Virtual reality for pediatric procedural pain: An umbrella review and re-analysis of meta-analytic evidence

Needle-related medical procedures are among the most common sources of pain, fear, and anxiety in children. Negative procedural experiences may lead to behavioral distress, avoidance of future care, and reduced treatment compliance. Virtual reality (VR) has recently emerged as a promising non-pharmacological intervention that provides multisensory distraction, thereby reducing the perception of pain. However, inconsistencies across existing meta-analyses limit the generalizability of current evidence.

This umbrella review aimed to synthesize and re-analyze existing meta-analytic evidence on the effectiveness of VR in reducing pain and anxiety during needle-related procedures in children and adolescents.

A systematic search was performed across PubMed, Cochrane Database of Systematic Reviews, and Web of Science up to September 2025. Only meta-analyses of randomized controlled trials (RCTs) examining VR interventions for pediatric procedural pain were included. Two independent reviewers conducted study selection and data extraction. Methodological quality was assessed using AMSTAR 2 criteria. Heterogeneity (I²), standardized mean differences (SMD), and publication bias (Egger / Begg tests) were recorded.

Six meta-analyses (n = 1450 children) met the inclusion criteria. VR interventions demonstrated significant reductions in pain across self-, parent-, and observer-reported measures (SMD range: -0.5 to -3.5). The strongest effects were observed for self-reported pain, indicating high clinical relevance. Despite high heterogeneity (I² = 81-100%), all analyses showed consistent effect directions favoring VR. Methodological quality was moderate to moderate-high, with limited protocol registration and publication bias analysis. Evidence overlap between studies was substantial (CCA = 15.8%).

VR significantly reduces needle-related pain in pediatric patients and demonstrates moderate-to-high reliability across studies. Despite methodological heterogeneity, findings strongly support integrating VR as a complementary tool in pediatric pain management.

Nurses and clinicians can incorporate immersive VR interventions into routine pediatric care to minimize pain and anxiety during short invasive procedures, improving patient comfort and cooperation.