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Psychological interventions using virtual reality for pain associated with medical procedures: a systematic review and meta-analysis

Published online by Cambridge University Press:  28 August 2019

Raluca Georgescu ,
Liviu A. Fodor ,
Anca Dobrean  and
Ioana A. Cristea Open the ORCID record for Ioana A. Cristea [Opens in a new window]
Raluca Georgescu
Affiliation:
International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, Cluj-Napoca, Romania
Liviu A. Fodor
Affiliation:
International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, Cluj-Napoca, Romania
Anca Dobrean
Affiliation:
International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Republicii Street 37, 400015, Cluj-Napoca, Romania
Ioana A. Cristea*
Affiliation:
Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Republicii Street 37, 400015, Cluj-Napoca, Romania Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
*
Author for correspondence: Ioana A. Cristea, E-mail: ioana.alina.cristea@gmail.com
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Abstract

Background

Virtual reality (VR) may enhance the effectiveness of psychological interventions for acute pain. We conducted a meta-analysis to assess the efficacy and safety of VR-based interventions for pain associated with medical procedures.

Methods

We searched PubMed, EMBASE, the Cochrane Library, and PsycINFO until June 17th 2018. We identified randomized controlled trials (RCTs), comparing VR-based psychological interventions to usual care, for pain intensity (primary outcome) or affective and cognitive components of pain (secondary outcomes), assessed real-time or retrospectively. Two independent reviewers performed study selection and data extraction. Risk of bias was independently evaluated by three raters using the revised Cochrane Collaboration tool. A random-effects model using the Paule and Mandel estimator was used for pooling effect sizes.

Results

27 RCTs (1452 patients) provided enough data for meta-analysis. Compared to usual care, VR-based interventions reduced pain intensity both real-time (9 RCTs, Hedges' g = 0.95, 95% CI 0.32–1.57) and retrospectively (22 RCTs, g = 0.87, 95% CI 0.54–1.21). Results were similar for cognitive (8 RCTs, g = 0.82, 95% CI 0.39–1.26) and affective pain components (14 RCTs, g = 0.55, 95% CI 0.34–0.77). There was marked heterogeneity, which remained similarly high in sensitivity analyses. Across domains, few trials were rated as low risk of bias and there was evidence of publication bias. Adverse events were rare.

Conclusions

Though VR-based interventions reduced pain for patients undergoing medical procedures, inferring clinical effectiveness is precluded by the predominance of small trials, with substantial risk of bias, and by incomplete reporting.

Keywords

Acute painmedical procedureprocedural painpsychological interventionvirtual realitymeta-analysis
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 11 , August 2020 , pp. 1795 - 1807
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Copyright
Copyright © Cambridge University Press 2019

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