Systematic Review and Meta-analysis of Virtual Reality in Paediatrics: Effects on Pain and Anxiety.

This is a systematic review and meta-analysis of the effectiveness of virtual reality (VR) in reducing pain and/or anxiety in paediatric patients.  Distraction is commonly used in paediatric patients for medical procedures and VR is a relatively new technique.  This review defined VR as a fully immersive three-dimensional environment displayed in surround stereoscopic vision on a head-mounted display.  This has promise in the paediatric population given the utility of imaginative play in these patients.

Seventeen studies met the inclusion criteria and reported on the effect of VR on reducing pain (14 studies) and/or anxiety (7 studies) in paediatric patients ( £21 years) undergoing a variety of medical procedures.  These included venous access, dental, burns (the most common procedure studied) and oncological care, while only one study considered use of VR prior to elective surgery and general anaesthesia.  VR intervention was compared to standard care conditions in all studies.  Outcome data from the studies was from behavioural observations, self-reports or questionnaires.

The meta-analysis concluded that VR may be an effective intervention to reduce patient-reported pain (SMD = 1.30) and anxiety (SMD = 1.32) during a variety of medical procedures.  Caregiver or professional observed reduction in pain was also noted (SMD = 3.02).  There was limited observer data for anxiety.


This paper highlights an apparent reduction in patient-reported and observed pain when using VR as a distraction technique for a variety of medical procedures.  The data on anxiety is less convincing with only seven studies reporting on this outcome, predominantly using patient-reporting and very limited observer data to correlate the effectiveness of the invention.  It should be noted that there was significant heterogeneity in the study findings, with some studies showing no meaningful benefit.

There are a number of limitations to the meta-analysis that emerge, including the difficulty in controlling factors such as using different kinds of VR software and including non-randomised controlled trials in the analysis.  Eijlers et al note that the studies themselves are of variable quality and several have relatively small numbers of patients.  The findings should therefore be interpreted with caution, although there is sufficient evidence to suggest that VR may be useful in some contexts.

In relation to paediatric anaesthetic practice, only one study was included that used VR as a preparation tool before entering the operating theatre.  There is therefore insufficient evidence to recommend use in the perioperative setting at this stage.  Given induction of anaesthesia is reported to be a period when patients experience high levels of anxiety, further research is required to determine the effectiveness of VR in reducing both pain and anxiety pre-operatively and at induction.

Reviewed by Dr Natasha Epari