Cited by 653Virtual Reality Applications and ImpactsPediatric Pain Management TechniquesPain Management and Treatment

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The effectiveness of virtual reality distraction for pain reduction: A systematic review

Malloy, Kevin M., Milling, Leonard S.·2010·Clinical Psychology Review

DOI 10.1016/j.cpr.2010.07.001

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Abstract

Virtual reality technology enables people to become immersed in a computer-simulated, three-dimensional environment. This article provides a comprehensive review of controlled research on the effectiveness of virtual reality (VR) distraction for reducing pain. To be included in the review, studies were required to use a between-subjects or mixed model design in which VR distraction was compared with a control condition or an alternative intervention in relieving pain. An exhaustive search identified 11 studies satisfying these criteria. VR distraction was shown to be effective for reducing experimental pain, as well as the discomfort associated with burn injury care. Studies of needle-related pain provided less consistent findings. Use of more sophisticated virtual reality technology capable of fully immersing the individual in a virtual environment was associated with greater relief. Overall, controlled research suggests that VR distraction may be a useful tool for clinicians who work with a variety of pain problems.

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Method
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BackgroundResult
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Method
Effectiveness of Hypnoanalgesia in Paediatric Dermatological Surgery
María, P. P. J., Marcelino, S. C., Quintana‐Díaz, M., Benhaiem, J.-M., & Javier, E. A. F. (2021) · Children · doi:10.3390/children8121195 · Cited by 8
“The comparison group (distraction) was also shown to be effective for anxiety and pain with regard to invasive procedures in children [13].”
Background
Virtual Reality in Healthcare: Exploring the Patients’ Behavior through the Lens of Extended Stimulus, Organism, and Response Framework
Kundi, G. M. (2023) · Open Access Public Health and Health Administration Review · doi:10.59644/oapr.1(1).2022.10 · Cited by 7
“According to (Malloy & Milling, 2010), quality of authenticity is imperative, which could enhance the patients' experience of VR because some of the patients' experience using VR in health services could not be perceived as an authentic because they use poor quality equipment (Borrego, Latorre,…”
Background
Potential of Artificial Intelligence to Accelerate Drug Development for Rare Diseases
Napolitano, G., Has, C., Schwerk, A. M. K., Yuan, J.-H., & Ullrich, C. (2024) · Pharmaceutical Medicine · doi:10.1007/s40290-023-00504-9 · Cited by 7
“AI can empower medical technologies towards applicable solutions in clinical practice, with current AI-based medical applications ranging from the prediction of disease risk based on electronic patient records [2] to target identification [3], computer-assisted surgery [4] and pain management [5].”
Amish-Initiated Burn Care Project
Hess, R. F. (2015) · Journal of Transcultural Nursing · doi:10.1177/1043659615613417 · Cited by 7
“…had observed that patients under their care seldom used analgesics and rarely experienced pain during dressing changes in sharp contrast to conventional burn care (Kornhaber & Wilson, 2011; Malloy & Milling, 2010; Morris, Louw, & GrimmerSomers, 2009; Smith, Murray, McBride, & McBride-Henry, 2011).”
Background
Observations and Opportunities for Deploying Virtual Reality for Passenger Boats
Carter, L., Paroz, A., & Potter, L. E. (2018) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3170427.3188615 · Cited by 7
“VR therefore may be able to provide this distraction to people feeling seasick, as it has been shown to be a beneficial distraction in other areas, such as pain management [12] and rehabilitation [11].”
Background
A Case Study: Chronic Pain Patients’ Preferences for Virtual Reality Games for Pain Distraction
Tong, X., Jin, W., Cruz, K., Gromala, D., Garret, B., & Taverner, T. (2018) · Lecture notes in computer science · doi:10.1007/978-3-319-91584-5_1 · Cited by 7
Virtual Reality als Baustein in der Behandlung akuter und chronischer Schmerzen
Lindner, S., Latoschik, M. E., & Rittner, H. L. (2020) · AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie · doi:10.1055/a-1022-3038 · Cited by 7
“Die stärksten analgetischen Effekte wurden bisher bei experimentellem Schmerz beschrieben [24].”
Background
Virtual walking therapy in neuropathic spinal cord injury pain: a feasibility study
Landmann, G., Aerni, M., Abächerli, R., Ernst, M., Ljutow, A., & Ottiger-Böttger, K. (2024) · Spinal Cord Series and Cases · doi:10.1038/s41394-024-00667-w · Cited by 6
“To draw conclusions about the effectiveness and therapeutic outcome on pain a further study with more patients is needed.”
Background
Technological Interventions for Pain Management
Suso-Ribera, C., Castilla, D., Martínez-Borba, V., Jaén, I., Botella, C., Baños, R. M., & García-Palacios, A. (2022) · Comprehensive Clinical Psychology · doi:10.1016/b978-0-12-818697-8.00009-1 · Cited by 6
Use of Virtual Reality to Improve the Quality of the Hospital Stay for Patients in Neurosurgery
Vayssière, P., Constanthin, P. E., Baticam, N. S., Herbelin, B., Degremont, C., Blanke, O., Schaller, K., & Bijlenga, P. (2021) · Frontiers in Virtual Reality · doi:10.3389/frvir.2021.736122 · Cited by 6
“Virtual reality (VR) technology provides an immersive, multisensory and three-dimensional (3D) environment that enables users to have modified experiences of reality by creating a sense of “presence” (Malloy and Milling, 2010; Li et al., 2011).”
Background
Effectiveness of Virtual Reality in Reducing Pain and Stress During Office Hysteroscopy: A Randomized Controlled Trial
Estadella, J., Perelló-Capó, J., González, M. S., Queiruga, M. B., Real, J., Gomis‐Pastor, M., Marre, D., & Llurba, E. (2025) · Healthcare · doi:10.3390/healthcare13020131 · Cited by 7
Smart device–assisted telerehabilitation versus conventional rehabilitation after total nee arthroplasty: a systematic review and meta-analysis
Zhai, S., Wu, R., Du, G., Chen, X., Liu, Y., Zhao, J., Yuan, X. H., & Huang, W. (2025) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-025-06393-9 · Cited by 6
“Existing studies have shown that psychological factors play a key role in postoperative pain perception, and AR may enhance pain management by providing an immersive, multisensory feedback environment for virtual training[53].”
Effectiveness of Virtual Reality in Reducing Perceived Pain and Anxiety Among Patients Within a Hospital System: Protocol for a Mixed Methods Study
Mittal, A. K., Wakim, J., Huq, S., & Wynn, T. (2024) · JMIR Research Protocols · doi:10.2196/52649 · Cited by 7
“Some studies have already used VR technology as a beneficial distractor for pain given its inherent immersive properties [5,6].”
Background
Factors influencing the hypoalgesic effects of virtual reality
Shafir, R., Watson, L., Felix, R. B., Muhammed, S., Fisher, J. P., Hu, P. F.-M., Wang, Y., & Colloca, L. (2025) · Pain · doi:10.1097/j.pain.0000000000003549 · Cited by 6
Serious gaming during multidisciplinary rehabilitation for patients with complex chronic pain or fatigue complaints: study protocol for a controlled trial and process evaluation
Vugts, M. A. P., Joosen, M. C. W., Mert, A., Zedlitz, A. M. E. E., & Vrijhoef, H. J. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016394 · Cited by 6
“In the fields of rehabilitation and pain management, virtual environments have shown promise in reducing acute pain by distraction, or in activity management to restore physical functioning.(34) 35 Despite of promising results for various monodisciplinary applications of gaming and simulation, no evident application s…”
Kanser Hastalarının Ağrı ve Kaygı Yönetiminde Sanal Gerçeklik Teknolojisi Kullanımı
Özdağ, S., & İnkaya, B. V. (2021) · Türkiye Sağlık Bilimleri ve Araştırmaları Dergisi · doi:10.51536/tusbad.901503 · Cited by 5
Hospital homebound students and K-12 online schooling
Black, E. W., Ferdig, R. E., Fleetwood, A., & Thompson, L. A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0264841 · Cited by 14
Spatially dependent veiling glare degrades image quality in medical extended reality
Zhao, C., Beams, R., Dahal, E., & Badano, A. G. (2024) · Virtual Reality · doi:10.1007/s10055-023-00893-x · Cited by 6
“…Izard et al. 2020), diagnostic imaging (Douglas et al. 2017; Słyk et al. 2019), therapy (Jang et al. 2002; Bohil et al. 2011), pain management (Malloy and Milling 2010; Mosso-Vázquez et al. 2014), training (Fried et al. 2007; Moody et al. 2008), and surgical applications (Wang et al. 2015;…”
Development of a mental stress relaxation tool based on guided imagery and Microsoft Kinect
Lui, A. K.-F., Wong, K.-F., Ng, S.-C., & Law, K.-H. (2012) · International Conference on Distributed Smart Cameras · Cited by 6
DREAM project
May, S. L., Paquin, D., Fortin, J.-S., & Khadra, C. (2016) · Virtual Reality International Conference · doi:10.1145/2927929.2927934 · Cited by 6
“Despite the seeming utility of VR in pain management (12,13), its use in healthcare settings was limited, mainly due to its high cost (6).”
Background
Interacting With Augmented Reality Mirrors
Portalés, C., Gimeno, J., Casas, S., Olanda, R., & Martínez, F. G. (2018) · IGI Global eBooks · doi:10.4018/978-1-5225-5469-1.ch002 · Cited by 6
Prosedürel Ağrı Yönetiminde Sanal Gerçeklik Kullanımı
Yılmaz, E. D., & Dinçer, N. Ü. (2022) · Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi · doi:10.31125/hunhemsire.1102099 · Cited by 6
The effect of virtual reality (VR) glasses and therapeutic touch (TT) on pain, anxiety, and patient satisfaction during intrauterine insemination (IUI) compared to standard care: a single-blind, randomized controlled trial
Bal, S., Karakaya, N., Koç, E., & Güven, D. (2025) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-025-07435-0 · Cited by 5
“Indirectly, their attention is diverted, creating a therapeutic environment [13–15].”
Virtual reality as a distraction technique in pediatric patients undergoing orthopedic procedures: A systematic review and meta-analysis of randomized controlled trials
Alharran, A. M., AlAyyaf, A. E., Addar, A., Hamdy, R. C., & Marwan, Y. (2026) · Journal of Children s Orthopaedics · doi:10.1177/18632521251414463 · Cited by 5
“19,20 However, this is the first meta-analysis to focus specifically on orthopedic interventions, which are characterized by strong sensory stimulation and procedural discomfort.”
Virtual reality for interventional radiology patients: a preliminary study
Grange, L., Grange, R., Bertholon, S., Morisson, S., Martin, I., Boutet, C., & Grange, S. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08621-0 · Cited by 5
“It is also useful in the management of chronic pain [12–14], phobias or anxiety [15].”
The Impact of Visual Distraction Interventions on Patients’ Pain and Anxiety During Colonoscopy
Saab, O. N., Al-Obaidi, H. O., Merza, N., Bhagat, U., Al-Sagban, A., Algodi, M., Abuelazm, M. T., & El‐Serag, H. B. (2024) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000002086 · Cited by 5
Assessing the Use and Acceptability of Virtual Reality to Assist Coping in Children Undergoing Clinical Procedures
Samnakay, S., Bell, E., Evans, D., Sommerfield, D. L., Sommerfield, A., Hauser, N. D., & von Ungern-Sternberg, B. S. (2024) · Journal for Specialists in Pediatric Nursing · doi:10.1111/jspn.70002 · Cited by 5
An exploration of the use of visually appealing contexts in a pain management program
Tse, M. Y. M., Ng, S. S. M., Bai, X., Lee, P. H., Lo, R. S. K., Yeung, S. S. Y., Li, Y., & Tang, S. K. (2020) · European Geriatric Medicine · doi:10.1007/s41999-020-00339-6 · Cited by 5
Reducing pain through distraction therapy in small acute paediatric burns
Chu, H., Brailey, R., Clarke, E., & Sen, S. K. (2021) · Burns · doi:10.1016/j.burns.2021.01.012 · Cited by 5
The Virtual “Enfacement Illusion” on Pain Perception in Patients Suffering from Chronic Migraine: A Study Protocol for a Randomized Controlled Trial
Bottiroli, S., Matamala-Gomez, M., Allena, M., Guaschino, E., Ghiotto, N., Icco, R. D., Sances, G., & Tassorelli, C. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11226876 · Cited by 5
Virtual reality–guided mindfulness for chronic pain in cancer survivors: protocol for the virtual mind study—a single-group feasibility trial
Baydoun, M., Gajtani, Z., Patton, M., McLennan, A., Cartwright, S., & Carlson, L. E. (2024) · Frontiers in Pain Research · doi:10.3389/fpain.2024.1291374 · Cited by 7
Concept Protocol for Developing a DAid® Smart Socks-Based Biofeedback System: Enhancing Injury Prevention in Football Through Real-Time Biomechanical Monitoring and Mixed Reality Feedback
Davidoviča, A., Semjonova, G., Kamynina, L., Lancere, L., Jonate, A., Tomsone, S., Kataševs, A., Okss, A., & Davidovičs, S. (2025) · Applied Sciences · doi:10.3390/app15031584 · Cited by 5
Design considerations of a randomized clinical trial on a cognitive behavioural intervention using communication and information technologies for managing chronic low back pain
Doménech, J., Baños, R., Peñalver, L., García‐Palacios, A., Herrero, R., Ezzedinne-Angulo, A., Díaz, M. M., Ballester, J. G., Horta, J., & Botella, C. (2013) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-14-142 · Cited by 5
“There are several studies supporting the efficacy of virtual reality (VR) as a powerful distraction technique for acute pain control associated with medical procedures (see Malloy and Milling, 2010 [20] and Keefe et al.”
Background
Visuo–tactile Stimulation, but not Type of Movement, Modulates Pain During the Vision of a Moving Virtual Limb
Gordon, C., Barbullushi, A., Tombolini, S., Margiotta, F., Ciacci, A., Yosef, L. S., Barker, L., & Martini, M. (2019) · Pain Management · doi:10.2217/pmt-2019-0019 · Cited by 5
The effects of game-based virtual reality application on labor pain and childbirth satisfaction in primiparous pregnant women: A randomized controlled study
Sunay, Z., & Uçar, T. (2025) · Health Care For Women International · doi:10.1080/07399332.2025.2522767 · Cited by 4
“According to the results of many studies examining satisfaction with childbirth, the satisfaction levels of pregnant women who gave vaginal births, received support from healthcare personnel, and experienced less labor pain were higher (Bilgin et al., 2018; Malloy & Milling, 2010).”
P124: EFFICACY OF NON-PHARMACOLOGICAL INTERVENTIONS TO REDUCE PAIN IN CHILDREN WITH SICKLE CELL DISEASE: A SYSTEMATIC REVIEW
Vuong, C., van Veelen, S., Gerritsma, J. J., Eckhardt, C. L., Verbeek, S. T., Peters, M., & Fijnvandraat, K. (2022) · HemaSphere · doi:10.1097/01.hs9.0000821588.40217.a7 · Cited by 4
Virtual Reality for Motor Rehabilitation of Children with Down Syndrome: Systematic Review
(2019) · The Medical Journal of Cairo University/The Medical Journal of Cairo University · doi:10.21608/mjcu.2019.53291 · Cited by 4
Using and Creating Therapeutic Games in Virtual Reality and the Player/Game/Therapy Model
Ústav lékařské etiky a humanitních základů medicíny, 2. L. F. U. K., Zielina, M., Šmahaj, J., Raudenská, J., & Javůrková, A. (2022) · Ceskoslovenska psychologie · doi:10.51561/cspsych.66.3.332 · Cited by 4
Virtual reality interventions designed to support parents during and throughout the first year after birth: A scoping review
Fallon, V., Davies, S. M., Silverio, S. A., & Creagh, L. (2024) · Digital Health · doi:10.1177/20552076241245373 · Cited by 3

Authors: Malloy, K. M., & Milling, L. S.
Affiliations: University of Hartford (US)
Corresponding author: Milling, Leonard S.
ORCID: Milling, Leonard S.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2010-12
Volume: 30
Issue: 8
Pages: 1011-1018
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2010.07.001
OpenAlex: W2164662311
Cited by: 653
References: 59
Citations by year: 2026: 44 · 2025: 72 · 2024: 52 · 2023: 67 · 2022: 59 · 2021: 75 · 2020: 66 · 2019: 53 · 2018: 51 · 2017: 31 · 2016: 18 · 2015: 18 · 2014: 23 · 2013: 9 · 2012: 7
FWCI: 2.06
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
Topics: Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: virtual reality, distraction therapy, analgesia, experimental pain, immersion, pain management
MeSH terms: Attention, Burns, Humans, Injections, Pain, Research, User-Computer Interface, Treatment Outcome, Controlled Clinical Trials as Topic, Pain Management

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The effectiveness of virtual reality distraction for pain reduction: A systematic review

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