JMIR Publications

ABSTRACT

Background:

Endometriosis is a common benign chronic disease in women of reproductive age, in which endometrial cells form lesions within the uterine wall and extrauterine sites. The disease can impair fertility and cause symptoms that vary greatly, tend to be unspecific, and typically include chronic pelvic pain, which is often severe and can adversely impact daily life. Nonpharmacologic and nonsurgical treatments for endometriosis-related pain include psychotherapy, distraction techniques, and physical activity. Virtual reality (VR) based technology may offer new avenues in the management of chronic endometriosis-related pain.

Objective:

Our prospective, 14-week, open, three-phase, cross-over pilot study aimed to investigate whether the use of VR technology with a relaxation-inducing application (HypnoVR®; VR-R) or an activity-stimulating application (SyncVR Fit®; VR-A) could change the levels of endometriosis-related chronic pelvic pain and impairment of daily life.

Methods:

23 women aged 32.7 (SD 8.2) with endometriosis-related pelvic pain were each assigned to a permutated sequence of three 4-week phases: (A) the VR-R phase, (B) the VR-A phase, and (C) the intervention-free control phase. Phases were separated by two interspersed 1-week washout phases. Main outcome measures included: momentary, average, and maximum pain intensities on a 0–10 numerical rating scale (NRS); the Pain Disability Index (PDI) score; the Pain Catastrophizing Scale (PCS) score; sleep quality (Medical Outcomes Study Sleep Scale (MOS-SS) score); the Depression Anxiety Stress Scales (DASS) score; and the general health-related quality of life (Short Form (12) Health Survey (SF-12)) score.

Results:

Compared to baseline, VR-R use showed statistically significant positive effects for several scores (NRS “average pain”; PDI “total score”; PCS “total score” and the “magnification”, “rumination”, and “helplessness” subscores; MOSS-SS “index I and II”; and the DASS “depression” and “stress” subscores), whereas VR-A yielded significant positive changes only for PDI “total score”; PCS “total score” and the “helplessness” and “magnification” subscores; MOSS-SS “index II”; and DASS “depression” and “stress”. As four scale scores also showed significant improvements for control, a comparison of the effects was performed to offset a potential placebo-like effect by comparing difference from baseline against control. This analysis yielded significantly greater positive effects only for VR-R: PCS “total score” and “helplessness”; MOSS-SS “index I” and “index II”; and the three DASS subscores “depression”, “anxiety”, and “stress”. SF-12 showed no significant changes in either analysis.

Conclusions:

VR-R and VR-A showed positive effects on a number of pain and quality of life scores, which were significant for several scores when compared to baseline. For VR-R some of these improvements were indeed significantly greater than under control conditions while the effects with VR-A were not. Larger studies are needed to explore these findings in greater depth. Clinical Trial: DRKS00030189