Virtual Reality for Acute Pain in Outpatient Hysteroscopy: A
Randomised Controlled Trial
We would like to thank E.Mirza and colleagues for their interest in our
study, Virtual Reality for acute pain in outpatient hysteroscopy: A
randomised controlled trial.
We would like to point out that in light of the fact that the sample
size was limited to 40 patients, the interpretation of further subgroup
analysis is likely to be limited.
On further analysing patients we noted that a total of 7/40 (18%) which
included 3 in the Standard Procedure (SP) arm and 4 in the Virtual
Reality (VR) arm, had had a previous outpatient hysteroscopy. The mean
expected pain scores in the VR and SP groups were comparable (VR group
was 6.5 and in the SP group was 7) however the perceived average pain
scores were 2.25 and 6.3 respectively. This would suggest that VR might
have had a beneficial effect despite a previous experience of OPH.
We appreciate that patient’s pain thresholds are variable and that it is
a very subjective experience. 2 patients in the VR group reported
average pain scores of 0 whilst all patients in the SP group experienced
some degree of pain. It is difficult to ascertain how much VR
contributed to the experience in the context of the patient’s tolerance
to pain. We agree that future studies looking into patients with painful
hysteroscopies would most benefit from additional pain relief strategies
and would be of immense clinical value.
Analgesic intake included paracetamol, non steroidal anti-inflammatory
drugs, cocodamol either on their own or in combination and the numbers
of patients receiving analgesics was comparable across the two groups.
However we do not have data on dosages and how long before the procedure
the analgesics were taken. We acknowledge that standardisation of
analgesics intake would have helped in understanding the actual impact
of VR in pain relief.1,2 We agree with these
suggestions for future directions of research in this area and the
suggested improvements to methodology.
Claustrophobia was not an exclusion criterion in our study and hence one
patient was recruited but nevertheless only experienced the intervention
of a short period of time before she took the VR goggles off. We note
recent studies, which have used VR for treatment of
claustrophobia.3,4 The outcomes are
normally reported taking an Intention to Treat approach. We repeated a
regression analysis after removing the patient in question, and the
experimental group still reported significantly lower pain and anxiety
scores for those patients receiving the VR intervention.
Nandita Deo 1,2
Khalid Saeed Khan4
Jonathan Mak 4
John Allotey3
Francisoco Jose Gonzalez Carreras 3
Gianpaolo Fusari 5
Jonathan Benn 6
Imperial College London, UK1
Whipps Cross University Hospital, London, UK2
The London School of Medicine and Dentistry, London,
UK3
Queen Mary University, London, UK.4
Helix Centre, Imperial College London and the Royal College of Art,
London, UK 5
School of Psychology, University of Leeds, UK6
Corresponding Author- Nandita Deo MBBS, MD, FRCOG, MSc (Health Care and
Design)
Consultant Obstetrician and Gynaecologist
Whipps Cross University Hospital, Barts Health NHS Trust,
Leytonstone, London, E11 1NR
Tel: 0044 7939360357
nandita.deo@gmail.com
1. De Silva PM, Mahmud A, Smith PP, Clark TJ. Analgesia for office
hysteroscopy: systematic review & meta-analysis. Journal of Minimally
Invasive Gynecology. 2020 Jan;S1553465020300467.
2. Ghamry NK, Samy A, Abdelhakim AM, Elgebaly A, Ibrahim S, Ahmed AA, et
al. Evaluation and ranking of different interventions for pain relief
during outpatient hysteroscopy: A systematic review and network
meta-analysis. J Obstet Gynaecol Res. 2020 Jun;46(6):807–27.
3. Carl E, Stein AT, Levihn-Coon A, Pogue JR, Rothbaum B, Emmelkamp P,
et al. Virtual reality exposure therapy for anxiety and related
disorders: A meta-analysis of randomized controlled trials. J Anxiety
Disord. 2019;61:27–36.
4. Rahani VK, Vard A, Najafi M. Claustrophobia Game: Design and
Development of a New Virtual Reality Game for Treatment of
Claustrophobia. J Med Signals Sens. 2018 Dec;8(4):231–7.