Effect of use of virtual reality on morphine-sparing in patients with sickle cell disease for main management of vaso-occlusive crises in an adult emergency department.

BACKGROUND AND IMPORTANCE Vaso-occlusive crisis is the main reason for emergency department (ED) visits for patients with sickle cell disease. Therapeutic management involves multimodal analgesia, which often comprises the administration of morphine. Recently, the use of virtual reality (VR) has garnered growing interest as a nonpharmacological approach for pain modulation. OBJECTIVE The objective of this study was to assess the impact of integrating VR on the reduction of the total dose of morphine administered during vaso-occlusive crisis. SETTINGS AND PARTICIPANTS This was a prospective before-and-after study conducted in a French adult ED on patients with sickle cell disease and acute pain from vaso-occlusive crisis. INTERVENTION OR EXPOSURE During the first period, patients were managed according to the standard protocol, with no use of VR. During the second period, patients were able to benefit from VR sessions in addition to the usual care. OUTCOME MEASURES AND ANALYSIS The primary outcome was the total dose of morphine administered in the ED. Secondary objectives were to evaluate the feasibility, tolerance, acceptability, and effectiveness of VR in pain management, measured using a numeric rating scale. MAIN RESULTS A total of 97 patients were included in the study, 50 during the noninterventional phase and 47 during the interventional phase. The median morphine dose was 30.7 mg [interquartile range (IQR), 19.7-45.7] in the VR group and 37.7 mg (IQR, 24.7-53.3) in the control group. The median difference between the two groups was -7 mg [95% confidence interval (CI), (-18.6 to 4.6)]. In the VR group, 18.2% of patients (8 out of 44 responders) reported side effects, which included primarily dizziness (50%), followed by nausea (25%) and headaches (25%). Additionally, 83.3% (35 out of 42 responders) of patients expressed the desire to use this method again. CONCLUSION In this prospective study, the use of VR did not reduce the total morphine dose administered in the ED for patients with acute pain and vaso-occlusive crisis. However, the use of VR appeared to be effectively integrated into multimodal pain management, with a high level of patient satisfaction.