Effect of virtual reality intervention on hospitalized patients with acute pain after thoracoscopic surgery: A randomized controlled trial

Abstract

Abstract Background: Acute postsurgical pain remains one of the most common complaints among patients treated with minimally invasive video-assisted thoracoscopic surgery (VATS). Immersive virtual reality (VR) has been found to be a nonpharmaceutical technological means to deliver effective behavioral therapies for acute pain in some postsurgical settings. However, the role of VR in pain management after thoracoscopic surgery is still not determined. Objective: To determine the analgesic effects of behavioral skill-based VR on patients after VATS. Methods: Patients with a numerical rating scale (NRS) score ≥ four for postoperative pain were randomly assigned in a 1:1:1 ratio to the QTC-VR, Placebo-VR, and control groups. Postoperative standard analgesia comprised an analgesia pump and flurbiprofen injections. All three groups of patients received standard analgesics. Patients in the Placebo-VR group watched a 10-minute relaxation-based 2D film through VR headsets, while patients in the QTC-VR group engaged in 10-minute interactive pain relief 3D VR programs while wearing VR headsets. Results: Of the 61 postsurgical patients randomized and allocated to the QTC-VR, placebo-VR, and control groups, 15 failed to meet the criteria for analgesic drug use, and 1 suffered severe vertigo, leaving the data from 45 patients for final statistical analyses. There were no significantdifferences among the three groups in terms of age, sex, smoking status, education level, thoracoscopic surgical modalities, or baseline pain intensity. Patients who received QTC-VR interventions experienced considerable pain alleviation on the first (P < 0.001, 95% CI, 0.687 to 1.246), second (P < 0.001, 95% CI, 0.158 to 0.642), and third (P < 0.001, 95% CI, 0.108 to 0.559) postoperative days. The effect of pain interference on relations with others for patients receiving QTC-VR improved on postoperative days 2 (P= 0.007, 95% CI, -2.477 to 0.323) and 3 (P < 0.001, 95% CI, -2.420 to 0.780) compared with patients in the placebo-VR group, while the effect of pain on emotion (P = 0.018, 95% CI, -1.810 to 0.210), sleep (P = 0.004, 95% CI, -2.422 to 0.378), enjoyment of life (P= 0.005, 95% CI, -2.207 to 0.326), walking ability (P= 0.022, 95% CI, -1.882 to -0.118), and general activity (P= 0.007, 95% CI, -1.997 to 0.270) improved only on day 3 following surgery. Moreover, patients who underwent therapeutic QTC-VR interventions reported satisfaction with their treatment and experienced few adverse events. Conclusions: This randomized controlled trial (RCT) demonstrates the efficacy and feasibility of immersive QTC-VR interventions in pain management after thoracoscopic surgery. This needs to be further validated by the ongoing phase III clinical trial. Trial registration: ClinicalTrials.gov ID: NCT05926817