AB1382 USE OF VIRTUAL REALITY HEADSETS TO REDUCE PAIN AND ANXIETY DURING EPIDURAL INFILTRATION OF THE SACRRAL HIATUS FOR LUMBAR RADICULAR PAIN
Authors: M. Javelot, C. Chopin, L. Bolko, A. Hittinger, C. Coutureau, A. Duvivier, J. H. Salmon
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The virtual reality (VR) headset is an innovative technological tool used in the healthcare for its analgesic effect. The value of the VR has already been evaluated in rheumatology for chronic low back pain, osteoporosis and osteoarthritis. However, there are no studies on the use of this device in infiltrative procedures. <h3>Objectives:</h3> The aim of our study was to evaluate the impact of the VR headset on pain and anxiety during infiltration through the sacral hiatus in lumbar radicular pain. <h3>Methods:</h3> We performed a prospective randomised cross-over superiority study from August 2022 to February 2023 at the University Hospital of Reims. All patients received at least 2 epidural infiltrations through the sacral hiatus. The first group used the VR headset during the first infiltration, while group 2 used the VR headset during their second infiltration. The primary endpoint was pain perception via the verbal numerical rating scale (VNRS) during the infiltration using the VR headset. Secondary endpoints were assessment of anxiety during infiltration via the STAI and tolerance during use of the VR headset. A Wilcoxon test was performed as well as intention-to-treat and per-protocol analyses. Results were significant if p &lt; 0.05. <h3>Results:</h3> Overall, 116 patients were included in the 2 groups, 55 patients in group 1 and 54 patients in group 2 with 7 patients excluded before the first infiltration. The ITT analysis showed a significant reduction in pain with the use of the VR headset during the first infiltration (median VNRS group 1 = 3 [1-6] vs median group 2 = 5 [3-7]; (p=0.045)). The median VNRS for the second infiltration was 4 [2-6] in group 1 and 5 [2-7] in group 2. The cross-over analysis was not statistically interpretable due to an interaction between the effect of the VR headset and the sequence of it administration. The median STAI A was 34 [28-44] during the first infiltration and 35 [25; 47] during the second infiltration for group 1. The group 2 median was of 41.5 [30; 49] during the 1st infiltration and 33.5 [27; 43] during the 2nd infiltration. The ITT cross-over analysis showed a significant reduction in anxiety with the use of the VR headset (p=0.004). Concerning tolerance, 27.6% of patients experienced minor and transient side effects during the VR headset. The median satisfaction was 9 [7-10] and 92.4% would like to use it for other medical procedures. To our knowledge, this is the first study to evaluate the using interest of a VR headset during infiltration. This study shows that this therapy significantly reduces pain and anxiety during epidural infiltration. The strengths of our study are originality and methodological aspect (superiority study based on a randomised prospective cohort). Our study has limitations. Firstly, it is an open-label study. Secondly, there is no clinically relevant threshold in current practice for the STAI questionnaire to classify the level of anxiety. Finally, interaction bias was responsible for a loss of power for pain perception. It is simple and practical to use. It can be less restrictive than pharmacological treatment, as allergic reaction, adverse effects and misuse associated with some drugs. <h3>Conclusion:</h3> Immersive VR represents a relevant non-pharmacological alternative for analgesia and anxiety during epidural infiltration through the sacral hiatus for lumbar radicular pain. Tolerance was satisfying and the majority of patients will recommand in the future for medical procedures. Further studies in rheumatology to help rheumatologists extend the use of the helmet in current practice (other infiltrations, in hospitals and/or private practice, cost, etc.) are necessary. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>