Methodological considerations in interpreting virtual reality-assisted analgesia during nasal procedures - a letter to the editor.

A recent randomized-controlled trial by Alotaibi et al investigated the use of virtual reality (VR) for pain and anxiety management during nasal procedures, reporting positive findings that warrant critical methodological examination. While the study's randomized design strengthens internal validity, the interpretation of its findings is complicated by the inclusion of an intra-group analysis comparing current VR-assisted pain to patients' recalled pain from unstandardized historical procedures, which introduces a high risk of recall bias. Furthermore, the unblinded nature of the study makes the self-reported outcomes susceptible to expectancy and novelty effects, potentially overestimating the true treatment benefit. Although VR holds significant potential as a non-pharmacological analgesic in otorhinolaryngology, the findings must be interpreted with caution, and future investigations should prioritize standardized controls and objective measures to accurately determine its independent clinical effect on procedural pain.