Virtual reality simulation in reducing discomfort and pain during intrauterine device insertion: a randomized controlled trial.

OBJECTIVES

This study aimed to assess the patient-reported overall experience when using virtual reality (VR) simulation during intrauterine device (IUD) insertion (primary), the impact of VR in reducing pain, on patient satisfaction, and to assess the difficulty and success of the procedure utilizing VR (secondary).

STUDY DESIGN

This was a single-center randomized controlled trial in a Belgian tertiary teaching hospital. Two hundred participants, requesting a levonorgestrel-releasing IUD, were 1:1 computer randomized in either the VR group, where participants wore VR goggles, or in the standard-of-care group. The primary outcome is the patient's overall experience assessed by means of a Visual Analog Scale (VAS; 0-100 mm, continuous, higher is better). A Numeric Pain Rating Scale (0-100, continuous, higher is more pain) was used to address pain during insertion.

RESULTS

In the VR group, 95 participants were included (five were excluded due to failed previous IUD extraction), and in the standard-of-care group, 100 participants were included. There is no evidence for differences in general patient experience (median VAS 72 [intervention] vs 70 [control]; odds ratio [OR] 1.22, 95% CI 0.92-1.61) or pain (median Numeric Pain Rating Scale 50 [intervention] vs 45 [control]; OR 1.04, 95% CI 0.79-1.37) between groups. After 6 weeks, VR-patients reported no evidence for improved general experience (median VAS 70 [intervention] vs 74 [control]; OR 1.09, 95% CI 0.83-1.43) and were less likely to repeat the procedure or recommend it compared to the control group (OR 2.03, 95% CI 1.17-3.56).

CONCLUSIONS

VR simulation does not conclusively alter the overall experience or reduce pain, therefore not reducing discomfort during IUD insertion in this randomized controlled trial.

IMPLICATIONS

Although VR has already been successfully used in the management of acute pain or during procedures, this study cannot demonstrate improved patient-reported outcomes during the insertion of a levonorgestrel-containing IUD.