Perioperative immersive virtual reality intervention for acute and persistent postoperative pain after video-assisted thoracoscopic surgery: A randomized controlled trial.

BACKGROUND

Postoperative pain remains a major barrier to recovery after video-assisted thoracoscopic surgery (VATS) and may progress to persistent postoperative pain. We evaluated whether perioperative immersive virtual reality (VR) could reduce acute and longer-term pain after VATS.

METHODS

A total of 120 patients undergoing elective VATS were randomized 1:1 to a VR group or a control group. The VR group received immersive VR from 1 day before surgery to postoperative days (POD) 1-3, followed by a 2-week home-based intervention. The primary outcome was pain scores during coughing over POD 1-3. Secondary outcomes included resting pain, pain on deep breathing, rescue analgesia within 72 h, subacute postoperative pain at 1 month, and persistent postoperative pain at 3 months.

RESULTS

Among 120 randomized patients, 100 were included in the evaluable acute pain cohort, of whom 96 completed the 3-month follow-up. Linear mixed-effects models showed significant group effects, time effects, and group × time interactions for resting pain, pain on deep breathing, and pain scores during coughing over POD 1-3. In Holm-adjusted time-point-specific comparisons, the VR group showed lower pain scores at selected postoperative time points across the three pain dimensions. A ≥30% reduction in pain during coughing was achieved in 48.1% of VR patients versus 16.7% of controls (P = 0.001). At follow-up, the VR group had lower rates of subacute postoperative pain at 1 month (24.0% vs. 56.5%, P = 0.002) and persistent postoperative pain at 3 months (10.0% vs. 32.6%, P = 0.011). Pain scores at both time points were also lower in the VR group.

CONCLUSION

Perioperative immersive VR may improve acute postoperative pain recovery after VATS and may lower the risk of subacute and persistent postoperative pain. VR may serve as a useful non-pharmacological adjunct in thoracic perioperative pain management.