Virtual reality for pain management during extracorporeal lithotripsy: A randomized pilot study

Virtual reality (VR) creates an immersive environment that may alleviate pain and improve tolerance of extracorporeal shockwave lithotripsy (SWL). This randomized pilot trial evaluated feasibility and explored the effects of a pre-procedural VR session on pain, anxiety, and opioid use during SWL.

Thirty patients undergoing their first SWL for kidney stones were randomized (2:1 minimization) to VR or control. The VR group received 20 minutes of audiovisual stimulation via headset before SWL, while controls rested quietly in a calm room. Pain during SWL was measured using a verbal rating scale, anxiety with the State-Trait Anxiety Inventory (STAI), and fentanyl consumption was recorded.

The study took place between November 2022 and May 2024, with an eligibility rate of 25.8% (69/267) and a recruitment rate of 43% (30/69). Eighteen patients were allocated to VR and 12 to control (mean age 57, range 21-82). All patients completed the VR session except for one, who interrupted the session after experiencing mild distress. SWL pain intensity was significantly lower in the VR group (3.8/10 vs. 5.9/10, p=0.043). No differences were found in STAI scores and opioid consumption. Principal limitations of the study include its small sample size and selection bias.

The implementation of an adequately powered randomized controlled trial may face low recruitment rates if restricted to first SWL experience. VR showed promising outcomes for SWL-induced pain, although opioid consumption and anxiety were not reduced. Future studies with larger sample sizes are required to confirm these preliminary findings.