Virtual reality distraction for patients to relieve pain and discomfort during colonoscopy

Govert Veldhuijzen, Nienke J M Klaassen, Richard J A Van Wezel, Joost P H Drenth, Aura A Van Esch, Govert Veldhuijzen, Nienke J M Klaassen, Richard J A Van Wezel, Joost P H Drenth, Aura A Van Esch

Abstract

Background and study aims Colonoscopy is an invasive procedure that may cause patients pain and discomfort. Routine use of sedation, while effective, is expensive and requires logistical planning. Virtual reality (VR) offers immersive, three-dimensional experiences that distract the attention and might comfort patients. We performed a pilot study to investigate the feasibility of VR distraction during colonoscopy. Patients and methods Adults referred for colonoscopy were considered for inclusion and divided over two groups: with and without VR glasses. The main outcome was patient acceptance of wearing VR glasses during colonoscopy without compromising the technical success of the procedure. Secondary outcomes were patient comfort, pain, and anxiety before, during and after the procedure, using validated patient questionnaires. Patient comments were collected through a qualitative interview. Results We included 19 patients, 10 of whom were offered VR glasses. All patients accepted VR glasses without prolonging procedural time. No disadvantages of the VR glasses were reported in terms of communication or change of position of the patient. We found that patient comfort, pain, anxiety, and satisfaction in relation to the procedure were similar in both groups. Patients described a pleasant distracting effect using VR glasses. Conclusion VR glasses during colonoscopy are accepted by patients and do not compromise endoscopic technical success. Patients reported that the VR experience was pleasant and distracting.

Conflict of interest statement

Competing interests Funding for the trial was supported by Radboudumc. Visyon (supplier of hardware) had no role in the funding of this trial, nor in design and conduct of the study or in the writing and submission of the manuscript.

Figures

Fig. 1
Fig. 1
Study flowchart.
Fig. 2
Fig. 2
Samsung Gear VR shown on a patient during colonoscopy (with permission).

References

    1. Peterse E FP, Meester R GS, Siegel R L et al.The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline. Cancer. 2018;124:2964–2973.
    1. Lauriola M, Tomai M, Palma R et al.Intolerance of uncertainty and anxiety-related dispositions predict pain during upper endoscopy. Frontiers Psychol. 2019;10:1112.
    1. Brandt L J. Patients' attitudes and apprehensions about endoscopy: how to calm troubled waters. Am J Gastroenterol. 2001;96:280.
    1. Bynum S A, Davis J L, Green B L et al.Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. Am J Health Promotion. 2012;26:295–300.
    1. Shafer L A, Walker J R, Waldman C et al.Factors associated with anxiety about colonoscopy: the preparation, the procedure, and the anticipated findings. Digest Dis Sci. 2018;63:610–618.
    1. Cohen L B, Delegge M H, Aisenberg J et al.AGA Institute review of endoscopic sedation. Gastroenterology. 2007;133:675–701.
    1. Cote G A, Hovis R M, Ansstas M A et al.Incidence of sedation-related complications with propofol use during advanced endoscopic procedures. Clin Gastroenterol Hepatol. 2010;8:137–142.
    1. Lee L A, Caplan R A, Stephens L S et al.Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology. 2015;122:659–665.
    1. Kollmann C M, Schmiegel W, Brechmann T. Gastrointestinal endoscopy under sedation is associated with pneumonia in older inpatients-results of a retrospective case-control study. United European Gastroenterol J. 2018;6:382–390.
    1. Wernli K J, Brenner A T, Rutter C M et al.Risks associated with anesthesia services during colonoscopy. Gastroenterology. 2016;150:888–894; quiz e818.
    1. Lin O S. Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction. Intest Res. 2017;15:456–466.
    1. El Hassan H, McKeown K, Muller A. Clinical trial: music reduces anxiety levels in patients attending for endoscopy. Aliment Pharmacol Therap. 2009;30:718–724.
    1. Lee D, Chan A, Wong S et al.Can visual distraction decrease the dose of patient-controlled sedation required during colonoscopy? A prospective randomized controlled trial. Endoscopy. 2004;36:197–201.
    1. Martindale F, Mikocka-Walus A A, Walus B P et al.The effects of a designer music intervention on patients' anxiety, pain, and experience of colonoscopy: a short report on a pilot study. Gastroenterol Nursing. 2014;37:338–342.
    1. Umezawa S, Higurashi T, Uchiyama S et al.Visual distraction alone for the improvement of colonoscopy-related pain and satisfaction. World J Gastroenterol. 2015;21:4707.
    1. Nomura T, Higuchi K, Yu H et al.Slow‐wave photic stimulation relieves patient discomfort during esophagogastroduodenoscopy. J Gastroenterol Hepatol. 2006;21:54–58.
    1. Fanti L, Gemma M, Passaretti S et al.Electroacupuncture analgesia for colonoscopy: a prospective, randomized, placebo-controlled study. Am J Gastroenterol. 2003;98:312–316.
    1. Lembo T, Fitzgerald L, Matin K et al.Audio and visual stimulation reduces patient discomfort during screening flexible sigmoidoscopy. Am J Gastroenterol. 1998;93:1113–1116.
    1. Sjolander A, Jakobsson Ung E, Theorell T et al.Hospital design with nature films reduces stress-related variables in patients undergoing colonoscopy. HERD. 2019;12:186–196.
    1. Gold J I, Belmont K A, Thomas D A. The neurobiology of virtual reality pain attenuation. CyberPsychol Behav. 2007;10:536–544.
    1. Hoffman H G, Richards T L, Van Oostrom T et al.The analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments. Anes Analg. 2007;105:1776–1783.
    1. Chapman C R, Nakamura Y. Hypnotic analgesia: A constructivist framework. Int J Clin Exp Hypn. 1998;46:6–27.
    1. McCaul K D, Malott J M. Distraction and coping with pain. Psychol Bull. 1984;95:516.
    1. Dascal J, Reid M, IsHak W W et al.Virtual reality and medical inpatients: a systematic review of randomized, controlled trials. Innov Clin Neurosci. 2017;14:14–21.
    1. Jeffs D, Dorman D, Brown S et al.Effect of virtual reality on adolescent pain during burn wound care. J Burn Care Res. 2014;35:395–408.
    1. Maani C V, Hoffman H G, Morrow M et al.Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. J Trauma. 2011;71:S125.
    1. Das D A, Grimmer K A, Sparnon A L et al.The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: a randomized controlled trial. BMC Ped. 2005;5:1.
    1. Furman E, Jasinevicius T R, Bissada N F et al.Virtual reality distraction for pain control during periodontal scaling and root planing procedures. J Am Dental Assoc. 2009;140:1508–1516.
    1. Blokzijl S J, Lamberts K F, van der Waaij L A et al.Short article: Willingness to undergo colonoscopy with virtual reality instead of procedural sedation and analgesia. Europ J Gastroenterol Hepatol. 2019;31:334–339.
    1. Julious S A. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat. 2005;4:287–291.
    1. Vander Zee K I, Sanderman R, Heyink J W et al.Psychometric qualities of the RAND 36-Item Health Survey 1.0: a multidimensional measure of general health status. Int J Behav Med. 1996;3:104–122.
    1. Breivik H, Borchgrevink P, Allen S et al.Assessment of pain. Br J Anaesthesia. 2008;101:17–24.
    1. Spielberger C D. Plato Alto, CA: Consulting Psychologists Press; 1987. Manual for the State‐Trait anxiety inventory (form Y)
    1. Rostom A, Ross E D, Dubé C et al.Development and validation of a nurse-assessed patient comfort score for colonoscopy. Gastrointest Endosc. 2013;77:255–261.
    1. Reichheld F F. The one number you need to grow. Harvard Bus Rev. 2003;81:46–55.
    1. Kipping B, Rodger S, Miller K et al.Virtual reality for acute pain reduction in adolescents undergoing burn wound care: a prospective randomized controlled trial. Burns. 2012;38:650–657.
    1. Morris L D, Louw Q A, Crous L C. Feasibility and potential effect of a low-cost virtual reality system on reducing pain and anxiety in adult burn injury patients during physiotherapy in a developing country. Burns. 2010;36:659–664.
    1. McCarthy J D, Sasse M A, Miras D. Vienna, Austria: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; 2004. Sharp or smooth? comparing the effects of quantization vs. frame rate for streamed video.
    1. Nguyen N, Lavery W J, Capocelli K E et al.Transnasal endoscopy in unsedated children with eosinophilic esophagitis using virtual reality video goggles. Clin Gastroenterol Hepatol. 2019 doi: 10.1016/j.cgh.2019.01.023.
    1. Terruzzi V, Paggi S, Amato A et al.Unsedated colonoscopy: A neverending story. World J Gastrointest Endosc. 2012;4:137–141.
    1. Whitehead A L, Julious S A, Cooper C L et al.Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res. 2016;25:1057–1073.

Source: PubMed

Подписаться