Virtual Reality Use for Peri-Procedural Analgesia and Anxiolysis
Status:
Not yet recruiting
Trial end date:
2021-01-20
Target enrollment:
Participant gender:
Summary
Currently, most analgesic regimens for painful bedside procedures rely on pharmacologic
sedation or high doses of opioids (e.g.: nurse-administered IV opioids, anxiolytics, and
sedatives; patient-controlled analgesia; anesthesiologist-administered sedation; and
occasionally general anesthesia). Pharmacologic interventions are frequently associated with
suboptimal analgesia, opioid-induced side effects, requirement for increased monitoring due
to over sedation, and progressive acute tolerance to opioids over time, particularly with
multiple/repeat procedures.
Alternative, non-pharmacologic strategies may help reduce pain, side-effects and opioid
tolerance associated with painful bedside procedures. These strategies have not been studied
as extensively, but are becoming more important in view of the current national opioid
crisis. In particular, with recent technologic advancements, virtual reality (VR) has emerged
as a non-pharmacologic modality for analgesia and anxiolysis, which can have tremendous
benefits in acute pain management.
VR provides an immersive, realistic, often interactive experience for the user. It is
frequently described as "transporting" the user to an alternate environment, with the use of
high-fidelity head-mounted displays (HMD), noise-cancelling headsets, and a complete
audio-visual experience. The user's sense of "presence" in the VR environment is crucial in
providing patient engagement, and correlates with non-pharmacologic pain control.
VR has been shown to provide non-pharmacologic analgesia in children and adults undergoing
painful procedures such as bedside wound care, burn treatment, and physical therapy. The use
of VR during painful bedside procedures is one specific setting which offers a good starting
point to investigate this technology for acute pain management.
Our study wishes to determine if VR plus standard therapy provides superior analgesia for
painful bedside procedures (e.g. burn treatment, wound care) compared with standard therapy
alone. Our primary outcome is a reduction in pain scores by 30%, as measured by a numerical
analog scale (NAS) during painful bedside procedures. The investigators will use a
randomized, cross-over study design in which hospitalized patients receiving repeated painful
bedside procedures, will be randomized to 2 groups. Group A will have an initial painful
bedside procedure under standard treatment only, and a repeat procedure under standard
treatment + VR. Group B will have an initial procedure under standard treatment +VR, and a
subsequent one under standard treatment. Questionnaires including pain scores and secondary
outcomes will be administered to each patient before and after the bedside procedure. A
convenience sample of patients will be recruited over 1 year (anticipated N~30).