The effect of virtual reality glasses on reducing pain during chest tube removal

Zeynep Kızılcık Özkan 1 * , Ayşe Gökçe Işıklı 2, Fazlı Yanık 3
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1 Department of Surgical Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
2 Department of Thoracic Surgery, Trakya University Health Research and Application Center, Edirne, Turkey
3 Department of Thoracic Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 4, pp. 38-42.
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Background: The studies that generally investigate the effectiveness of pharmacological and non-pharmacological methods in reducing chest tube removal related pain are remarkable. However, new studies need to expand the use of virtual reality glasses and evaluate its effectiveness.
Aim: This study aims to determine the effect of distraction with virtual reality glasses on pain during chest tube removal in patients undergoing tube thoracostomy.
Material and methods: This quasi-experimental study with a pre-test post-test control group design was performed with the participation of 40 patients. The patients in the intervention group (n=20) watched the video with virtual reality glasses throughout procedure. Pain measurements were evaluated before, during, and after chest tube removal. The patients in the control group (n=20) received standard care.
Results: In the intervention group, it was revealed that the pre-procedure pain score decreased compared to the pain score obtained during the procedure (p=0.002). After the chest tube removal procedure, a statistically significant decrease was observed in pain score in favor of the intervention group. In the intervention group, the pre-procedure pain score was found to decrease statistically significantly in the measurement at the 10th min of the procedure (p=0.000). The pain score of the intervention group 10 min after the chest tube removal procedure was lower than that of the control group (1.80 vs 2.95 and p=0.028).
Conclusion: The virtual reality glasses assisted chest tube removal procedure can help reduce pain. Surgical nurses should benefit from the use of virtual reality glasses for pain control.


Özkan ZK, Gökçe Işıklı A, Yanık F. The effect of virtual reality glasses on reducing pain during chest tube removal. J CLIN MED KAZ. 2023;20(4):38-42.


  • Paydar S, Ghahramani Z, Johari HG. Tube thoracostomy (chest tube) removal in traumatic patients:what do we know? what can we do?. Bulletin of Emergency and Trauma. 2015; 3(2):37-40.
  • Friesner SA, Curry DM, Moddeman GR. Comparison of two pain-management strategies during chest tube removal: Relaxation exercise with opioids and opioids alone. Heart & Lung. 2006; 35(4):269-276.
  • Tarhan M, Gökduman S, Ayan A. Nurses’ knowledge levels of chest drain management: a descriptive study. Eurasian Journal of Pulmonology. 2016; 18:153-9.
  • Demir Y, Khorshid L. The effect of cold application in combination with standard analgesic administration on pain and anxiety during chest tube removal: a single-blinded, randomized, double-controlled study. Pain Management Nursing. 2010; 11(3):86-96.
  • Sheykhasadi H, Abbaszadeh A, Bonakdar H, Salmani F, Tavan A, Sedri N. The effect of distraction with a loved one’s voice on pain reduction while extracting the chest tube after open heart surgery. The Open Pain Journal. 2019; 12(7):6-10.
  • Watanebe S, Imai K, Kimura T, et al, Effect of lidocaine cream analgesia for chest drain tube removal after video-assisted thoracoscopic surgery for lung cancer: a randomized clinical trial. Regional Anesthesia & Pain Medicine. 2019; 1–6.
  • Siu E, Quick JS, Xu X, Correll DJ. Evaluation of the determinants of satisfaction with postoperative pain control after thoracoscopic surgery: a single-center, survey-based study. Anesthesia & Analgesia. 2019; 128(3):555-562.
  • Indovina P, Barone D, Gallo L, Chirico A, De Pietro G, Giordano A. Virtual reality as a distraction intervention to relieve pain and distress during medical procedures. The Clinical Journal of Pain. 2018; 34(9):858-877.
  • Birnie KA, Kulandaivelu Y, Jibb L, Hroch P, Positano K, Robertson S, Campbell F, Abla O, Stinson J. Usability testing of an interactive virtual reality distraction intervention to reduce procedural pain in children and adolescents with cancer. Journal of Pediatric Oncology Nursing. 2018;
  • Wiederhold M, Wiederhold B. Virtual reality and interactive simulation for pain distraction. Pain Medicine. 2008; 8(3):182-188.
  • Mosso-Vázquez JL, Gao K, Wiederhold BK, Wiederhold MD. Virtual reality for pain management in cardiac surgery. Cyberpsychology, Behavior, and Social Networking. 2014; 17(6):371-378.
  • Nilsson S, Enskär K, Hallqvist C, Kokinsky E. Active and passive distraction in children undergoing wound dressings. Journal of Pediatric Nursing. 2013; 28(2):158-66.
  • Sharar SR, Miller W, Teeley A, Soltani M, Hoffman HG, Jensen MP, Patterson DR. Applications of virtual reality for pain management in burn-injured patients. Expert Review of Neurotherapeutics. 2008; 8(11):1667-1674.
  • Freitas O, Spadoni V. Is virtual reality useful for pain management in patients who undergo medical procedures? Einstein. 2019; 17(2):eMD4837.
  • Delshad SD, Almario CV, Fuller G, Luong D, Spiegel BM. Economic analysis of implementing virtual reality therapy for pain among hospitalized patients. NPJ Digital Medicine. 2018; 1:22.
  • Matsangidou M, Ang CS, Sakel M. Clinical utility of virtual reality in pain management: a comprehensive research review. British Journal of Neuroscience Nursing. 2017; 13(3):133-143.
  • Pallavicini F, Orena E, Di Santo S, Greci L, Caragnano C, Ranieri P, et al. MIND-VR: Design and evaluation protocol of a virtual reality psychoeducational experience on stress and anxiety for the psychological support of healthcare workers involved in the COVID-19 pandemic. Frontiers in Virtual Reality. 2021; 2:620225.
  • Moore N, Dempsey K, Hockey P, Jain S, Poronnik P, Shaban R, et al. Innovation during a pandemic: developing a guideline for infection prevention and control to support education through virtual reality. Frontiers in Digital Health. 2021; 3:628452.
  • Du A, Hannan L, Muruganandan . A narrative review on pain control interventions for non-surgical pleural procedures. Respiratory Medicine. 2023; 107119.
  • Ceylan E, Rızalar S. Which is more effective: cold application or relaxation exercise on pain during chest tube removal. International Journal of Caring Sciences. 2022; 15(3):1879-1885.
  • El Mokadem N, El-Sayed, Ibraheem S. Cold application and breathing exercises to reduce pain and anxiety during chest tube removal. American Journal of Nursing Science. 2017; 6(4):285-292.
  • Elmetwalyl R, Sayed R.Chest tube removal: efficacy of cold application and breathing exercise on pain and anxiety level. Evidence Based Nursing. 2020; 2(4):34-45.
  • Gorji H, Nesami B, Ayyasi M, Ghafari R, Yazdan J. Comparison of ice packs application and relaxation therapy in pain reduction during chest tube removal following cardiac surgery. North American Journal of Medical Sciences. 2014; 6:19-24.
  • Jarrah M, Hweidi I, Al-Dolat S, Alhawatmeh H, Al-Obeisat S, Hweidi L, et al., The effect of slow deep breathing relaxation exercise on pain levels during and post chest tube removal after coronary artery bypass graft surgery. International Journal of Nursing Science. 2022; 9(2):155-161.
  • Mohammadi N, Pooria A, Yarahmadi S, Tarrahi M, Najafizadeh H, Abbasi P. Effects of cold application on chest tube removal pain in heart surgery patients. Tanaffos. 2018; 17(1):29-36.
  • Özcan N, Karagözoğlu Ş. Effects of progressive muscle relaxation exercise, cold application and local anesthesia performed before chest tube removal on pain and comfort levels and vital sings of the patient. Turkiye Klinikleri Journal of Medical Sciences. 2020; 40(3):285-296.
  • Sajedi-Monfared Z, Rooddehghan Z, Haghani H, Bakshandeh A, Sajedi-Mofared L. Cold therapy and respiratory relaxation exercise on pain and anxiety related to chest tube removal: a clinical trial. Iranian Journal of Nursing and Midwifery Research. 2021; 26:54-59.
  • Yarahmadi S, Mohammadi N, Ardalan A, Najafizadeh H, Gholami M. The combined effects of cold therapy and music therapy on pain following chest tube removal among patients with cardiac bypass surgery. Complementary Therapies in Clinial Practice. 2018; 31:71-75.
  • Başak T, Duman S, Demirtaş A. Distraction-based relief of pain associated with peripheral intravenous catheterisation in adults: a randomised controlled trial. Journal of Clinical Nursing. 2019; 00:1–8.
  • Guo C, Deng H, Yang J. Effect of virtual reality distraction on pain among patients with hand injury undergoing dressing change. Journal of Clinical Nursing. 2015; 24(1-2):115–120.
  • JahaniShoorab N, Ebrahimzadeh Zagami S, Nahvi A, Mazluom SR, Golmakani N, Talebi M, Pabarja F. The effect of virtual reality on pain in primiparity women during episiotomy repair: a randomize clinical trial. Iranian Journal of Medical Sciences. 2015; 40(3):219-224.
  • Soydan D, Uğraş G. Effect of different cold application materials on pain during chest tube removal: three-arm randomized controlled clinical trial. African Health Sciences. 2021; 21(3):1273-1281.
  • Aktaş Y, Karabulut N. The use of cold therapy, music therapy and lidocaine spray for reducing pain and anxiety following chest tube removal. Complementary Therapies in Clinical Practice. 2019; 34:179-184.