Children undergoing needle-based procedures are often very anxious. New research shows that virtual reality headsets can act as a distraction. When distracted, children reported significantly lower levels of anxiety and pain. The approach could also be used to calm nervous parents.
People of all ages can be afraid of needles, although this fear is particularly common among children.
Distraction devices such as toys can help reduce feelings of anxiety and pain in infants undergoing needle-based procedures.
And now, new research has found that virtual reality (VR) devices can be an even more effective distraction tool, leading to even more positive outcomes.
The study, led by the Chinese University of Hong Kong and published on the JAMA Network, builds on previous research into the benefits of distraction during venipuncture (a common needle-based procedure).
“Previous [studies] were just distractions like cartoons or games,” Cho Lee Wong, associate professor at the Nethersole School of Nursing at the Chinese University of Hong Kong and co-author of the study, told Healthline.
A total of 149 children aged 4 to 12 years undergoing venipuncture, in which a needle penetrates the skin, participated in the study and were divided into control and intervention groups.
The control group received ‘standard’ care during the procedure, including words of comfort and an explanation from a doctor of what was happening.
Meanwhile, those in the intervention group received standard care but also received a VR headset to wear during the procedure.
For children aged 4 to 7, VR consisted of watching a cartoon character perform a venipuncture and explain why the procedure was necessary. For children aged 8 to 12, the character explained the process in more detail – and they also played an interactive game in which they took on the role of the “doctor”.
“Our VR integrates distraction and procedural information,” noted Wong. “We think it’s important to prepare and let patients know what’s going on and what to expect. [as] It also helps alleviate their anxiety about the procedure.”
In addition, Wong shared, “We found that children had no trouble understanding the content. The process wasn’t difficult to understand and we explained it to them in simple, age-appropriate language.”
The children reported their feelings of anxiety using a visual scale, while the researchers used the self-reported facial pain scale to assess their pain levels.
Compared to the control group, those in the VR group reported significantly less pain and greatly reduced anxiety.
The average venipuncture time was also significantly shorter in the VR group at just under 4:30 minutes than in the control group at just over 6:30 minutes.
In addition, the researchers monitored the children’s heart rate and cortisol levels to gain further insight into their physiological responses to fear and pain.
However, while the VR group showed a smaller increase in heart rate and a larger decrease in cortisol (the stress hormone), the amounts were not statistically significant.
Interestingly, the researchers found that providing an additional gameplay element in the 8- to 12-year-old VR group did not further reduce stress levels.
“Our results showed that the added element of gameplay made no difference – although other studies have found that interactive gaming has a greater impact than passively viewing VR content,” revealed Wong.
“This may be because kids aged 8 to 12 weren’t as scared as younger kids, so the effects were less pronounced,” Wong shared. “This aspect may require further research.”
Since one is cognitive and the other is physical, it can be easy to think of fear and pain as separate entities.
But the two are very closely related, explained Dr. Christopher A. Kearney, Distinguished Professor and Chair of Psychology at the University of Nevada, Las Vegas.
“Pain and anxiety share key response sets that include physiological, cognitive, and behavioral components,” he told Healthline. “Common physiological components may include hyperventilation, tachycardia, and nervousness.”
Meanwhile, Kearney continued, “Shared cognitive components may include fear of negative consequences and concern about physical or emotional harm; and common behavioral components may include withdrawal and constant seeking for validation.”
How exactly does pain affect fear and vice versa?
“Understand [this]it’s important to try to understand how our body perceives pain,” said Dr. Zishan Khan, a psychiatrist at Mindpath Health, told Healthline.
“Pain is felt after nerve endings are activated by some kind of stimulus, such as being injected with a needle into the skin,” he explained. “These nerve endings trigger impulses that travel through the spinal cord to higher levels of our brain.”
“Depending on the part of the brain that is activated,” Khan continued, “the body will have different responses — such as a stress response if the hypothalamus is triggered.”
When stress responses kick in, “it leads to an influx of cortisol and adrenaline into our blood,” he said. “This release ends up causing an inflammatory response, which our body perceives as pain.”
In addition, according to Khan, “Anxiety can directly affect the nerves of the body and disrupt their function. This causes them to become overstimulated and exaggerate the pain sensation.”
Last but not least, “the expectation that you might be in pain can make you feel anxious,” he revealed.
“The more anxious you feel, the more likely it is that the pain will get worse due to the factors mentioned above. It can easily become a vicious circle.”
As this study — and others — have shown, distraction can be key to reducing children’s anxiety. There are a few key factors behind its effectiveness.
“[Distraction] involves a patient’s active participation in a task that requires cognitive or behavioral functioning,” shared Dr. Karla Molinero, MS, medical director for Newport Healthcare in Utah.
“When the mind focuses on a distraction, it allows people to develop thoughts and feelings related to that distraction — like the color, shape, and feel of a toy,” she told Healthline.
As a result of the brain’s focus on other things, Molinero said, it’s less likely to register pain.
Biological aspects can also play a role.
Kearney noted that “distraction can help reduce activity in certain areas of the brain associated with pain processing.”
“[When distracted]the body is more relaxed and doesn’t release stress hormones that could increase pain sensitivity,” Molinero added.
While adults experience stress and anxiety related to medical procedures, children often feel it more.
“Children don’t have abstract thinking and instead can have more irrational thoughts,” Molinero explained.
“You can imagine scenarios where if a needle gets stuck, their arm could fall off, or they could turn into a zombie,” she continued. “Their magical thinking can allow for endless worrying thoughts and scenarios when they become anxious.”
Additionally, according to Kearney, “young children tend to focus more on the physical aspect of pain because of their less developed cognitive coping mechanisms.”
“They are also less able to understand the reasons why pain is introduced into the body,” he noted. In contrast, “adults can understand that short-term pain leads to long-term gain.”
Khan explained that another notable difference revolves around children’s reduced ability to recognize and express emotions.
“Children often have a harder time expressing their feelings, while many adults find it easier to verbalize that they are anxious,” he said. “Because their brains are better developed, many adults are also better at recognizing when they are reacting inappropriately to a stressor.”
VR has yet to be widely used as a distraction tool in needle-based medical procedures. So what can parents do in the meantime to calm an anxious child?
According to Kearney, Khan, and Molinero, some of the best approaches include:
Let them know they are not alone. Engage them in conversation. Give them a stuffed animal to make them feel comfortable. Give them an interactive toy to play with. Play videos on an iPad. Listen to soothing music
New research has found that VR may help reduce feelings of anxiety in children undergoing needle-based procedures.
And less fear can lead to less pain.
“Fear can make people hypersensitive to pain, causing them to focus even more on the pain,” Molinero said.
Wong notes that VR not only benefits children, but can also be a useful tool for parents – and this is an area he and his team are now investigating.
“We found that parents are also very concerned about the procedure and their anxiety can have a negative impact on their children,” Wong revealed.
“That’s why we’re considering developing a VR intervention that can both engage and distract parents and children during invasive procedures.”
