Virtual reality for pain and anxiety management during bone marrow biopsy: A systematic review.

Abstract

12075 Background: Bone marrow biopsy (BMB) procedures often cause significant pain and anxiety. Virtual reality (VR) has emerged as a promising non-pharmacological intervention, but its effectiveness needs systematic evaluation. Methods: A systematic review following PRISMA guidelines examined studies from 2014-2024 that evaluated VR interventions during BMB procedures through literature searches in PubMed, Scopus, and EMBASE. Studies were included if they evaluated VR as a non-pharmacological intervention and reported pain or anxiety outcomes. Results: Five studies (n=481) met inclusion criteria, including three randomized controlled trials and two prospective studies. Patient ages ranged from 6-87 years. VR interventions showed high retention rates (66.7-93.3%) with low discontinuation (5%). Pain and anxiety reduction was significant in two studies (p<0.05 and p<0.001 respectively), while three showed no significant difference versus standard care. Patient satisfaction exceeded 90%, with minimal adverse events, mainly discomfort leading to discontinuation in 5% of participants. Conclusions: VR represents a safe, well-tolerated intervention during BMB procedures with high patient satisfaction. While pain and anxiety reduction results were mixed, the consistent safety profile and positive patient experience suggest VR may be a valuable adjunct to standard care, particularly for anxiety management. Future research should focus on standardizing protocols and defining patient selection criteria to optimize outcomes. Study characteristics and clinical outcomes of virtual reality use during bone marrow procedures. Study Sample Size Patient Population VR Type Control Group Pain Outcomes Significant Pain Reduction? Anxiety Outcomes Significant Anxiety Reduction? Patient Satisfaction Adverse Events Glennon 2018 97 Adults ezVision X4 VR goggles with nature scenes + lidocaine Standard TV viewing + lidocaine VR: 3.9 vs Control: 4.0 (NPRS) No (p > 0.05) State anxiety decrease: VR: 2.3 pts vs Control: 1.3 pts (5 item Likerty-type scale) No (p = 0.42) 98.3% satisfied None reported Le Du 2023 126 Adults Meta Quest VR headset None specified VR: 3.0 vs Control: 3.5 (VAS) No (p = 0.26) No difference on STAI scores No (p = 0.83) Not reported Not reported Korkmaz 2023 126 Adults Bliss VR with 4 environments MEOPA (nitrous oxide/oxygen) VR: 3.8 vs Control: 6.28 (VAS) Yes (p < 0.001) VR: 32.06 ± 8.69 vs Control: 40.88 ± 11.36 (STAI) Yes (p = 0.022) 95% satisfied 5% discontinued Reitze 2024 75 Adults Support V5 VR headset Standard care (No distraction) Mean difference -1.0 with VR (VNRS) Yes (p < 0.05) VR: 28.6 vs Control: 33.5 (BAADS) Yes (p < 0.001) > 90% satisfied 5% mild effects Soret 2022 57 Children (6-18y) Not specified Standard care (No distraction) VR: 3.8 (IQR 2.0-6.3) vs Control: 3.0 (IQR 1.9-3.0) (FPS-r) No (p = 0.09) No difference between groups (mYPAS-SF) No (p = 0.71, 0.42) 71% more relaxed 5% discontinued