Abstract
Ineffective postoperative pain management affects more than 25% of hospitalized children, leading to increased morbidity, impaired physical function, delayed recovery, prolonged opioid use, and heightened health care costs. Traditional pharmacological interventions have limitations, particularly given growing concerns over long-term opioid use in pediatric populations. Virtual reality (VR) has emerged as a promising nonpharmacological intervention for pediatric pain management, offering immersive, multisensory experiences that can effectively distract and engage patients' attention away from pain sensations. This viewpoint examines the current evidence and prospects for VR as a component of pediatric multimodal pain management strategies. Several VR modalities have shown potential for reducing pain and anxiety in pediatric populations, including virtual reality-distraction therapy, virtual reality-exposure therapy, virtual reality-guided relaxation-based therapy, and virtual reality-biofeedback therapy. The neurobiological underpinnings of VR's analgesic effects involve multiple mechanisms: the gate control theory explains how intense multisensory VR inputs compete with pain signal transmission, while the attention-modulation pathways involving the anterior cingulate cortex and periaqueductal gray work alongside emotional regulation pathways through amygdala connections to reduce pain perception. Recent studies involving various pediatric surgical populations have demonstrated VR's potential to reduce postoperative pain intensity, pain unpleasantness, anxiety, and in some cases, the need for rescue analgesia. However, VR's analgesic effects appear to be transient, typically lasting 15-30 minutes, which suggests the need for optimization in timing and frequency of VR sessions. Implementation challenges include cost considerations, technological access disparities, logistical requirements for safe use and storage, and staff training needs. As hospitals and health care systems continue to explore nonpharmacological pain management strategies, VR represents a promising adjunct to traditional approaches, potentially reducing reliance on opioid medications while improving patient experience and outcomes. Throughout this viewpoint, we address the major concepts related to VR, the use of VR in differing clinical situations, various VR-based therapy methods, and the practicality of VR to alleviate pain, as well as several key findings to date and future directions.