A beautiful VR environment can reduce pain in an unpleasant medical procedure

According to new research, being immersed in a stunning “virtual” Icelandic landscape can reduce the pain caused by uncomfortable medical procedures.

The study compared patients with and without virtual reality (VR) headphones with rigid cystoscopies, where a rigid telescope is inserted through the urethra into the bladder. The research is presented today at the congress of the European Association of Urology, UAE21.

The diagnosis and treatment of bladder cancer usually requires reviewing the bladder using a cystoscopy, which patients perceive as unpleasant and painful. Some patients avoid follow-up and, as a result, suffer from an irreversible and uncontrolled development of the disease. It is possible to have a flexible cystoscopy, which is less painful, but certain treatments can only be done with a rigid cystoscopy. Rigid cystoscopy can be performed under local anesthesia. It can also be performed under general and spinal anesthesia, but these procedures carry an additional risk of complications.

In some fields of medicine, VR has been shown to be an effective tool for relieving pain; for example, in patients with burns while changing dressings. In these applications, patients have tended to be upright and the RV experience interactive.

Dr. Wojciech Krajewski and colleagues at Wrocław Medical University in Poland recruited 103 patients, with a mean age of 66 years, who were listed for rigid cystoscopy with only local intraurethral anesthesia. Some were for an initial diagnosis and others required follow-up after having experienced the procedure in the past. Individuals were randomized to undergo classical cystoscopy or the procedure with VR glasses and headphones featuring an image of the Skógafoss waterfall in Iceland.

Patients were asked about their level of fear and completed a questionnaire on anxiety and depression before the procedure. During cystoscopy, the team measured blood pressure, oxygen saturation, and heart rate in patients, as well as taking pain-related observations using a measurement score called FLACC (observation of the face, legs, consolation and crying), which is used in children but is adjusted here for adults. After the procedure, patients were also asked to rate cystoscopy-related perception of pain and nausea.

Pain scale scores were lower in the VR group than controls and, although nausea and vertigo were higher with headphones and glasses, patients found it bearable and, therefore, no procedure had to be stopped.

Blood pressure and heart rate increased in all patients during the procedure, but less in the VR group. Oxygen saturation remained stable, but these measurements are less reliable because masks were introduced during the trial when the COVID-19 pandemic began.

The results were the same for male, female, primary, and follow-up cystoscopies, and the researchers believe the technology could be used for other awkward or painful procedures to help reduce patient pain.

Dr. Krajewski says, “Cystoscopy is uncomfortable for patients and they may be anxious about it. My colleagues and I were eager to find new ways to make them more comfortable and we had seen that RV technology was used for patients. younger patients to relieve pain interactively, in which case we wanted to try to present a reassuring picture, more appropriate for older patients, and see if we could better support them during their procedures. ”

“Patients reported less pain, and this was also reflected in our observations of their experience. VR is certainly an option to reduce pain on cystoscopies and we are studying whether it will have the same effect on other medical interventions. , such as lithotripsy, kidney stones or prostate biopsy “.

Professor James N’Dow, of the University of Aberdeen, who chairs the UAU Guidelines Office, says: “Improving the patient experience in the care they receive is as important as improving treatment outcomes. While it is logical to avoid general anesthesia whenever possible, telescopic bladder examinations with local anesthesia can be very uncomfortable and frightening for some patients.This study allows us to understand how virtual reality can distract patients and “reducing anxiety and pain. What is needed now is a larger trial, which would also involve a cost-benefit analysis, to determine whether this approach should be considered as part of standard clinical practice.”

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