Objective
Procedural pain is an important source of fear and distress for children. Distraction is a widely used non-pharmacological approach to manage pediatric pain. A new distraction method is Virtual Reality (VR) technology; it combines multiple senses to provide a feeling of presence into a virtual world. Most reviews so far assessed the effect of VR distraction in adults. This systematic review of randomized controlled trials aims to evaluate the analgesic effect of VR distraction in procedural pain in children.
Methods
A systematic search was conducted using MEDLINE (through PubMed), Embase, CENTRAL and Web of Science from the earliest date until October 2018. By determining a set of inclusion and exclusion criteria, 17 trials were retrieved and qualitatively analyzed using the Cochrane risk of bias tool. Selected studies were grouped by type of procedure.
Results
Children distracted by VR during painful procedures had overall less pain when compared to standard of care. The analgesic effect is better using active VR distraction than passive VR distraction. Mainly for minor procedures (wound care and venipuncture), VR technology seems to be an appropriate technique to redirect children’s attention away from the painful stimulus. This was not the case for port catheter access (with EMLA) and lumbar puncture (compared to EMLA topically and sedation).
Conclusion
This systematic review provides evidence that immersive VR technology is a promising distraction method to provide analgesia for procedural pain in children. Especially wound care and IV access could be proper indications for VR distraction. The effect of active VR distraction is better than passive VR distraction. More large trials of good methodologic quality are needed to further investigate its analgesic effect, and to draw conclusions about which type and content of VR are the most suited for certain types of patients.

THE ANALGESIC EFFECT OF VIRTUAL REALITY IN PEDIATRIC PROCEDURAL PAIN: A SYSTEMATIC REVIEW