S0081 Virtual Reality Can Reduce Pain and Opioid Use in Sphincter of Oddi Dysfunction (SOD) Type III: A Prospective Pilot Study

Abstract

INTRODUCTION: Patients with classic SOD III have chronic debilitating pain not amenable to pharmacologic or endoscopic therapy. Our previous studies have shown benefits of virtual reality (VR) for pain management through immersive three-dimensional (3D) multisensory experiences, but only in short-term inpatient settings. To evaluate the impact of VR for chronic pain in patients with SOD III in an outpatient setting. METHODS: In this prospective pilot cohort study, adults who met the criteria for conventional SOD III (biliary-type pain for ≥3 months without abnormal liver enzymes or imaging) with an average pain score of ≥3 out of 10 for at least 3 episodes per week were enrolled. The study was divided into four 2-week periods: pre-intervention, early VR intervention, late VR intervention, and post-intervention. Subjects were given Samsung Gear Oculus headsets during the intervention period (early and late) with preloaded 21 VR experiences and were instructed to view one 3D VR experience at least 3 times a day for 10–15 minutes each. Throughout the study, subjects filled out daily questionnaires including pain scores on a numeric rating scale (0–10), pain medication use (opioids, NSAIDs, etc.), their VR experience, and hospitalizations. RESULTS: 9 patients were included with a median age of 47 (IQR, 41–51) years, 100% female, and a median disease duration of 8 (IQR, 5–9) years. Overall pain medication use decreased from 67% to 40% in the pre-intervention vs. post-intervention period. Opiate use also decreased from 40% to 20% in the same period. On univariate analysis, post-intervention pain scores decreased by 2.02 points out of 10 (95% CI: −2.55 to −1.49; P-value < 0.001; Table 1 and Figure 1) compared to pre-intervention pain scores. After adjusting for anti-depressant use in multivariable analyses, post-intervention pain scores remained significantly decreased by 1.99 points (95% CI: −2.60 to −1.39; P < 0.001). There were no adverse events or hospitalizations. Furthermore, 6/6 (100%) of patients had a positive VR experience. CONCLUSION: This is the first study evaluating VR for management of patients with SOD III. We showed that pain scores not only declined throughout the VR intervention period, but also in the post-intervention period, suggesting a possible sustained therapeutic benefit. Pain medication use, including opioids, was also reduced at the end of the study. Future large controlled trials should evaluate the role of VR in treating patients with SOD III.Table 1.: Univariate analysis of pain scores revealed multiple factors for significant pain score reduction including VR, older age, higher BMI, anxiety/depression, and use of anti-depressantsFigure 1.: Pain scores significantly improved during the VR intervention period and was sustained into the post-intervention period when compared to pre-intervention pain scores.