Written by Nick Zelt
Distraction as a method of analgesia and anxiolysis for minor ED procedures using a 3D virtual reality (VR) display was not better than using a 2D screen.
Why does this matter?
The majority of patients who present to the ED have pain and anxiety; frequently, this is their chief complaint. Distraction can be an effective method of improving these aspects of patient care and, no doubt, many of you can attest to how distracting modern technology can be. The use of VR to reduce procedural pain and anxiety has mostly been studied in children and adolescents. How would it perform in adults?
Not to worry, it should be virtually painless
This was a single-centre randomized controlled trial on 117 adult patients requiring a procedure in the ED (suturing, fracture reduction/casting or arterial blood gas puncture). Patients were randomized to either a VR headset or a laptop screen, both of which displayed a “Zen garden” accompanied by relaxing music played through noise-reduction headphones. The primary outcome was maximal pain and anxiety intensity during the procedure. All suturing was still done with local anesthesia and 54% of fracture/dislocation patients received systemic analgesia. The headphones could be briefly removed to give the patient instructions during the procedure if necessary.
There was no statistically significant difference in pain or anxiety scores between the VR group and the laptop group. 51% of patients reported “cybersickness,” a symptom similar to motion sickness but in the context of virtual immersion. The rates of cybersickness were similar between both groups, and no patients vomited.
The authors chose a 2D screen as the control, because in order for VR to be worth the additional cost, it would have to outperform the more convenient option of a regular screen. However, since both groups received distraction, the magnitude of effect of distraction could not be assessed. Most physicians found the interventions helpful, with only a few percent reporting them as impediments.
This study certainly does not put the question of VR as an adult analgesic/anxiolytic to rest, despite negative findings. I expect future studies with immersion experiences tailored to patient preference and perhaps the addition of an interactive component, via eye-motion tracking, could improve immersion and effectiveness. For the time being, I would allow my patient to watch a video on their phone, if they preferred, and would spare the expense for a VR headset.
Analgesic and Anxiolytic Effects of Virtual Reality During Minor Procedures in an Emergency Department: A Randomized Controlled Study. Ann Emerg Med. 2022 May 28:S0196-0644(22)00264-5. doi: 10.1016/j.annemergmed.2022.04.015. Epub ahead of print.