Virtual reality-based pain control in endometriosis: a questionnaire-based pilot study of applications for relaxation and physical activity.

PURPOSE: Virtual reality (VR) based technology may offer new avenues in the management of chronic endometriosis-related pain. Our prospective, 14-week, open, three-phase, cross-over pilot study investigated whether the use of VR technology equipped with a relaxation-inducing application (VR-R) or an activity-stimulating application (VR-A) could change endometriosis-related chronic pelvic pain levels and impairment of daily life.

METHODS

23 women aged 32.7 (SD 8.2) with endometriosis-related pelvic pain were each assigned to a permutated sequence of three 4-week phases: (A) the VR-R, (B) VR-A, and (C) intervention-free control phases. Phases were separated by two interspersed 1-week washout phases. Main outcome measures included: momentary, average, and maximum pain intensities on a 0-10 numerical rating scale (NRS); the Pain Disability Index (PDI) score; the Pain Catastrophizing Scale (PCS) score; sleep quality (Medical Outcomes Study Sleep Scale (MOS-SS) score); the Depression Anxiety Stress Scales (DASS) score; and the general health-related quality-of-life score (Short Form (12) Health Survey (SF-12)).

RESULTS

Compared to baseline, VR-R use showed statistically significant positive effects for several scores (NRS "average pain"; PDI "total score"; PCS "total score" and the "magnification", "rumination", and "helplessness" subscores; MOSS-SS "index I and II"; and the DASS "depression" and "stress" subscores), whereas VR-A yielded significant positive changes only for PDI "total score"; PCS "total score" and the "helplessness" and "magnification" subscores; MOSS-SS "index II"; and DASS "depression" and "stress". As four scale scores also showed significant improvements for control, a comparison of the effects was performed to offset a potential placebo-like effect by comparing difference from baseline against control. This analysis yielded significantly greater positive effects only for VR-R: PCS "total score" and "helplessness"; MOSS-SS "index I" and "index II"; and the three DASS subscores "depression", "anxiety", and "stress". SF-12 showed no significant changes in either analysis.

CONCLUSIONS

VR-R and VR-A showed positive effects on several pain and quality-of-life scores, which were significant for some scores compared to baseline. For VR-R, some of these improvements were indeed significantly greater than under control conditions, while the effects with VR-A were not. Larger studies are needed to corroborate these findings.

TRIAL REGISTRATION: DRKS00030189.