Table 2.
Summary of studies for utility of virtual reality in acute pain.
| Study | Intervention | Standard care; control | Measurement tools | Results |
| Chad et al [25] | VRa | N/Ab | FACESc (scale of 0-5) | Descriptive evidence of significantly reduced pain as reported by parents: 83% reduction (P=.02) in pain noted pre-VR (mean 3.34, SD 1.30) and post-VR (mean 0.76, SD 1.06). Insignificant reduction in pain reported by children: 77% reduction in pain noted with VR use (mean difference –2.5; P=.52). No information on pain score from children and variance. |
| Chan et al [26] | VR | Routine analgesia | FACES (scale of 0-100) | Significant differences (P<.05) of pain intensity found between VR group and non-VR group with ANOVAd: pain during procedure (VR: mean 38.13, SD 12.02; control: mean 53.75, SD 11.80) and pain after procedure (VR: mean 8.75, SD 2.95; control: mean 18.75, SD 9.53). |
| Chau et al [27] | VR | N/A | FLACCe (scale of 0-10) | FLACC scores with VR use: median 2.5 (1-5.5); range (1-8). 64.3% (9/14) of caregivers felt that the VR experience was positive and wanted to use it again. No between group differences explored for the following study. Descriptive evidence of reduced pain as reported by parents. |
| Frey et al [28] | VR | Unmedicated labor | VNSf (scale of 0-10) | Worst pain intensity was significantly lower in VR vs control (–1.5 (95% CI, –0.8 to –2.2). Significant differences in difference of pain intensity found between VR group and non-VR group with ANOVA. |
| Gerceker et al [29] | VR | External cold and vibration (buzzy); analgesia alone | Wong Baker FACES (scale of 0-10) | There was a statistically significant difference observed in pain scores between the VR group and control as reported by the patients (VR: mean 1.5, SD 0.2; control: mean 5.1, SD 0.4; P<.01) and parents (VR: mean 1.5, SD 0.2; control: mean 4.7, SD 0.4; P<.01). |
| Gershon et al [30] | VR with topical anesthetic | Video game with topical anesthetic; topical anesthetic | VASg (scale of 0-100); CHEOh pain scale | There was a significant reduction in pain in the VR and non-VR distraction group as observed by nurses (P<.05) based on MANOVAi. No summary measures were provided in the paper. From the CHEO pain scale, the VR group had significantly fewer behavioral markers in comparison to those of the controls for pain (P<.05). No summary measures were provided in the paper. No summary statistics on pain score from children and variance. |
| Glennon et al [31] | VR | Analgesia alone | NPSj (scale of 0-10) | Participants in the VR group (mean 3.9, SD 2.3)did not experience a statistically significant decrease (P<.05) in pain and anxiety in comparison to controls (mean 4, SD 2.7). Not powered adequately. Recruited individuals with prior exposure to bone marrow biopsy which may have skewed the reporting of pain. |
| Gold et al [32] | VR and analgesia | Analgesia alone | VAS (scale of 0-10); CASk; FACES | Significantly less pain (P<.05) was reported by the VR group (mean 1.31, SD 1.59) compared to that reported by the control group (mean 1.93, SD 2.22). |
| Hoffman et al [18] | VR and analgesia | Analgesia alone | GRSl | Statistically significant reduction (P<.01) in pain observed in VR (mean 7.6, SD 1.9) vs control (mean 5.1, SD 2.6). |
| McSherry et al [33] | VR and analgesia | Analgesia alone | VNS; opioid administration | Total opioid administration during VR therapy was significantly less than that when no VR was used (VR: 91.7 SD 10.1; no VR: 103.1 SD 16.1 μg/kg; P<.05). Overall, 39% less opioids were used with VR therapy. Pain scores (post procedure – pre procedure) were not significantly (P>.05) reduced in VR group (mean difference –1.2, SD 2.9) vs control (mean difference –0.3, SD 1.7). |
| Mosso-Vasquez et al [17] | VR and analgesia | N/A | VNS | 88% of patients reported a reduction in pain after VR therapy. Mean change in the Likert pain scale was 3.75. No descriptive statistics were provided. Change in pain scores (post procedure – pre procedure) was substantially correlated with change in respiratory rate (R2=0.26). It was, however, minimally correlated with heart rate (R2=0.05), mean arterial pressure (R2=0.09), and SpO2m (R2=0.00). |
| Mosso-Vasquez et al [34] | VR and analgesia | Mobile VR and analgesia | VAS | Overall, both head mounted display (presurgery: 6.06; postsurgery: 1.73) and mobile groups (presurgery 3.78; postsurgery 0.64) showed significant reductions (P<.01) in pain with VR. Head mounted display VR group experienced a significantly greater pain reduction from intra to postoperative states in comparison to the mobile VR group (–1.5 vs –0.07; P=.02). |
| Nilsson et al [19] | VR and analgesia | Analgesia alone | CAS; FASn; FLACC | No significant difference in CAS, FAS, and FLACC scores between VR and non-VR groups (P>.05). No descriptive statistics were provided. |
| Piskorz et al [35] | VR and analgesia | Analgesia alone | VAS | The VR group (mean 15.16, SD 20.51) reported significantly lower (P<.02) pain intensity compared to that of the control group (37.05 SD 30.66). Pain intensity was 59% lower in the VR group than in the control with a large effect size (Cohen d= 0.86). |
| Shoorab et al [36] | VR and analgesia | Analgesia alone | VNS | Statistically significant reduction in the pain scores were observed during episiotomy repair in the VR group using ANOVA (VR effect: f=88.6, df=1, P<.01). VR group had lower pain scores during several phases of the procedure in comparison to those of the non-VR group (P<.0001): during the repair of the hymen (VR: mean 9.0, SD 12.6; non-VR: mean 23.6, SD 19.8), skin (VR: mean 16.7, SD 16.5; non-VR: mean 39.3, SD 22.5), and after the repair (VR: mean 6.0, SD 12.8; non-VR: mean 25.2, SD 14). |
| Tashjian et al [37] | VR | Nature video | VNS | Pain reduction in the VR group (preintervention: mean 5.4, SD 2.6; postintervention: mean 4.1, SD 2.7) was greater (percentage reduction: 24% vs 12.2%, P<.01) than that in the control group within subjects (preintervention: mean 5.4, SD 2.6; postintervention: mean 4.8 SD 2.7). Higher number of responders in VR in comparison to control (≥0.5 SD drop in pain) (65% vs 40%, P<.01). |
| Walker et al [38] | VR and analgesia | Analgesia alone | VAS | No significant difference in pain scores (P>.05) between VR group and control—average pain (VR: 44 mm; control: 43 mm) and worst pain (VR: 66 mm; control: 59 mm)—during the procedure. |
| Yun Hua et al [39] | VR and analgesia | Analgesia alone | FACES;VAS; FLACC | Significantly less pain reported in the VR group compared to the control group before, during and after the dressing change (P<.05). Also, significantly lower scores during dressing change in VR vs control (P<.05): FACES—VR: mean 2.42, SD 1.85; control: mean 4.19, SD 2.12) VAS—VR: mean 4.35, SD 2.64; control: mean 6.25, SD 2.84) FLACC—VR: mean 4.18, SD 2.97; control: 7.36, SD 3.47). |
aVR: virtual reality.
bN/A: Not applicable.
cFACES: facial analysis scale (such as the Wong-Baker Faces Scale).
dANOVA: analysis of variance.
eFLACC: Face, Legs, Activity, Cry, Consolability.
fVNS: verbal numerical scale.
gVAS: visual analog scale.
hCHEO: Children’s Eastern Ontario Hospital Pain Scale.
iMANOVA: multivariate analysis of variance.
jNPS: numerical pain scale
kCAS: color analog scale
lGRS: graphical representation scale.
mSpO2: oxygen saturation.
nFAS: facial affective scale