VR Game Reduces Self-Reported Pain Scores During Burn Dressing Changes Among Children

pediatric patient, child in hospital using virtual reality, VR
Researchers sought to determine whether smartphone-based virtual reality (VR) games are effective in reducing pain among pediatric patients in real-world burn clinics.

Among pediatric patients with burns, playing a smartphone-based virtual reality (VR) game decreased self-reported pain scores during dressing changes. These findings were published in JAMA Network Open.

Patients with burn injuries were recruited between 2016 and 2019 at the Nationwide Children’s Hospital in the US. The patients were randomly assigned in a 1:1:1 ratio to the active VR game (n=31), the passive VR condition (n=30), and standard care (n=29) cohorts.

The active VR game was entitled the “Virtual River Cruise” and was played by tilting one’s head. It was set in a winter river environment, and the objective was to shoot snow at boats. The passive VR group was immersed in the same game environment as in the active game but without interaction.

Patients reported pain scores on a visual analog score (VAS; range, 0-100) after a bandage change.

Children were 50% girls, with a mean age of 11.3 years, and 57% were White. Of the patients, 90% had second-degree burns, their total body surface area burned was most commonly between 1.0% and 4.9% (51%), and 33% received pain medication within 6 hours before dressing change.

The active VR condition was associated with lower pain scores (VAS, 24.9; 95% CI, 12.2-37.6) compared with the control group participants (VAS, 47.1; 95% CI, 32.1-62.2; P =.02). Worst pain scores were also significantly lower among the active VR group (VAS, 27.4; 95% CI, 14.7-40.1) compared with the control group (VAS, 48.8; 95% CI, 31.1-64.4; P =.03) and the passive VR cohort (VAS, 47.9; 95% CI, 31.8-63.9; P =.04).

Among only those children who did not receive pain medication, both the active VR (VAS, 18.4; 95% CI, 2.8-34.0; P =.03) and passive VR (VAS, 21.3; 95% CI, 5.7-36.9; P =.04) recipients reported less pain than did control group participants (VAS, 46.6; 95% CI, 25.7-67.5).

In the multivariate analysis, significant interactions were observed for White ethnicity (b, -22.05; 95% CI, -41.12 to -2.97; P =.02), active VR assignment (b, -26.39; 95% CI, -50.12 to -2.67; P =.03), and passive VR assignment (b, -24.09; 95% CI, -47.11 to -1.09; P =.04).

Clinicians scored the VR game as being highly useful (VAS, active: 84.2; 95% CI, 74.5-93.8; passive: 76.9; 95% CI, 65.2-88.7) and easy to use (VAS, active: 94.8; 95% CI, 91.8-97.8; passive: 96.0; 95% CI, 92.9-99.1).

A limitation of this study was that it did not assess the efficacy of the VR game to distract the children during repeated burn dressing changes.

The study authors concluded that a smartphone-based VR game effectively reduced self-reported pain during burn dressing changes among a pediatric population.


Xiang H, Shen J, Wheeler KK, et al. Efficacy of smartphone active and passive virtual reality distraction vs standard care on burn pain among pediatric patients: a randomized clinical trial. JAMA Netw Open. 2021;4(6):e2112082. doi:10.1001/jamanetworkopen.2021.12082