Virtual reality is as effective as sedation in reducing pain and anxiety during epidural steroid injections, with no significant difference between virtual reality and sedation (mean difference 0.5 [−0.6, 1.7]). Trends towards reduced procedure-related anxiety and increased satisfaction were observed in the virtual reality and sedation groups, compared to control, though these differences were not statistically significant, according to a recent study.
The comparative effectiveness of virtual reality (VR) vs. sedation and local anesthetic for pain and anxiety management during epidural steroid injections was investigated. The study, published in The Lancet Regional Health Southeast Asia, enrolled 146 patients from six hospitals in Thailand and the U.S. Patients were randomized to receive either immersive VR with local anesthetic, sedation with midazolam and fentanyl plus local anesthetic, or only local anesthetic.
The main outcome measured was the level of pain experienced during the procedure, recorded on a 0-10 scale. Secondary outcomes included pain from a standardized skin wheal, procedure-related anxiety, communication ability, satisfaction, and time to discharge. Intermediate-term outcomes at 4 weeks included back and leg pain scores, functional outcomes, and a success rate defined as a ≥2-point decrease in average leg pain coupled with a score ≥5/7 on a Patient Global Impression of Change scale.
Results showed that both VR (mean pain score 3.7) and sedation (mean pain score 3.2) reduced procedure-related pain compared to control (mean pain score 5.2; mean differences: VR vs. control, −1.5 [−2.7, −0.4]; sedation vs. control, −2.1 [−3.3, −0.9]). Communication ability was higher in the VR group (mean 4.1) compared to the sedation group (mean 3.7; mean difference 0.4 [0.1, 0.6]). Recovery time was shorter for the VR group compared to the sedation group (mean difference 11.7 minutes [2.2, 21.4]). Intermediate-term outcomes showed no significant differences among groups except for medication reduction, which was lowest in the control group.
Full disclosures available in the original study.