Impact of Virtual Reality on Anxiety in Patients Undergoing Interventional Procedures

Study Overview
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Brief Summary
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Periprocedural anxiety is a common problem for patients who undergo interventional pain procedures. Virtual Reality (VR) is an immersive experience that has gained acceptance in the medical field as a tool for reducing anxiety and pain for patients.Research Aim: To evaluate the effect of immersive virtual reality (VR) on periprocedural anxiety related to therapeutic cervical epidural steroid injections (ESI). The investigators hypothesize that immersive virtual reality will result in a clinically meaningful anxiety reduction, defined as the proportion of participants with > 50% reduction in Numeric Rating Scale (NRS) anxiety scores when compared to participants in the non-treatment group who will have standard preprocedural waiting time conditions in clinic, but no VR experience. Similarly, the investigators hypothesize a significant reduction in objective sympathetic tone as measured by skin sympathetic nerve activity (SKNA).

Official Title
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Assessing the Impact of Immersive Virtual Reality Experience on Injection-related Anxiety in Patients Undergoing Interventional Pain Spine Procedures: a Prospective Randomized Trial

Conditions
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Anxiety

Intervention / Treatment
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* Other: Group 1 Immersive Virtual Reality (VR)
* Other: Group 2 Control Group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18-80 years old at day of enrollment Neck pain patient deemed to be a candidate for pain control treatment with interventional fluoroscopically guided cervical epidural steroid injection as determined by their pain medicine provider based on history, physical exam, and radiographic findings Willingness to undergo pre-procedural intervention of VR viewing experience or equivalent pre-procedural wait time No history of prior epidural steroid injections Did not receive sedatives prior to or during procedure Exclusion Criteria: Refusal / inability to participate or provide consent Contraindications to injection (anticoagulated states, allergy to components of injection, local infection at injection site, current infectious process or treatment of antibiotics for current infection) Uncontrolled anxiety disorder or untreated/inadequately treated psychiatric disorder History of Alzheimer's, dementia, or cognitive dysfunction Patient currently taking benzodiazepines Severe motion sickness Seizure disorder Vision loss Non-English speaking patients

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized controlled observational trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group 1 Immersive Virtual Reality (VR)<br>Participants in Group 1 Immersive Virtual Reality (VR) will wear the device covering their eyes. The viewing experience will include calming nature sounds for between 15-20 minutes before their planned plain clinic procedure. | Other: Group 1 Immersive Virtual Reality (VR)<br>* Participants in Group 1 Immersive Virtual Reality (VR) participants wear the device covering their eyes. The viewing experience will include calming nature sounds for between 15-20 minutes before their planned plain clinic procedure<br>|
| Placebo Comparator: Group 2 control group<br>Group 2 control group has no preprocedural intervention. Standard clinic waiting conditions for 15-20 minutes before their planned pain clinic procedure. | Other: Group 2 Control Group<br>* Group 2 control group participants have no preprocedural intervention. Standard clinic waiting conditions for 15-20 minutes before their planned pain clinic procedure.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric rating score for anxiety while positioning on the fluoroscopy table. | Numeric rating score for anxiety on an 11-point scale, ranging from 0 (no anxiety at all) to 10 (worst possible level of anxiety) when positioning on the fluroscopy table. | Before planned procedure | 
| Numeric rating score for anxiety when local anesthetic is injected. | Numeric rating score for anxiety on an 11-point scale, ranging from 0 (no anxiety at all) to 10 (worst possible level of anxiety) when local is injected. | Start of planned procedure | 
| Numeric rating score for anxiety when the epidural needle is removed. | Numeric rating score for anxiety on an 11-point scale, ranging from 0 (no anxiety at all) to 10 (worst possible level of anxiety) after the epidural needle is removed | End of planned procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Procedural pain during epidural steroid injection reported by participants. | NRS Level of subjective procedural pain during epidural steroid injection recorded by numeric rating score on a scale of 0 (no pain) to 10 (worst pain imaginable) Level of subjective procedural pain during epidural steroid injection recorded by NRS | During planned procedure | 
| Timepoint at peak of numeric rating score anxiety rating | Timepoint at peak numeric rating score for anxiety (NRS) 0 (no anxitey) to 10 (worst anxiety). | Through study completion average of 2 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Anxiety, Pain Procedures, Virtual Reality