Virtual reality (VR) represents a potential method for easing labor pain. By stimulating the visual cortex while engaging other senses, VR modulates the user’s processing of nociceptive stimuli; head-to-head trials show that VR achieves similar or greater analgesia as hydromorphone. The aim of this randomized controlled trial (RCT) is to evaluate whether VR is effective in reducing pain in laboring women.
We conducted an open-label, RCT of nulliparous, term women in labor. We included women with a pain score of 4-7 having contractions at least every 5 minutes. We excluded women who had received any pharmacologic pain relief including epidural or with contraindications to VR use. Participants were randomized to up to 30 minutes of either VR or no intervention (Control).
Our primary outcome was the difference in differences from pre to post intervention pain score. Prespecified secondary outcomes included pain scores, duration of intervention use, pharmacologic analgesia use, vitals, and obstetric outcomes. We used minimum clinically important difference for sample size calculations which for subjects starting with a baseline pain score of 40-70 mm is 13 mm. With an 80% power and 2-sided alpha 0.05 starting from a baseline median pain of 55 mm, we would require 40 total subjects.
From 3/2018 to 2/2019, 40 patients were enrolled in and completed the study; 19 were randomized to Control and 21 to VR. Half were inductions and all were latent phase with mean dilatation pre-intervention of 2.5 cm (Control) and 2.8 cm (VR).
For the primary outcome – difference in pain score following the intervention – those assigned to the Control arm had a statistically significant increase in pain of +0.58 while receiving VR had a significant reduction in pain of -0.52. (p = 0.03) (Figure 1). Post-intervention heart rate was also higher in the Control arm (86.8 vs 76.3, p = 0.01). Other secondary outcomes did not differ (Table 1).
In our study, we found that VR was effective for reducing pain in women in labor compared to those receiving no intervention.
© 2019 Published by Elsevier Inc.