Virtual Reality Therapy for Pain Management at the Emergency Department (VRxOPUS-2)

Rationale: Prescriptions of analgesics, especially opioids, have doubled in the Emergency department (ED) over the past decades in response to frequently reported undertreatment of pain in ED patients. Consequently, there is a shift towards a more restrained utilisation of opioids at the ED. However, there are still few (non-)pharmacological alternatives. Virtual Reality (VR) therapy is a relatively new and promising technique in non-pharmacologic pain reduction and anxiolysis and shows positive results on pain relief and pain. Objective: Primary objective is to investigate the effect of VR on patient-reported pain outcomes in the ED. Secondary objectives are to investigate the effect of VR on analgesics use, patient-reported outcomes, and process indicators and to identify barriers to implementation. Last, subanalyses will be performed to compare the effectiveness of two types of VR: VR based on distraction (VRD) and VR based on focussed attention (VRF). Study design: randomized controlled trial. Study population: Adults admitted to the ED with a NRS pain score of 4 (out of ten) or more and unacceptable pain. Intervention: There will be a control group receiving usual care and a intervention group that receives additional VR therapy. Main study parameters/endpoints: The main study outcome is the difference in patient-reported NRS pain score.

Patients receive virtual reality therapy in the form of active distraction or focussed attention (randomized between those two)

Dose of morphines adminstered to a patient during their stay at the Emergency Department calculated in OME

registered type and total dose of analgesics administered to patient during the time they stayed at the Emergency Department

registered type of non-pharmacological analgesia adminstered during patients' stay at Emergency Department

Interview one week after ED admission about patient experiences exploring barriers and facilitators to implementation

Inclusion Criteria: Patient ≥16 years admitted to ED NRS pain at rest score ≥4 Pain not acceptable for patient Patient is willing and able to comply with the study protoc Exclusion Criteria: Patients initially treated by another physician than the emergency physician (EP). EMV < 14 History of dementia, seizures Severe hearing/visual impairment not corrected Headwounds or damaged skin with which comfortable and hygienic use is not possible. Presentation to the ED because of chronic pain (≥3 months) exacerbation Chronic opioid use (≥3 months) Psychiatric disorders interfering with patients' understanding of the study protocol and informed consent