Virtual Reality Distraction for Reducing Acute Postoperative Pain After Hip Arthroplasty: A Randomized Trial

Abstract

BACKGROUND: Relaxation and distraction provided by virtual reality presentations might be analgesic and reduce the need for opioid analgesia. We tested the hypothesis that a virtual reality program (AppliedVR) decreases acute postoperative pain and opioid requirements in patients recovering from hip arthroplasty. We also evaluated whether virtual reality distraction improves patient mobility and reduces the need for antiemetics. METHODS: We evaluated 106 adults who were recovering from elective primary total hip arthroplasty. Participating patients were randomized to 2- to 8-minute-long 3-dimensional immersive virtual reality relaxation and distraction video presentations (eg, guided breathing exercises, games, mindfulness) or to 2-dimensional presentations of nature short films (eg, forest wildlife) with neutral music that was chosen to be neither overly relaxing nor distracting, presented through identical headsets. Our primary outcome was pain after virtual reality or sham video presentations, adjusted for pretreatment scores. Secondary outcomes included total opioid consumption, pain scores obtained per routine by nurse staff, perception of video system usability, and pain 1 week after hospital discharge. RESULTS: Fifty-two patients were randomized to virtual reality distraction and relaxation, and 54 were assigned to 2-dimensional sham presentations. Virtual reality presentations were not found to affect pain scores before and after presentations, with an estimated difference in means (virtual reality minus sham video) of −0.1 points (95% confidence interval [CI], −0.5 to 0.2; P = .391) on a 0 to 10 scale, with 10 being the worst. The mean (standard error [SE]) after-intervention pain score was estimated to be 3.4 (0.3) in the virtual reality group and 3.5 (0.2) in the reference group. Virtual reality treatment was not found to affect postoperative opioid consumption in morphine milligram equivalents, with an estimated ratio of geometric means (virtual reality/sham video) of 1.2 (95% CI, 0.6–2.1; P = .608). Virtual reality presentations were not found to reduce pain scores collected every 4 hours by nursing staff, with an estimated difference in means of 0.1 points (95% CI, −0.9 to 0.7; P = .768). CONCLUSIONS: We did not observe statistically significant or clinically meaningful reductions in average pain scores or opioid consumption. As used in our trial, virtual reality did not reduce acute postoperative pain.

How Real Are the Effects of Virtual Reality in Decreasing Acute Pain?

“…However, they are, in a way, easier to criticize--it is hard to combat the idea that perhaps if the study had been designed or conducted differently, then a positive result would have ensued. With that consideration in mind, the following issues and questions become pertinent regarding the study by Araujo-Duran et al 2 As the study looked to demonstrate the effects of VR as compared to an inactive control, it was asking a question more on the explanatory side of spectrum and necessitated a tighter control over the anesthetic and analgesic regimen. However, there was no such standardization during the pre-, intra-, or postoperative phases of the protocol.…”

“…1 With significant advancement in the field of computer modeling and simulation, VR applications have started to find a place in several health care fields and applications including pain management. 1 In this editorial, we attempt to provide a succinct summary of VR technology and briefly review published literature of its use in the context of acute pain, so that we can better appreciate and appraise the reported randomized controlled trial (RCT) by Araujo-Duran et al 2 For the purpose of our discussion, we will consider VR as a broad category and do not distinguish it from other variants of VR such as augmented reality or mixed reality.…”

Virtual reality-based therapy for chronic low back and neck pain: a systematic review with meta-analysis

“…Virtual reality-based therapy (VRTV) is a complementary therapeutic tool that could increase motivation and adherence to conventional physiotherapy programs and could be a therapeutic option to add to physiotherapy programs. There has been an increase in the creation and use of virtual reality hardware and software in physical rehabilitation, which has shown to be effective in pathologies such as total knee arthroplasty ( 25 ), total hip arthroplasty ( 26 ), or fibromyalgia ( 27 ). VR headsets enable the recreation and motor interaction with immersive or semi-immersive experiences and objects that subjects consider to be similar to real ones.…”