Effects of Virtual Reality on Relieving Pain During Endoscopy in Adults: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

Virtual reality is an emerging non-drug treatment for pain caused by endoscopy procedure. We conducted a meta-analysis to evaluate the effectiveness and safety of virtual reality based interventions for pain during endoscopy. PubMed, EMBASE, Cochrane Library, Web of Science and Clinical Trials database were searched until 26 May 2024. Randomised controlled trials on the application of virtual reality in endoscopic examinations were included. The standardised mean difference (SMD) was calculated using random-effects models, and included studies were appraised using Cochrane Risk of Bias tool version 1. Meta- analysis was conducted using Stata Statistical Software version 17.0. Overall, 21 studies enrolling 1721 participants were included. Our results demonstrated that the patients receiving the virtual reality intervention had lower pain scores than those receiving the usual care (SMD = -0.42; 95% CI = -0.65, -0.20). Subgroup analysis showed that real-time assessment of pain scores during the medical process had less heterogeneity (I = 20.2%, p = 0.257) and a smaller range of confidence intervals (95% CI = -0.43, -0.14) than retrospective assessment (95% CI = -0.75, -0.09). For different types of endoscopes, virtual reality was statistically significant for reducing pain during colonoscopy (SMD = -0.70; 95% CI = -1.12, -0.28), cystoscopy (SMD = -0.28; 95% CI = -0.53, -0.04) and laparoscopy (SMD = -0.54; 95% CI = -0.98, -0.10). Additionally, statistically significant improvements in relieving anxiety were reported when using virtual reality (SMD = -0.56; 95% CI = -0.78, -0.35). The application of virtual reality can effectively relieve the pain and anxiety of endoscopy. The types of endoscopy and the way of retrospective evaluation of pain scores were the main sources of heterogeneity. More rigorous studies about the relationship between virtual reality and endoscopic pain relief will be needed. The application effect of virtual reality technology on endoscopy was verified by summarising several randomised controlled trials. Patients and healthcare providers can be better informed about the use of such intervention to relieve pain. Virtual reality is recommended as being potentially useful and practical for reducing the pain of endoscopy.