e-Natureza Blue Care: Nature-based Virtual Reality and Pain Perception

Pain is a global health issue and remains the most feared symptom among cancer patients. With over 14 million new cancer diagnoses annually and projections suggesting this number will triple by 2030. The majority of patients are diagnosed at an advanced stage, where pain is the predominant complaint. The concept of total pain, as described in palliative care, highlights the need for a multidimensional approach that addresses physical, psychological, social, and spiritual aspects.

In the management of chronic pain, complementary therapies such as acupuncture, meditation, and massage have gained prominence for offering holistic benefits without the side effects associated with pharmacological treatments. Another promising complementary approach involves exposure to natural environments. Immersive Virtual Reality (VR) is an innovative strategy that provides distraction and reduces pain perception by transporting patients to engaging, nature-based virtual settings.

This study is a randomized, controlled, parallel-group clinical trial designed to investigate the impact of an immersive virtual reality (VR) intervention with nature-themed content (blue spaces) on pain and emotional well-being in hospitalized cancer patients. The research will be conducted in three oncology units of a large private hospital in São Paulo, Brazil.

A total of 130 adult oncology inpatients experiencing chronic pain will be randomly assigned to either the intervention or control group. Participants in the control group will receive standard pain management as provided by the hospital's pain control team, guided by electronic medical records, and institutional pain protocols. The intervention group will receive the same standard care, plus a VR session using the Oculus Go headset and 360-degree nature videos with synchronized natural sounds (e.g., beach, waterfall, birdsong), lasting approximately 8 minutes.

Data will be collected using the following validated instruments:

Visual Analog Scale (VAS) for pain intensity,

PANAS for positive and negative affect,

Nature Connectedness Scale (NCS),

Sociodemographic and clinical questionnaire,

Analgesic Use Form, developed by researchers to quantify medication use and pharmacological class.

Ethical approval was obtained (CAAE: 86844425.5.0000.0071), and all participants will provide written informed consent. If the results are positive, the intervention will be made available to the hospital's pain management team for broader implementation in clinical practice.

Inclusion criteria

• hospitalized oncological patients with chronic pain.
• both sexes
• aged 18 years or older
• preserved clinical condition and communication abilities that allow participation in the study
• report pain documented in the electronic medical record

Exclusion criteria

• Patients who are unable to tolerate wearing the virtual reality (VR) headset for at least 8 minutes
• blind patients
• patients who experience any side effects or worsening clinical condition during the interview/intervention period
• patients undergoing other complementary treatments