Effects of Virtual Reality-Based Distraction of Pain, Fear, and Anxiety During Needle-Related Procedures in Children and Adolescents

Background: Needle-related pain, fear, and anxiety can be a deterrent to treatments in children and adolescents. Virtual reality (VR) can be used to manage the poor experience of needle procedures. Objective: This meta-analysis aimed to examine the effects of VR on pain, fear, and anxiety related to needle procedures in children and adolescents. Methods: PubMed, EMBASE, and the Cochrane Library were searched for potentially eligible studies published up to June 2021. The outcomes were pain assessed by the Wong-Baker Faces Pain Scale (WBS) or Faces Pain Scale-Revised (FPS-R), and Visual Analog Scale (VAS), fear assessed by Children's Fear Scale (CFS), and anxiety assessed by Children's Anxiety Meter (CAM), VAS, or CFS. Because of expected heterogeneity among studies, all analyses were conducted using the random-effects model. Results: Ten studies were included (571 children in the VR group and 575 in the control group). Based on the WBS, VR reduced pain, either self-reported (WMD = -2.17, 95%CI: -3.37, -0.97), parent-reported (WMD = -3.52, 95%CI: -4.62, -2.42), nurse-reported (WMD = -3.29, 95%CI: -5.59, -0.99), and physician/investigator-reported (WMD = -3.48, 95%CI: -5.93, -1.04). Using the FPS-R, VR reduced needle-related pain compared with controls (WMD = -0.85, 95%CI: -1.64, -0.06). Similar results were observed for fear (children/adolescents: WMD = -1.52, 95%CI: -2.18, -0.86; parents: WMD = -1.71, 95%CI: -2.30, -1.13; nurses: WMD = -1.55, 95%CI: -2.47, -0.63; physicians/investigators: WMD = -0.59, 95%CI: -1.00, -0.18) and anxiety (self-reported: WMD = -2.79, 95%CI: -4.07, -1.54; parent-reported: WMD = -3.87, 95%CI: -5.58, -2.15; nurse-reported: WMD = -4.64, 95%CI: -6.56, -2.71; physician/investigator-reported: WMD = -2.06, 95%CI: -4.13, -0.00). Conclusion: A VR-based intervention could reduce needle-related pain, fear, and anxiety in children and adolescents.