| Virtual reality for managing pain and fear and anxiety during pediatric needle procedures: an umbrella review |
Thomas Saliba1 
, Guillaume Fahrni2
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1Medical Faculty, Vrije Universiteit Brussel, Brussels, Belgium
2Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland |
Correspondence:
Thomas Saliba, Email: tes1066@hotmail.com
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Received: 14 May 2026 • Revised: 9 June 2026 • Accepted: 10 June 2026 |
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| Abstract |
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Needle-involving procedures often cause significant pain and anxiety, particularly in the pediatric population. Virtual reality (VR) has emerged as a nonpharmacological tool for alleviating these effects. However, the methodological quality and consistency of current meta-analyses of VR tools remain unclear. Here we performed an umbrella review to evaluate published meta-analyses that assessed the ability of VR to reduce pain, fear, and anxiety during medical procedures involving needles. A systematic search following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) 2020 guidelines was performed of the PubMed, Web of Science, Embase, ScienceDirect, and Cochrane Library databases in May 2026. Study methodological quality was assessed using A MeaSurement Tool to Assess systematic Reviews, version 2 (AMSTAR 2). The primary study overlap was quantified using the corrected covered area (CCA) and visualized using the GROOVE (Graphical Representation of Overlap of OVErviews) approach. An umbrella meta-analysis was performed using a metaumbrella analysis tool, with sensitivity analyses varying for inter- and intrastudy variance estimators and correlations. Eleven meta-analyses were included, containing 49 unique primary studies. The CCA was 15.7%, indicating very high overlap. The AMSTAR 2 ratings were predominantly low or critically low, with only one high-confidence review. The umbrella meta-analysis demonstrated statistically significant reductions in pain (I²=90.5%), fear (I²=91.1%), and anxiety (I²=89.9%), with a significant publication bias for pain and fear. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) classification was "very weak" for all 3 outcomes. Although available meta-analyses consistently suggest that VR reduces procedural pain, fear, and anxiety in children, the evidence base is undermined by high heterogeneity, substantial primary study overlap, and predominantly low methodological quality. VR may serve as an additional distraction tool for selected pediatric needle procedures;however, current evidence is insufficient to recommend it as a replacement for established analgesic strategies. |
| Key Words:
Virtual reality exposure therapy, Needles, Pain management, Fear, Anxiety |
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