PAIN+ CPN

Mallari B, Spaeth EK, Goh H, et al. Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. J Pain Res. 2019 Jul 3;12:2053-2085. doi: 10.2147/JPR.S200498. eCollection 2019. (Systematic review)
Abstract

Background: Previous studies have shown that virtual reality (VR) is effective in reducing acute and chronic pain both in adults and in children. Given the emergence of new VR technology, and the growing body of research surrounding VR and pain management, an updated systematic review is warranted. Purpose: The purpose of this systematic review is to compare the effectiveness of VR in reducing acute and chronic pain in adults. Data Sources: A search was conducted in three databases (PubMed, CINAHL, Trip) using standardized search terms. Study Selection: Twenty experimental and quasi-experimental trials published between January 2007 and December 2018 were included based on prespecified inclusion and exclusion criteria. Pain intensity was the primary outcome. Data Extraction: We extracted data and appraised the quality of articles using either the PEDro or Modified Downs and Black risk of bias tools. Data Synthesis: The majority of studies supported the use of VR to reduce acute pain both during the procedure and immediately after. Numerous studies found VR reduced chronic pain during VR exposure but there is insufficient evidence to support lasting analgesia. There was considerable variability in patient population, pain condition and dosage of VR exposure. Limitations: Due to heterogeneity, we were unable to perform meta-analyses for all study populations and pain conditions. Conclusions: VR is an effective treatment for reducing acute pain. There is some research that suggests VR can reduce chronic pain during the intervention; however, more evidence is needed to conclude that VR is effective for lasting reductions in chronic pain.

Ratings
Discipline Area Score
Nurse 6 / 7
Physician 5 / 7
Comments from MORE raters

Nurse rater

I found the article very newsworthy and pertinent to my specialty. The study focused on acute and chronic. I can only speak to the population of healthcare providers that care for patients in acute pain. I am uncertain if providers in the chronic pain specialty know this info. I feel confident they would find it informative and relevant.

Nurse rater

While this could have application for some procedures in the Emergency Department, it is probably more relevant to areas like day surgery wards. To be able to discuss this with colleagues as a developing drug free adjunct to pain management is definitely useful.

Nurse rater

As a registered nurse working a busy emergency department in the metropolitan area, this research article definitely gave me an anchor to adjust the dose of narcotics I would recommend to administer for certain medical and nursing procedures such as X-ray and CT scan.

Nurse rater

As an emergency nurse in a busy emergency department and trauma center, VR is an interesting intervention; however, there are opportunities to improve the provision of NSAIDs and opioids and non-pharm therapies like heat/cold. I'm surprised they only searched 3 databases. Further, for the VR to be effective in cystoscopy, the user needs to feel immersed. I worry immersion would be difficult to achieve in crowded, loud emergency departments. Interesting but not particularly useful. We'll have to be guarded against biases that value technology, just for technology's sake.

Physician rater

This is interesting but not surprising. I wonder how useful it will end up being.

Physician rater

Very heterogeneous review. Hard to draw helpful conclusions.

Physician rater

The use of distraction during painful procedures is well established. It is not clear if VR is superior than other approaches or if there is any lasting benefit.

Physician rater

Meta analysis summarizing 48 studies examining the use of virtual reality (most often using goggles) as an adjunct method to reduce acute or chronic pain, and in particular surrounding medical procedures. There was a general trend towards benefit - while this evidence does not directly translate to the ED setting, it could be an interesting avenue of future investigation as a relatively feasible and implementable adjunct to traditional pain management.

Physician rater

The VR studies included are generally of low to medium quality levels. The impact of pain relief seems modest at best.

Physician rater

The concept is intriguing but the majority of studies were not in the Emergency Care Environment.

Physician rater

This review provides a comprehensive description of the state of the art on the use of VR for pain management. It is interesting that VR was reported effective in the management of acute pain during episiotomy repair, providing a possible tool to improve pain management. Nevertheless, as obstetrician, it does not seem really applicable in the usual clinical practice, particularly during labor or immediately after when the mother should let be focused on the newborn. Although interesting, VR represents a new tool that require further research before possible clinical applications in Obstetrics.

Physician rater

Emergency physicians routinely provide pain control for both acute and chronic pain. VR has emerged an effective treatment for reducing pain. This review provides an evidence to suggest to include VR as an adjunct to standard care to control the pain. Further research is required in order to determine the extent of immersion and availability in the acute settings.
Comments from PAIN+ CPN subscribers

No subscriber has commented on this article yet.