Letter to editor: Virtual reality as a promising method of pain relief in patients with venous leg ulcers

We read your article ‘Virtual Reality as a Promising Method of Pain Relief in Patients with Venous Leg Ulcers’ with great interest. By exploring virtual reality (VR) as a non-pharmacological intervention for pain relief during venous leg ulcers, the study examines an important facet of wound care. While the study offers insightful data, certain aspects warrant further discussion and consideration.

First, the authors should be commended for utilizing a randomized controlled trial design, which enhances the credibility and reliability of their findings. The results depict a significant reduction in pain among VR users and the control group. However, a key drawback is the relatively small sample size of only 60 patients. A larger population could have provided more robust outcomes, allowing for generalization of the results to the broader population.

Another limitation is the absence of comparison with conventional pain relief strategies, such as topical agents, dressings and analgesics, which have been reported safe and effective for rapid pain relief.¹ These comparative analyses would have provided an adequate understanding of VR's relative effectiveness and potential benefits.

The Numerical Rating Scale (NRS), which has inherent limitations in clinical administration, is primarily employed in the study. Inconsistencies in NRS result in overestimated or underestimated pain levels.² Some other drawbacks are reliability of NRS scores obtained in clinical settings, non-normal distribution, irregular evaluation intervals and subject variability across short periods of time.³ Hence, other pain scales should be considered to increase data accuracy.

Gate Control Theory of Pain, which is quite pertinent in this situation, is not considered. According to this theory, the level of attention, the patient's emotions and prior pain experiences impact pain perception.⁴ VR might reduce pain by diverting attention from the painful stimulus, effectively ‘closing gate’ that permits the conduction of pain signals to the brain. An explicit explanation of this hypothesis could have added depth to VR's pain-relieving mechanism.

The study fails to address the cost and accessibility of VR. Expensive VR headsets and software make them inaccessible to patients belonging to lower socio-economic background. Moreover, it does not report potential side effects of prolonged VR use, such as its impacts on cognitive processes and issues like cybersickness and simulation sickness.⁵ Addressing these factors would provide an equitable view of VR's potential and limitations.

In conclusion, although the study offers valuable insights regarding VR as a pain relief method in venous leg ulcers, it also leaves few aspects undiscovered for further exploration. A larger study population, in comparison with other pain relief options, and consideration of economic and side-effect profiles would provide a more comprehensive evaluation of its applications in wound care. Such considerations will be essential as healthcare providers thrive to explore creative approaches to enhance patient outcomes.

No conflicts of interest are declared by any author.