M. K. Toneman1, R. P. Ten Broek1, H. Van Goor1 1Radboudumc, Surgery, NIJMEGEN, GELDERLAND, Netherlands
Introduction: Following abdominal surgery, chronic abdominal pain affects quality of life in 10-20% of patients. Postoperative adhesions are a prominent cause of chronic pain and can be treated by adhesiolysis with application of an adhesion barrier in selected patients. However, many patients depend on conservative pain treatment because of increased operative risks or recurrence of adhesions. Mainstay of conservative treatment is pain medication such as opioids, associated with severe side effects and risk of dependence. VR has demonstrated good results for other chronic pain condition. Encouraged by the concept of non-pharmacological chronic pain management, we designed a pilot study assessing feasibility, usability and preliminary efficacy of virtual reality (VR) and VR with prior pain education in patients with chronic pain related to adhesions and the role of prior pain education.
Methods: Patients with chronic abdominal pain associated with adhesions were eligible for this pilot study. Adhesions were diagnosed with cineMRI, a validated imaging technique for peritoneal adhesion detection. VR treatment consisted of a specific chronic pain application (Reducept BV) combined with a general relaxation application (SyncVR Medical) at home during 4 weeks. Reducept is based on evidence based psychological therapies for chronic pain, such as acceptance and commitment therapy, eye movement desensitization and reprocessing (EMDR), mindfulness and hypnotherapy. Part of the participants received prior pain education to learn about their pain and set expectations for VR pain treatment. Questionnaires (e.g. Pain Disability Index (PDI) and Patient Health Questionnaire (PHQ-9)) were taken at baseline, and at 4 weeks. Outcomes are primarily analyzed as a total group, and secondarily compared between participants with and without pain education.
Results: Fourteen patients undergoing VR pain management and seven patients undergoing VR pain management and pain education were included in this pilot. The majority was female (67%) with a mean age of 54 (range 28-80). The user experience was positive in over half of patients (65%). Side effect such as vertigo or nausea occurred in five patients (25%), all short term and self-limiting. Six patients experienced technical difficulties with the VR goggles or the module. The mean numeric rating scale (NRS) score for pain was 6.6 at baseline and 5.9 (p=0.069) after the 4-week treatment period. PHQ-9 scores at baseline were 14 and lowered to 11 (p=0.002), both still indicating moderate depression. PDI at baseline (45) was comparable with PDI after the treatment period (43, p=0.356). No significant differences were found between the two groups.
Conclusion: Self-administered VR at home seems feasible and usable, with low side effects, in patients with chronic abdominal postoperative pain attributed to adhesions. Preliminary effects on pain and health status are promising, however, need confirmation in large trials.