Turning distress into distraction: using virtual reality during penicillin injections for rheumatic fever

In Aotearoa New Zealand, people with acute rheumatic fever (ARF) receive 4-weekly intramuscular benzathine penicillin G (BPG) injections for a minimum of 10 years to prevent recurrence and progression to rheumatic heart disease. Within a phase IIA trial of a higher-dose subcutaneous injection of penicillin (SCIP), which provides at least 10 weeks of coverage, we piloted immersive virtual reality (VR) distraction to assess whether it improved injection acceptability through reductions in pain and anxiety.

Ten participants aged 9-20 years used a Meta Quest VR headset during their SCIP procedure. Participants rated anxiety before and after the injection and reported both their usual injection pain (based on prior SCIP injections) and pain during the current injection using zero to 10 scales. Acceptability and user experience were assessed through structured feedback from participants, caregivers and nurses.

Acceptability of the VR headset was high; all participants reported they would use VR again and recommend it to others. Mean pain scores decreased from 5.1 (usual) to 3.3 (current), and mean anxiety from 3.4 (pre-injection) to 1.1 (post-injection). Nurses noted procedures were faster and patients visibly calmer, while caregivers strongly agreed that VR reduced injection-related distress.

Immersive VR was feasible and highly acceptable during SCIP and was associated with reduced pain and anxiety, as well as smoother, faster procedures. VR distraction has the potential to improve the experience of injectable treatments, including intramuscular penicillin injections, and warrants further exploration.