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PACUPod is your trusted source for evidence-based insights tailored to advanced clinical pharmacists and physicians. Each episode dives into the latest primary literature, covering medication-focused studies across oncology, and many more. We break down study designs, highlight key findings, and objectively discuss clinical implications—without the hype—so you stay informed and ready to apply new evidence in practice. Whether you’re preparing for board certification or striving for excellence in patient care, PACUPod helps you make sense of the data, one study at a time.
Britany: Welcome back to PACULit, your daily literature update for advanced clinical pharmacists and physicians. Today, we’re discussing a pilot dosing study exploring virtual reality for outpatient management of chronic cancer pain. Seth, have you seen the recent study by Groninger and colleagues in Supportive Care in Cancer?
Seth: Yes, Britany. Chronic cancer pain is a major challenge, especially outpatient. Traditional treatments often have side effects and incomplete relief. This study evaluates VR as a nonpharmacological adjunct, addressing a critical gap.
Britany: Exactly. Up to seventy percent of advanced cancer patients have moderate to severe pain. Managing this safely outpatient is vital as care shifts away from inpatient models. Opioid risks make adjuncts like VR appealing.
Seth: Until now, data on optimal VR dosing for chronic cancer pain was limited. Prior studies focused on single sessions or inpatient use. This pilot explores repeated outpatient VR sessions over three weeks to assess sustained analgesic effects and reduced pain interference.
Britany: That’s key. We don’t yet know if repeated VR can reduce opioid use or improve satisfaction. VR’s immersive distraction and neurocognitive modulation may reduce pain perception and anxiety during chemotherapy and procedures.
Seth: VR creates an immersive environment that distracts from pain and may modulate central pain pathways. Groninger et al. enrolled thirty-three adult outpatients with chronic cancer pain scoring at least four out of ten.
Britany: The population was mostly African American (91%), mean age 55, and 73% female. Inclusion required diagnosed cancer with persistent outpatient pain; exclusions included cognitive impairment limiting VR use and severe motion sickness.
Seth: They used the Meta Quest 2 headset with immersive content. Dosing was phased: week one had daily 10-minute sessions, week two twice daily 10-minute sessions, and week three daily sessions as needed. There was no control group, a limitation.
Britany: Right, the single-arm design limits causal inference, but as a pilot, it provides valuable preliminary data. Primary outcome was change in pain intensity by numeric rating scale. Secondary outcomes included PROMIS pain interference, patient satisfaction, and breakthrough opioid use.
Seth: Over three weeks, pain scores improved significantly (p=0.04). Pain interference decreased markedly (p=0.001). Patient satisfaction increased significantly (p<0.001).
Britany: However, breakthrough opioid use didn’t change significantly (p=0.49). Data suggested twice-daily VR in week two might be more effective than once daily in week one, indicating a possible dose-response.
Seth: That’s important. Twice-daily sessions may enhance analgesia, but the short duration and small sample size mean larger randomized trials are needed to confirm and assess long-term opioid-sparing effects.
Britany: Strengths include the innovative phased dosing design and high African American representation, improving demographic diversity often lacking in trials.
Seth: Also, validated patient-reported outcomes like PROMIS and satisfaction surveys add robustness. Conducting the study outpatient enhances real-world applicability.
Britany: Limitations include small sample size limiting generalizability, no control group restricting causal conclusions, and short three-week follow-up limiting durability assessment.
Seth: The lack of opioid reduction might be due to short duration or insufficient power. While VR has no direct drug interactions, improving pain control might allow opioid dose reductions, decreasing sedation or respiratory depression risks.
Britany: Good point. Until larger studies confirm opioid-sparing effects, clinicians should monitor carefully. Also, patients with cognitive impairment were excluded, but many cancer patients have some deficits, so patient selection is critical.
Seth: VR requires intact cognition and absence of severe motion sickness. The high African American representation is encouraging, but more data across diverse cancer types and demographics is needed.
Britany: This study fits within growing evidence. Tepe et al. published a 2025 systematic review supporting VR’s efficacy for oncology pain relief, confirming analgesic and anxiolytic effects.
Seth: Uçgun and Çitak’s meta-analysis also confirmed VR reduces cancer symptom burden, including pain. Dong et al. showed VR benefits for needle-related procedural pain; Eskici et al. demonstrated VR decreases chemotherapy-related anxiety and pain in mastectomy patients.
Britany: Hernandez et al.’s pilot supported VR feasibility in lung cancer pain, reinforcing VR’s potential across cancer types. Collectively, these studies highlight VR’s safety and feasibility as a nonpharmacological adjunct.
Seth: Systematic reviews emphasize VR’s short-term analgesic and psychological benefits during procedures and chemotherapy. However, heterogeneity in designs and dosing remains a challenge.
Britany: That’s why Groninger’s phased dosing pilot is valuable—it begins to clarify optimal frequency and duration. Twice-daily 10-minute sessions appear promising, but larger randomized trials with longer follow-up are needed.
Seth: Clinically, incorporating VR into outpatient cancer pain management could improve satisfaction and reduce pain interference without adding pharmacologic side effects. It’s a scalable, safe adjunct aligning with multimodal pain management.
Britany: For acute care and emergency clinicians, understanding VR’s role can optimize pain control, especially when opioid use is limited by side effects or dependence risk.
Seth: Before we wrap up, any final thoughts on integrating VR into practice based on this study?
Britany: Start by identifying appropriate patients—those with moderate to severe pain, intact cognition, and no VR contraindications. Educate on benefits and limitations, consider twice-daily sessions for better analgesia, monitor pain and opioid use, and adjust pharmacologic therapy accordingly.
Seth: From pharmacy, remain vigilant about interactions and counsel patients on realistic expectations. VR is an adjunct, not standalone. Watch for emerging research to guide dosing, long-term effects, and opioid-sparing benefits.
Britany: To summarize, Groninger et al.’s pilot shows repeated outpatient VR sessions can significantly reduce chronic cancer pain and interference while improving satisfaction. Twice-daily dosing may offer greater benefits, but further research is needed.
Seth: This adds to growing evidence supporting VR as a safe, feasible, effective adjunct in cancer pain management. It’s an exciting development that could transform outpatient oncology care.
Britany: Thanks for joining me, Seth, and thanks to our listeners for tuning in to PACULit. Stay curious and keep advancing patient care with the latest evidence.
Seth: Thanks, Britany. Looking forward to our next update. Take care!
Britany: You too. Goodbye!