Immersive Virtual Reality Interventions for Endometriosis-Related Pelvic Pain: Systematic Review With Meta-Analysis

OBJECTIVE: Immersive virtual reality (IVR) could be an innovative and promising approach for alleviating pelvic pain in women with endometriosis. The objective was to assess the effectiveness of active IVR in reducing endometriosis-associated chronic pelvic pain (EACPP). The secondary objective was to assess the safety of these IVR interventions. DATA SOURCES: A systematic review with meta-analysis was conducted according to the PRISMA guidelines. A comprehensive literature search was conducted in PubMed/MEDLINE, SCOPUS, WOS, CINAHL Complete, and PEDro databases up to 4th January 2025 without publication date or language filters. METHODS OF STUDY SELECTION: The inclusion criteria were: (Population) patients diagnosed with EACPP; (Intervention) IVR; (Comparison) other therapies that did not include IVR devices or sham treatment; (Outcome) EACPP intensity and adverse events; and (Study design) randomized controlled trials [RCTs] or pilot RCTs. A first meta-analysis was conducted to assess the effectiveness of active IVR in reducing the intensity of EACPP using Cohen's standardized mean difference (SMD) and 95% confidence intervals (95% CI) as pooled effect measure. Secondly, a proportional meta-analysis was carried out to quantify the proportion of adverse events reported. TABULATION, INTEGRATION, AND RESULTS: Three RCTs, enrolling 169 women (35.1 ± 9.3 years), were included. Meta-analysis revealed medium effect size (SMD = -0.4; 95% CI -0.7 to -0.1; p = .009) in favor of IVR in reducing EACPP intensity compared to others such as active exercises, sham or non-intervention. Furthermore, active IVR appears to be safe therapy. Adverse events, primarily headache and nausea, were reported in only 6.1% (95% CI 1.3-23.9; p < .001) of women undergoing the intervention. CONCLUSION: This systematic review with meta-analysis provides preliminary evidence supporting the potential clinical benefit of active IVR interventions in managing EACPP. While the safety of active IVR interventions for EACPP seems to be favorable, clinicians should nonetheless consider this approach carefully before its implementation.