• Neal Sikka, Liqi Shu, Brandon Ritchie, Richard L Amdur, and Ali Pourmand.
• Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia.
• Telemed J E Health. 2019 Dec 1; 25 (12): 1207-1215.

AbstractStudy Objective: Pain management in emergency department (ED) patients is challenging. Although both pharmacological and nonpharmacological therapies exist, they are often suboptimal. Immersive virtual reality (VR) uses distraction and possible other methods to reduce perceptions of pain. The purpose of the study is to evaluate the usability and acceptability of VR applications in ED patients by assessing patient-reported changes in pain, anger, and anxiety levels. Methods: This is a prospective cohort study at a single academic urban tertiary care center among ED patients with a pain score ≥3 on a numeric rating scale (0-10 integers) for any reason. Patients with stroke, epilepsy, dementia, or other diseases that may prevent use of VR were excluded. Enrolled patients in the intervention cohort spent 20 min using VR applications. A paired t test was used to analyze the change of pain, anger, and anxiety scores between pre- and postintervention. Analysis of variance and linear regression were used to assess the impact of other subject variables (including gender, age, race, and education) on pre-post intervention changes. Results: One hundred (N = 100) patients were enrolled in this study and 93 experienced the VR intervention. Of these, 57 (61.3%) were women, and mean age was 38 ± 14. Mean anger (2.28 ± 0.8 to 1.92 ± 0.7, p < 0.0001), anxiety (2.06 ± 0.8 to 1.81 ± 0.8, p < 0.0001), and pain (7.16 ± 2.5 to 6.49 ± 2.7, p < 0.0001) levels dropped significantly from pre- to postintervention. Outcomes of the VR intervention were impacted by subject variables, including education and ethnicity. Pain (1.86 ± 3.3, p = 0.03) and anger (1.03 ± 1.4, p = 0.02) levels dropped most for those with less than high school education. Linear regression analysis revealed that patients with higher levels of health/quality of life (QOL) had larger mean drop per unit predictor for anger (0.29 [0.09], p = 0.0013) and anxiety (0.22 [0.07], p = 0.001). Conclusions: VR applications are feasible for ED patients and may lead to reduced pain, anger, and anxiety levels. These outcomes are affected by subject ethnicity, educational status, and health/QOL although independent of the chief complaint.

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