Effectiveness of Virtual Reality on Anxiety in Patients Undergoing Diagnostic Medial Branch Blocks for Facet Joint Pain Syndrome: A Randomized Controlled Trial

Introduction:

Anxiety and stress are common problems during interventional pain management¹. While the latest guidelines do not recommend the routine use of sedation^2-4,Virtual reality (VR) technology has become a novel intervention to manage anxiety and pain⁵.

Methods:

Design :

• Two - center Randomized controlled study.
  • Phramongkutklao Hospital, Royal Thai Army, Thailand (Feb 2023–Sept 2025).
  • Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand (Sept 2024–Sept 2025).

Population :

Total of 127 eligible patients indicated for diagnostic medial branch blocks for facet joint pain syndrome were randomized into three groups

     1.Group L (local anesthesia only) n=47

     2.Group S (local anesthesia combined with sedative medications) n=40

     3.Group V (local anesthesia combined with a virtual reality device during the procedure) n=40

Analysis :

• Anxiety scores : State-Trait Anxiety Inventory (STAI)
  • Pre & Post Procedure.
• Pain scores: Visual Analog Scales (VAS).
• Side effects.

Results:

• Post procedure total STAI scores were significantly decreased in Virtual reality group (Adj. p-value = 0.001).
• No difference in post procedure total STAI scores in Virtual reality group compared to Sedation group (Adj. p-value = 0.333).
• Total STAI scores (Pre – Post procedure) were lower in both Sedation and Virtual reality group compared to Local anesthesia (Group S mean difference -3.87 (-7.50, -0.24) Adj. p-value = 0.033, Group V mean difference -5.84 (-9.48, -2.21) Adj. p-value < 0.001).
• Subcutaneous pain scores and Procedure-related pain scores were also significantly lower in both Sedation and Virtual reality group compared to Local anesthesia.
• Side effects were found
• Drowsiness in Sedation group (22.5%).
• Dizziness in Virtual reality group (22.5%).

Conclusion:

References

1.Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg. 1999 Dec;89(6):1346–51.

2.Cohen SP, Bhaskar A, Bhatia A, Buvanendran A, Deer T, Garg S, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020 Jun;45(6):424–67.

3.Manchikanti L. Comprehensive Evidence-Based Guidelines forFacet Joint Interventions in the Managementof Chronic Spinal Pain: American Society ofInterventional Pain Physicians (ASIPP) Guidelines. Pain Phys. 2020 May 14;3S;23(5;3S):S1–127.

4.Hellinga MD, van Eerd M, Stojanovic MP, Cohen SP, de Andrès Ares J, Kallewaard JW, et al. 7. Cervical facet pain: Degenerative alterations and whiplash-associated disorder. Pain Practice. 2025;25(2):e70005.

5.Cohen SP, Doshi TL, Munjupong CS, Qian C, Chalermkitpanit P, Pannangpetch P, et al. Multicenter, randomized, controlled comparative-effectiveness study comparing virtual reality to sedation and standard local anesthetic for pain and anxiety during epidural steroid injections. Lancet Reg Health Southeast Asia. 2024 Aug;27:100437.