Virtual reality-based pain control in endometriosis: a questionnaire-based pilot study of applications for relaxation and physical activity (Preprint)

Viktoria Pakebusch, Barbara Schlisio, Birgitt Schönfisch, Sara Y. Brucker, Bernhard Kraemer, Jürgen Andress
2024 · doi:10.2196/preprints.68554 · W4404320417
preprint OA: gold CC0
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This pilot study found that a virtual reality relaxation application, but not an activity application, significantly improved pain, disability, and psychological scores in women with endometriosis compared to a control group.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This 14-week, prospective, open, three-phase cross-over pilot study enrolled 23 women with endometriosis-related pelvic pain and tested two virtual reality (VR) applications delivered for 4-week periods: HypnoVR® (relaxation-inducing) and SyncVR Fit® (activity-stimulating), each compared with an intervention-free control period, using two 1-week washouts between phases. Outcomes included momentary/average/maximum pain ratings (NRS) and psychosocial measures including the Pain Disability Index, Pain Catastrophizing Scale, sleep quality, depression/anxiety/stress (DASS), and health-related quality of life (SF-12). Both VR-R and VR-A were associated with statistically significant improvements on multiple pain- and distress-related scales versus baseline, but the difference-from-control analysis showed significantly greater improvements for VR-R only (notably pain catastrophizing and helplessness, sleep indices, and DASS depression/anxiety/stress), while SF-12 showed no significant change; the paper explicitly notes a need for larger studies. This paper is centrally about endometriosis — it evaluates VR-based relaxation and activity interventions for endometriosis-related chronic pelvic pain and associated impairment.

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Abstract

BACKGROUND Endometriosis is a common benign chronic disease in women of reproductive age, in which endometrial cells form lesions within the uterine wall and extrauterine sites. The disease can impair fertility and cause symptoms that vary greatly, tend to be unspecific, and typically include chronic pelvic pain, which is often severe and can adversely impact daily life. Nonpharmacologic and nonsurgical treatments for endometriosis-related pain include psychotherapy, distraction techniques, and physical activity. Virtual reality (VR) based technology may offer new avenues in the management of chronic endometriosis-related pain. OBJECTIVE Our prospective, 14-week, open, three-phase, cross-over pilot study aimed to investigate whether the use of VR technology with a relaxation-inducing application (HypnoVR®; VR-R) or an activity-stimulating application (SyncVR Fit®; VR-A) could change the levels of endometriosis-related chronic pelvic pain and impairment of daily life. METHODS 23 women aged 32.7 (SD 8.2) with endometriosis-related pelvic pain were each assigned to a permutated sequence of three 4-week phases: (A) the VR-R phase, (B) the VR-A phase, and (C) the intervention-free control phase. Phases were separated by two interspersed 1-week washout phases. Main outcome measures included: momentary, average, and maximum pain intensities on a 0–10 numerical rating scale (NRS); the Pain Disability Index (PDI) score; the Pain Catastrophizing Scale (PCS) score; sleep quality (Medical Outcomes Study Sleep Scale (MOS-SS) score); the Depression Anxiety Stress Scales (DASS) score; and the general health-related quality of life (Short Form (12) Health Survey (SF-12)) score. RESULTS Compared to baseline, VR-R use showed statistically significant positive effects for several scores (NRS “average pain”; PDI “total score”; PCS “total score” and the “magnification”, “rumination”, and “helplessness” subscores; MOSS-SS “index I and II”; and the DASS “depression” and “stress” subscores), whereas VR-A yielded significant positive changes only for PDI “total score”; PCS “total score” and the “helplessness” and “magnification” subscores; MOSS-SS “index II”; and DASS “depression” and “stress”. As four scale scores also showed significant improvements for control, a comparison of the effects was performed to offset a potential placebo-like effect by comparing difference from baseline against control. This analysis yielded significantly greater positive effects only for VR-R: PCS “total score” and “helplessness”; MOSS-SS “index I” and “index II”; and the three DASS subscores “depression”, “anxiety”, and “stress”. SF-12 showed no significant changes in either analysis. CONCLUSIONS VR-R and VR-A showed positive effects on a number of pain and quality of life scores, which were significant for several scores when compared to baseline. For VR-R some of these improvements were indeed significantly greater than under control conditions while the effects with VR-A were not. Larger studies are needed to explore these findings in greater depth. CLINICALTRIAL DRKS00030189
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Abstract

Background: Endometriosis is a common benign chronic disease in women of reproductive age, in which endometrial cells form lesions within the uterine wall and extrauterine sites. The disease can impair fertility and cause symptoms that vary greatly, tend to be unspecific, and typically include chronic pelvic pain, which is often severe and can adversely impact daily life. Nonpharmacologic and nonsurgical treatments for endometriosis-related pain include psychotherapy, distraction techniques, and physical activity. Virtual reality (VR) based technology may offer new avenues in the management of chronic endometriosis-related pain.

Objective

Our prospective, 14-week, open, three-phase, cross-over pilot study aimed to investigate whether the use of VR technology with a relaxation-inducing application (HypnoVR®; VR-R) or an activity-stimulating application (SyncVR Fit®; VR-A) could change the levels of endometriosis-related chronic pelvic pain and impairment of daily life.

Methods

23 women aged 32.7 (SD 8.2) with endometriosis-related pelvic pain were each assigned to a permutated sequence of three 4-week phases: (A) the VR-R phase, (B) the VR-A phase, and (C) the intervention-free control phase. Phases were separated by two interspersed 1-week washout phases. Main outcome measures included: momentary, average, and maximum pain intensities on a 0–10 numerical rating scale (NRS); the Pain Disability Index (PDI) score; the Pain Catastrophizing Scale (PCS) score; sleep quality (Medical Outcomes Study Sleep Scale (MOS-SS) score); the Depression Anxiety Stress Scales (DASS) score; and the general health-related quality of life (Short Form (12) Health Survey (SF-12)) score.

Results

Compared to baseline, VR-R use showed statistically significant positive effects for several scores (NRS “average pain”; PDI “total score”; PCS “total score” and the “magnification”, “rumination”, and “helplessness” subscores; MOSS-SS “index I and II”; and the DASS “depression” and “stress” subscores), whereas VR-A yielded significant positive changes only for PDI “total score”; PCS “total score” and the “helplessness” and “magnification” subscores; MOSS-SS “index II”; and DASS “depression” and “stress”. As four scale scores also showed significant improvements for control, a comparison of the effects was performed to offset a potential placebo-like effect by comparing difference from baseline against control. This analysis yielded significantly greater positive effects only for VR-R: PCS “total score” and “helplessness”; MOSS-SS “index I” and “index II”; and the three DASS subscores “depression”, “anxiety”, and “stress”. SF-12 showed no significant changes in either analysis.

Conclusions

VR-R and VR-A showed positive effects on a number of pain and quality of life scores, which were significant for several scores when compared to baseline. For VR-R some of these improvements were indeed significantly greater than under control conditions while the effects with VR-A were not. Larger studies are needed to explore these findings in greater depth. Clinical Trial: DRKS00030189 Citation Request queued. Please wait while the file is being generated. It may take some time. Copyright © The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.

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Outcome instruments

NRS-pain

Condition tags

endometriosischronic_pelvic_pain

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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