Pain is one of the most common, yet challenging problems leading to emergency department (ED) presentation, despite the availability of a wide range of pharmacological therapies. Virtual reality (VR) simulations are well studied in a wide variety of clinical settings, including acute and chronic pain management, as well as anxiety disorders. However, studies in the busy environment of an adult ED are scarce. The aim of this study is to explore the feasibility and effectiveness of a VR simulation for pain and anxiety control in a convenience sample of adult ED patients presenting with traumatic and non-traumatic pain triaged 2–5 (i.e., urgent to non-urgent) with a pain rating of ≥ 3 on a numeric rating scale (NRS 0–10). Prospective within-subject, repeated measures interventional feasibility pilot study at a Swiss University ED. The intervention consisted of a virtual reality simulation in addition to usual care. Pain and anxiety levels were measured using a verbally administered numeric rating scale (NRS) before and after the intervention. Information on patient experience was collected using established rating scales. Fifty-two patients were enrolled. The most common pain localisations were extremities (n = 15, 28.8%) and abdomen (n = 12, 23.1%). About one third of patients presented with trauma-associated pain (n = 16, 30.8%). Duration of pain was mainly acute (< 24 h) (n = 16, 30.8%) or subacute (> 24 h) (n = 32, 61.5%). The majority of patients were triage category 3, i.e. semi-urgent (n = 48, 92.3%). Significant reduction in pain (NRS median pre-VR simulation 4.5 (IQR 3–7) vs. median post-VR simulation 3 (IQR 2–5), p < 0.001), and anxiety levels (NRS median pre-VR simulation 4 (IQR 2–5) vs. median post-VR simulation 2 (IQR 0–3), p < 0.001) was achieved, yielding moderate to large effect sizes (Cohen’s d estimate for pain reduction = 0.59 (95% CI 0.19—0.98), for anxiety level on NRS = 0.75 (95% CI 0.34—1.15). With medium immersion and good tolerability of the VR simulation, user satisfaction was high. Virtual reality analgesia for pain and anxiety reduction in the busy setting of an ED is feasible, effective, with high user satisfaction. Further randomized controlled studies are needed to better characterize its impact on pain perception and resource utilization.

中文翻译：

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用于急诊室疼痛缓解的虚拟现实 (VIPER) – 一项前瞻性的介入性可行性研究

尽管有多种药物疗法可供使用，但疼痛是导致急诊 (ED) 就诊的最常见但最具挑战性的问题之一。虚拟现实 (VR) 模拟在各种临床环境中得到了很好的研究，包括急性和慢性疼痛管理以及焦虑症。然而，在成人 ED 的繁忙环境中进行的研究很少。本研究的目的是探索 VR 模拟在疼痛和焦虑控制中的可行性和有效性，该样本对患有创伤性和非创伤性疼痛的 2-5 级（即紧急到非紧急）的成人 ED 患者进行了方便的样本分类在数字评分量表上疼痛评分≥ 3 (NRS 0-10)。在瑞士大学 ED 进行的受试者内、重复测量干预可行性试点研究。除了常规护理外，干预还包括虚拟现实模拟。在干预前后使用口头数字评分量表 (NRS) 测量疼痛和焦虑水平。使用既定的评分量表收集有关患者体验的信息。入组了 52 名患者。最常见的疼痛部位是四肢（n = 15, 28.8%）和腹部（n = 12, 23.1%）。大约三分之一的患者出现与创伤相关的疼痛（n = 16, 30.8%）。疼痛持续时间主要是急性（< 24 小时）（n = 16, 30.8%）或亚急性（> 24 小时）（n = 32, 61.5%）。大多数患者属于分诊类别 3，即半紧急（n = 48, 92.3%）。疼痛显着减轻（NRS VR 前模拟中位数 4.5（IQR 3-7）与 VR 后模拟中位数 3（IQR 2-5），p < 0.001），NRS 的焦虑水平 = 0.75 (95% CI 0.34-1.15)。VR模拟的沉浸感中等，耐受性好，用户满意度高。在 ED 的繁忙环境中减少疼痛和焦虑的虚拟现实镇痛是可行的、有效的，并且具有很高的用户满意度。需要进一步的随机对照研究来更好地描述其对疼痛感知和资源利用的影响。NRS 的焦虑水平 = 0.75 (95% CI 0.34-1.15)。VR模拟的沉浸感中等，耐受性好，用户满意度高。在 ED 的繁忙环境中减少疼痛和焦虑的虚拟现实镇痛是可行的、有效的，并且具有很高的用户满意度。需要进一步的随机对照研究来更好地描述其对疼痛感知和资源利用的影响。