Effect of Virtual Reality as Analgesia for Trans-Rectal Ultrasound Prostate Biopsy on Pain Severity: A Prospectively Randomised Controlled Study.
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BACKGROUND: TRUS Biopsy (TRUS Bx) can be poorly tolerated under local anaesthetic. Virtual Reality (VR) has been shown to reduce pain and anxiety levels as an adjunct to standard analgesia in a range of settings. This includes paediatric procedures, burn wound debridement and gynaecological procedures. However, its effect in TRUS Bx remains unclear. The aim of this study was to determine if intra-procedure VR improved patient pain and satisfaction during TRUS Bx. METHOD: A single-centre, parallel-group randomised controlled trial was conducted at Dunedin Hospital. Two hundred and fifty patients presenting for first TRUS Bx were randomised to either conventional TRUS or VR-assisted TRUS over 36 months. The intervention group wore a VR headset with distraction video software, with the control group having standard care. The primary outcome measured patients' pain scores using a visual analogue scale. RESULTS: Patients reported similar pain when distracted with VR (mean difference [MD] -2.6, 95% CI -8.5 to 3.2). Similarly, there was no evidence of a difference in 'time thinking about pain' (MD 0.9, 95% CI -7.2 to 9.0) or 'worst pain' (pain intensity) (MD -2.4, 95% CI -8.6 to 3.8). Both groups were equally satisfied with the procedure and would happily accept having the procedure again if needed. VR was not associated with any side effects. CONCLUSION: VR technology did not improve patients' pain and overall satisfaction with TRUS Bx. The inherent vulnerability and invasive nature of the procedure may impact the effectiveness of this distraction technique and prevent its analgesic effects proven in non-urological studies.