented at the 22nd Annual Meeting of the American Association of Gynecologic Laparoscopists, San Francisco, California, November 10 to 14, 1993. Fertil Steril 1995;63:414-6.
    1. Shahid A, Pathak M, Gulumser C, Parker S, Palmer E, Saridogan E. Optimum uterine filling pressure for outpatient diagnostic hysteroscopy: a double-blind, randomized controlled trial. Reprod Biomed Online 2014;28:86-91.
    1. de Carvalho Schettini JA, Ramos de Amorim MM, Ribeiro Costa AA, Albuquerque Neto LC. Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: a cohort study. J Minim Invasive Gynecol 2007;14:729-35.
    1. Cicinelli E. Hysteroscopy without anesthesia: review of recent literature. J Minim Invasive Gynecol 2010;17:703-8.
    1. Ahmad G, Saluja S, O'Flynn H, Sorrentino A, Leach D, Watson A. Pain relief for outpatient hysteroscopy. Cochrane Database Syst Rev 2017;(10):CD007710.
    1. O'Flynn H, Murphy LL, Ahmad G, Watson AJ. Pain relief in outpatient hysteroscopy: a survey of current UK clinical practice. Eur J Obstet Gynecol Reprod Biol 2011;154:9-15.
    1. Allen RH, Micks E, Edelman A. Pain relief for obstetric and gynecologic ambulatory procedures. Obstet Gynecol Clin North Am 2013;40:625-45.
    1. Calvo JS, Del Valle Rubido C. Review of analgesic and anesthetic methods for office hysteroscopy. Gynecol Surg 2016;13(1 Suppl 1):S402.
    1. del Valle C, Solano JA, Rodríguez A, Alonso M. Pain management in outpatient hysteroscopy. Gynecol Minim Invasive Ther 2016;5:141-7.
    1. Loreto-Quijada D, Gutierrez-Maldonado J, Nieto R, Gutierrez-Martinez O, Ferrer-Garcia M, Saldana C, et al. Differential effects of two virtual reality interventions: distraction versus pain control. Cyberpsychol Behav Soc Netw 2014;17:353-8.
    1. Chan E, Foster S, Sambell R, Leong P. Clinical efficacy of virtual reality for acute procedural pain management: a systematic review and meta-analysis. PLoS One 2018;13:e0200987.
    1. Dascal J, Reid M, IsHak WW, Spiegel B, Recacho J, Rosen B, et al. Virtual reality and medical inpatients: a systematic review of randomized controlled trials. Innov Clin Neurosci 2017;14:14-21.
    1. Garrett B, Taverner T, Masinde W, Gromala D, Shaw C, Negraeff M. A rapid evidence assessment of immersive virtual reality as an adjunct therapy in acute pain management in clinical practice. Clin J Pain 2014;30:1089-98.
    1. Gold JI, Belmont KA, Thomas DA. The neurobiology of virtual reality pain attenuation. Cyberpsychol Behav 2007;10:536-44.
    1. Hoffman HG. Virtual-reality therapy. Sci Am 2004;291:58-65.
    1. Hoffman HG, Chambers GT, Meyer WJ III, Arceneaux LL, Russell WJ, Seibel EJ, et al. Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Ann Behav Med 2011;41:183-91.
    1. Hoffman HG, Garcia-Palacios A, Thomas AK, Schmidt A. Virtual reality monitoring: phenomenal characteristics of real, virtual, and false memories. Cyberpsychol Behav 2001;4:565-72.
    1. Li A, Montaño Z, Chen VJ, Gold JI. Virtual reality and pain management: current trends and future directions. Pain Manag 2011;1:147-57.
    1. Raghav K, Van Wijk AJ, Abdullah F, Islam MN, Bernatchez M, De Jongh A. Efficacy of virtual reality exposure therapy for treatment of dental phobia: a randomized control trial. BMC Oral Health 2016;16:25.
    1. Freeman D, Haselton P, Freeman J, Spanlang B, Kishore S, Albery E, et al. Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial. Lancet Psychiatry 2018;5:625-32.
    1. Powers MB, Emmelkamp PMG. Virtual reality exposure therapy for anxiety disorders: a meta-analysis. J Anxiety Disord 2008;22:561-9.
    1. Frey DP, Bauer ME, Bell CL, Low LK, Hassett AL, Cassidy RB, et al. Virtual reality analgesia in labor: the VRAIL pilot study-a preliminary randomized controlled trial suggesting benefit of immersive virtual reality analgesia in unmedicated laboring women. Anesth Analg 2019;128:e93-6.
    1. Amer-Cuenca JJ, Marín-Buck A, Vitale SG, Rosa VLL, Caruso S, Cianci A, et al. Non-pharmacological pain control in outpatient hysteroscopies. Minim Invasive Ther Allied Technol 2020;29:10-9.
    1. Forest of Serenity [Internet]. St Giles Hospice []. Accessed 22 November 2018.
    1. Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Breivik Hals EK, et al. Assessment of pain. Br J Anaesth 2008;101:17-24.
    1. Kindler CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients' anesthetic concerns. Anesth Analg 2000;90:706-12.
    1. Dearnley C. A reflection on the use of semi-structured interviews. Nurse Res 2005;13:19-28.
    1. Pope C, Ziebland S, Mays N. Analysing qualitative data. BMJ 2000;320:114-6.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences [Internet]. Amsterdam: Elsevier; 1977 []. Accessed 19 December 2019.
    1. Wang Y-L, Gao H-X, Wang J-S, Wang J-H, Bo L, Zhang T-T, et al. Immersive virtual reality as analgesia for women during hysterosalpingography: study protocol for a randomized controlled trial. Trials 2020;21:102.
    1. De Silva PM, Mahmud A, Smith PP, Clark TJ. Analgesia for office hysteroscopy: a systematic review and meta-analysis. J Minim Invasive Gynecol [Internet]. 2020;27(5):1034-47. []. Accessed 21 February 2020.
    1. Angioli R, Nardone CDC, Plotti F, Cafà EV, Dugo N, Damiani P, et al. Use of music to reduce anxiety during office hysteroscopy: prospective randomized trial. J Minim Invasive Gynecol 2014;21:454-9.
    1. Mak N, Reinders IMA, Slockers SA, Westen E, Maas JWM, Bongers MY. The effect of music in gynaecological office procedures on pain, anxiety and satisfaction: a randomized controlled trial. Gynecol Surg 2017;14:14.
    1. Cooper NA, Smith P, Khan KS, Clark TJ. Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain [Internet]. Centre for Reviews and Dissemination (UK); 2010 []. Accessed 21 February 2020.
    1. Ogden J, Heinrich M, Potter C, Kent A, Jones S. The impact of viewing a hysteroscopy on a screen on the patient's experience: a randomised trial. BJOG 2009;116:286-93.
    1. Kahneman D. Attention and Effort. Englewood Cliff, NJ: Prentice Hall; 1973.
    1. Eccleston C. Role of psychology in pain management. Br J Anaesth 2001;87:144-52.
    1. Eccleston C, Crombez G. Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychol Bull 1999;125:356-66.

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