Akbulut SCY. et al., 2026: Investigation of the effect of virtual reality glasses used during extracorporeal shock wave lithotripsy on patients' pain, anxiety, and comfort levels: a randomized controlled trial.

Akbulut SCY, Ulubay S.
Urolithiasis. 2026 Jun 15;54(1):114. doi: 10.1007/s00240-026-02018-w

Abstract

Pain and anxiety are frequent issues that can significantly reduce patient comfort during extracorporeal shock wave lithotripsy. Virtual reality has recently gained attention as a non-pharmacological approach to improve the patient experience in various clinical procedures. This study was conducted to examine how the use of virtual reality during extracorporeal shock wave lithotripsy influences patients' perceived pain, anxiety, and comfort levels. This single-blind randomized controlled trial was conducted between February 1, 2025, and September 1, 2025. Patients in the virtual reality group received the standard protocol supplemented with virtual reality glasses throughout the procedure, whereas those in the control group received only standard care during the procedure. Study data were obtained through the "Descriptive Information Form," the "Visual Analog Scale," the "Visual Analog Scale-Anxiety," and the "State-Trait Anxiety Inventory." (NCT06804928). At baseline, the VR and control groups were homogeneous with respect to descriptive variables (p > 0.05). Following ESWL, pain scores increased in the control group, whereas a significant reduction was observed in the VR group, while comfort scores improved significantly only in the VR group (p < 0.05). Anxiety levels showed no significant change in the control group but were significantly reduced in the VR group (p < 0.05). Between-group comparisons confirmed lower post-procedure pain and anxiety and higher comfort in the VR group (p < 0.05). This study revealed that the use of virtual reality glasses during ESWL reduces pain and anxiety levels and enhances patient comfort, suggesting that VR may serve as a promising and feasible non-pharmacological method in clinical nursing practice.

Comment Peter Alken

Nice study, well design, performed and written.  As a prospective randomized study it will surely make into references in other publications on ESWL. Comes as surprise that Turkish patients are calmed down by looking at a video showing a Swiss landscape “Lauterbrunnen: “Close to Heaven”.

“The videos used for individuals in this group consisted of two titles: “Lauterbrunnen: Close to Heaven / Switzerland 4K / 360 / VR VIDEO” (13 min and 6 s), and “Under­water Life, Marsa Alam, Egypt.”

 I wondered why the placebo and nocebo effects (1) were not discussed. However, among the limitations the authors mention similar effects: ”Moreover, due to the nature of the intervention, blinding participants was not possible, which may have increased the risk of expectation bias. In addition, because all primary outcomes were self-reported and subjective in nature, the results may have been influenced by participants’ expectations and novelty effects associated with the use of virtual reality, which should be considered when interpreting the findings.”

1 Frisaldi E, Shaibani A, Benedetti F. Understanding the mechanisms of placebo and nocebo effects. Swiss Med Wkly. 2020 Sep 1;150:w20340. doi: 10.4414/smw.2020.20340. PMID: 32920787.

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Peter Alken