Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial
17 February 2020
20 February 2020
02 June 2020 (online)
Objective Virtual reality (VR) represents a potential method for easing labor pain and in nonpregnant patients has been shown to achieve similar or greater analgesia than hydromorphone. Few studies of VR have been performed in pregnant women. The aim of this randomized controlled trial (RCT) is to evaluate whether VR is effective in reducing pain in laboring women.
Study Design An open-label, RCT of nulliparous, term women in labor in a tertiary care hospital. We included women with a pain score level of 4 to 7 having regular contractions at least every 5 minutes. We excluded women who had received any pharmacologic pain relief including neuraxial analgesia and those with contraindications to VR. Participants were randomized to up to 30 minutes of either VR or the control arm (no additional intervention). Our primary outcome was the difference in differences from pre- to postintervention pain score. Prespecified secondary outcomes included postintervention pain scores, duration of intervention use, pharmacologic analgesia use, maternal vitals, and obstetric outcomes.
Results From March 2018 to February 2019, 40 subjects were enrolled, randomized, and completed the study; 19 were randomized to control and 21 to the VR arm. Most baseline characteristics were similar between groups. For the primary outcome, those assigned to the control arm had a statistically significant increase in pain of +0.58, while the VR arm had a significant reduction in pain of −0.52 (p = 0.03). There was also a difference in the proportion who had a minimum clinically important difference in pain (0% control and 23.8% VR; p = 0.049). Postintervention maternal heart rate was higher in the control arm (86.8 vs. 76.3, p = 0.01). Most other secondary outcomes did not differ.
Conclusion In our study, we found that VR was effective for reducing pain in women in labor as compared with those receiving no intervention.
Virtual reality (VR) represents a nonpharmacologic option for pain relief.
VR has been little studied in pregnant or laboring women.
VR was associated with a reduction in pain in nulliparous women in labor.
- 1 Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Mathews TJ. Births: final Data for 2015. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics. Natl Vital Stat Syst 2017; 66 (01) 1
- 2 Hawkins JL. Epidural analgesia for labor and delivery. N Engl J Med 2010; 362 (16) 1503-1510
- 3 Butwick AJ, Bentley J, Wong CA, Snowden JM, Sun E, Guo N. United States state-level variation in the use of neuraxial analgesia during labor for pregnant women. JAMA Netw Open 2018; 1 (08) e186567
- 4 Skouteris H, Wertheim EH, Rallis S, Paxton SJ, Kelly L, Milgrom J. Use of complementary and alternative medicines by a sample of Australian women during pregnancy. Aust N Z J Obstet Gynaecol 2008; 48 (04) 384-390
- 5 Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour. Cochrane Database Syst Rev 2006; ; ( (04) CD003521
- 6 Hoffman HG, Richards TL, Bills AR. , et al. Using FMRI to study the neural correlates of virtual reality analgesia. CNS Spectr 2006; 11 (01) 45-51
- 7 Chan E, Foster S, Sambell R, Leong P. Clinical efficacy of virtual reality for acute procedural pain management: a systematic review and meta-analysis. PLoS ONE 2018; 13 (07) e0200987
- 8 Luo H, Cao C, Zhong J, Chen J, Cen Y. Adjunctive virtual reality for procedural pain management of burn patients during dressing change or physical therapy: a systematic review and meta-analysis of randomized controlled trials. Wound Repair Regen 2019; 27 (01) 90-101
- 9 Dascal J, Reid M, IsHak WW. , et al. Virtual reality and medical inpatients: a systematic review of randomized, controlled trials. Innov Clin Neurosci 2017; 14 (1-2): 14-21
- 10 Indovina P, Barone D, Gallo L, Chirico A, De Pietro G, Giordano A. Virtual reality as a distraction intervention to relieve pain and distress during medical procedures: a comprehensive literature review. Clin J Pain 2018; 34 (09) 858-877
- 11 Tashjian VC, Mosadeghi S, Howard AR. , et al. Virtual reality for management of pain in hospitalized patients: results of a controlled trial. JMIR Ment Health 2017; 4 (01) e9-e9
- 12 Frey DP, Bauer ME, Bell CL. , et al. Virtual reality analgesia in labor: the VRAIL pilot study-a preliminary randomized controlled trial suggesting benefit of immersive virtual reality analgesia in unmedicated laboring women. Anesth Analg 2018
- 13 Shourab NJ, Zagami SE, Golmakhani N. , et al. Virtual reality and anxiety in primiparous women during episiotomy repair. Iran J Nurs Midwifery Res 2016; 21 (05) 521-526
- 14 Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 2009; 18 (07) 873-880
- 15 Lowe NK. Maternal confidence for labor: development of the Childbirth Self-Efficacy Inventory. Res Nurs Health 1993; 16 (02) 141-149
- 16 Olsen MF, Bjerre E, Hansen MD. , et al. Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain. BMC Med 2017; 15 (01) 35