Discussion
ascites, fatigue, anxiety, Pain, pain, depression
ASCITES
REVEH is the first randomized study to compare VR with standard MEOPA in preventing pain during bone marrow biopsy. The intensity of pain did not significantly differ between VR and MEOPA: 3.0 versus 3.5 (The main technical difficulty was related to the handling of the phone (connection and start of the VR program); a new generation of head-mounted displays has recently emerged with full smartphone integration to facilitate set-up and reduce start-up time (not investigated in this study). Only bone marrow biopsy was evaluated; the impact of VR in the same context should be evaluated for other procedures (eg, lumbar puncture, ascites puncture, pleural puncture, catheter placement). We do not know if the patients had already been exposed to VR during their leisure time (movies, video games; data not available). Patient choice of the scenario was not recorded in this study, so programs were not compared with each other. Patients also could not compare them from one procedure to another (only 1 biopsy per patient). Pain and anxiety are very subjective symptoms that vary from patient to patient and are influenced by the self-experience. Physiological markers (clinical, biological parameters, neuroimaging markers) to objectively assess pain and anxiety have been published: blood pressure and heart rate variations, pupil reflexes, stress hormonal changes, electro-encephalography, magnetic resonance imaging, and positron emission tomography to assess brain activity [Even if the primary outcome of the study has not been achieved, the VR-based relaxation method was well tolerated, and the satisfaction of patients and physicians was very high in the VR group. In the future, the patient will put the helmet on himself or herself and choose his or her own program; in contrast to the use of analgesics or sedatives, no medical monitoring is indicated during and after the procedure, and driving is allowed. The length of time that the patient must be present will be shorter, with a probable socioeconomic impact, which will have to be evaluated.Several meta-analyses were published between 2019 and 2020 that evaluated the impact of VR on fatigue, anxiety, depression, and care-induced pain [