Outcomes of improving chronic pelvic pain with "immersive digital therapeutics" at home.

Using an "Endocare Virtual Reality Headset" to treat chronic pelvic pain at home may be helpful for women with endometriosis.

Key Points

Importance:

• "Immersive digital therapeutics" are a platform that uses virtual reality to reduce acute and chronic pain effectively and is mostly conducted in medical centers under the supervision of a health care team.
• "Endocare" is a medical device of digital therapeutics consisting of visual and auditory procedures administered using a virtual reality headset to treat pelvic pain at home.

Highlights:

• The effectiveness and safety of self-repeated administration of a "virtual reality immersive treatment" used at home in women with endometriosis suffering moderate to severe pelvic pain were confirmed.

What's done here:

• This prospective, randomized, double-blind, sham-controlled, single-site, interventional clinical trial was conducted in a multidisciplinary endometriosis clinic in Bordeau, France.
• The study aimed to assess the effects of repeated at-home administration of virtual reality solutions ("Endocare") compared with a sham condition on pain in women experiencing pelvic pain due to endometriosis.
• Pain perception was measured using a numerical scale (0-10) before and after 60,120,180 minutes of each administration.

Key Results:

• The study included 102 patients with endometriosis (Endocare=51 and sham group=51 women) who suffered almost equal mean pain intensity. 
• Pain intensity decreased in both groups starting day 1 to day five, along with a decrease in medical administration.
• Endocare use was significantly superior to the sham group on day 1 (120 and 180 minutes after the administration) and on days 2 and 3 (0,60,120 and 180 minutes after the administration).
• On day 3, the Endocare group reported significantly lower pain than controls, while no difference was observed for days 4 and 5.

Lay Summary

Studies have shown that virtual reality can effectively treat acute pain experienced by burn victims, during labor, dental surgery, or for chronic musculoskeletal, neuropathic, and cancer pain.

Considering the effectiveness of treating chronic pelvic pain at home, Merlot et al. from Franco European Multidisciplinary Endometriosis Institute, Bordeaux, France, conducted a prospective, double-blind, randomized, controlled trial to evaluate the efficacy and safety of virtual reality treatment at home.

Patients were advised to use the treatment ("Endocare") or control starting on the first painful day of their menstrual cycle. Study treatment was mandatory for at least the first two days, and then all patients were free to continue to the fifth day. They were invited to complete two questionnaires to assess their baseline profiles. The daily follow-up diary for five days of the study program was added to these baseline data. Participants were allowed to take their pain medications if they did not feel any improvement in their pain during the five-day virtual reality intake.

According to the statistical evaluation of the groups, the pain reduction from the baseline was significantly higher in the Endocare group from day one at 120 minutes and day two at 180 minutes after treatment compared to the control group. No difference was observed on day 1, 60 minutes after treatment between the two groups. On day 3, the Endocare group reported significantly lower pain than controls, while no difference was observed for days 4 and 5.

At the end of the study, the impact of home administration of "Endocare" was widely discussed in relation to its effects on other medication use, stress and fatigue, and the quality of life. 

The authors concluded, "The use of virtual reality in multimodel chronic pelvic pain reduction is promising for the future and may help avoid opioid addiction for the long-term treatment of pain relief in patients with endometriosis."

This paper, published in the Journal of Medical Internet Research, reports the first-time home use of virtual reality software to improve chronic pain.

Research Source: https://pubmed.ncbi.nlm.nih.gov/37260160/