Effect of immersive virtual reality on pain and anxiety during lumbar puncture: A randomized controlled trial

Lumbar puncture (LP) is a commonly performed diagnostic procedure essential for cerebrospinal fluid analysis in neurological conditions. LP is frequently associated with pain and anxiety, which may negatively affect patient cooperation and procedural outcomes. The study aimed to evaluate the effects of virtual reality (VR) in reducing pain and anxiety during LP procedure.

A randomized controlled trial was conducted at two tertiary teaching hospitals in Iraq. 85 candidates for LP were randomly assigned to intervention (41) and control groups (44) from May to October 2025. Data were collected by Visual Analogue Scale (VAS) and VAS for Anxiety. Before the LP procedure, participants in the intervention group were given a 15-min VR session. At predetermined intervals, such as baseline (before to intervention) and right after the LP, outcome assessments were carried out. Primary outcome pain intensity measured immediately after lumbar puncture. Secondary outcomes: Anxiety level measured at baseline, 15 min prior to LP and immediately after the procedure. Pain intensity measured at additional time points (baseline and pre-procedure) for comparison. Data were entered into the SPSS version 26.0 and analyzed using Kolmogorov-Smirnov Test, Mann-Whitney U tests, Levene's test, Wilcoxon Signed Ranks Test and Spearman's rank correlation coefficient at a significance level of P ≤ 0.001. The outcome assessors and data analysis was blinding in the study.

Pain severity measured immediately after LP was significantly lower in the VR group compared to the control group. The mean pain score in the VR group was 2.49 ± 0.675, whereas it was 8.36 ± 1.348 in the control group. The mean difference between groups was -5.87 (95% confidence interval [CI]: -6.32 to -5.42), indicating a statistically and clinically significant reduction in pain in favor of the VR intervention (r = 0.610; P = 0.001). While, anxiety statistically significant reduction after VR exposure (6.11, 95% CI 5.48-6.74). Conversely, the control group's post-test scores continued to be considerably higher than those of the VR group, and there was no discernible decrease in pain or anxiety over time (P > 0.05). Between-group comparisons confirmed significantly lower post-intervention pain and anxiety scores in the VR group (P < 0.001).

Immersion VR may be a useful non-pharmacological strategy for reducing procedural discomfort and anxiety in individuals having LPs, according to the results of this randomized controlled experiment. However, these findings should be regarded as preliminary due to the methodological constraints of the study, such as sample size and single-setting design. To validate these results and determine the wider application of VR in clinical practice, more extensive, multi-center research is advised.