Use of virtual reality as an adjunct tool for the acute reduction of pain in hospitalized patientsABSTRACT
BACKGROUND AND OBJECTIVES Pain is an unpleasant sensory and emotional experience, frequent among hospitalized patients, and its management remains a clinical challenge. Virtual reality (VR) has been investigated as a complementary resource to promote reduction in pain perception. The objective of this study was to evaluate the acute analgesic effect of VR on pain intensity in hospitalized patients and compare session duration and pain reduction among immersive video categories.
METHODS This retrospective observational study was conducted using electronic medical records of patients treated by the physiotherapy team in a hospital. Individuals aged ≥14 years, admitted to the intensive care unit or inpatient unit between January 2023 and July 2025, were included. Pain was assessed using the Numeric Pain Rating Scale before and after physiotherapy sessions combined with the use of VR headsets. The videos displayed immersive natural landscapes. Data was analyzed considering the significance level of p<0.05.
RESULTS A total of 178 medical records were analyzed, corresponding to 226 sessions. The mean age of participants was 53±21 years, with a predominance of female patients (55%) and intensive care unit (ICU) admissions (61%). There was a significant reduction in pain after VR use from pre-intervention to post-intervention values (pre = 6.1±2.5; post = 2.8±2.4; p<0.0001). The mean session duration was 12.4 ± 6.7 minutes. No significant differences were observed among video categories.
CONCLUSION VR was associated with an acute reduction in pain intensity among hospitalized patients, with no differences among immersive video categories.
Keywords:
Acute pain; Analgesia; Hospitalization; Pain measurement; Rehabilitation
HIGHLIGHTS
The use of virtual reality (VR) led to a clinically significant reduction in pain, with an average decrease of 3.4 points on the Numeric Pain Rating Scale (NPRS)
The intervention was safe and well tolerated, even among critically ill patients in the ICU, with no significant hemodynamic changes observed
Short sessions (average of 12 minutes) were sufficient to produce meaningful analgesic effects, making VR feasible in complex and time-restricted hospital environments
No differences were found in pain reduction or session duration across different VR scenario categories, suggesting that immersion and distraction, rather than specific visual content, drive the analgesic effect
VR emerges as a valuable non-pharmacological strategy for pain management, supporting reduced reliance on analgesics and contributing to more humanized, patient-centered hospital care
RESUMO
JUSTIFICATIVA E OBJETIVOS A dor é uma experiência sensorial e emocional desagradável, frequente entre pacientes hospitalizados, e seu manejo permanece um desafio clínico. A realidade virtual (RV) tem sido investigada como recurso complementar para promover a redução da percepção dolorosa. O objetivo deste estudo foi avaliar o efeito analgésico agudo da RV sobre a intensidade da dor em pacientes hospitalizados e comparar a duração das sessões e a redução da dor entre as categorias de vídeos imersivos.
MÉTODOS Trata-se de um estudo observacional retrospectivo, realizado por meio da análise de prontuários eletrônicos de pacientes atendidos pela equipe de fisioterapia em um hospital. Foram incluídos indivíduos com idade ≥14 anos, internados em unidade de terapia intensiva ou unidade de internação entre janeiro de 2023 e julho de 2025. A dor foi avaliada por meio da Escala Numérica de Dor antes e após sessões de fisioterapia associadas ao uso de óculos de RV. Os vídeos exibidos apresentavam paisagens naturais imersivas. Os dados foram analisados considerando nível de significância de p<0,05.
RESULTADOS Foram analisados 178 prontuários, correspondentes a 226 sessões. A média de idade dos participantes foi de 53±21 anos, com predomínio de pacientes do sexo feminino (55%) e de internações em unidade de terapia intensiva (UTI) (61%). Observou-se redução significativa da dor após o uso da RV, comparando-se os valores pré e pós-intervenção (pré = 6,1±2,5; pós = 2,8±2,4; p<0,0001). A duração média das sessões foi de 12,4±6,7 minutos. Não foram observadas diferenças significativas entre as categorias de vídeos.
CONCLUSÃO A RV esteve associada à redução aguda da intensidade da dor em pacientes hospitalizados, sem diferenças entre as categorias de vídeos imersivos.
Descritores:
Analgesia; Dor aguda; Hospitalização; Mensuração da dor; Reabilitação
INTRODUCTION
Virtual reality (VR) has been increasingly investigated as a relevant tool for pain control in different clinical contexts, including adult and younger patients1. Its analgesic potential is commonly explained by the gate control theory of pain, according to which non-noxious sensory stimuli may interfere with pain transmission in the central nervous system, promoting short-term analgesia through multisensory cognitive distraction2.
VR consists of using electronic devices such as computers or smartphones attached to VR headsets, enabling immersive simulation of three-dimensional environments. In addition to acting on mechanisms associated with pain modulation, this technology helps increase patient engagement and motivation during rehabilitation, making the experience more pleasant and potentially more effective3.
Among non-pharmacological distraction interventions, such as music, relaxation, television, and video games, VR stands out because it combines immersive visual and auditory stimuli, thereby redirecting the patient’s attention and favoring an immediate reduction in pain perception4. This immersive experience creates a cognitive diversion capable of decreasing the salience of nociceptive stimuli during the intervention period5. Evidence indicates that VR may promote meaningful short-term pain relief in different clinical contexts6, and experimental studies have also suggested neural mechanisms underlying this analgesic response7.
In critically ill patients, the use of VR remains relatively recent. A recent systematic review and meta-analysis suggested potential benefits for anxiety, pain, sleep quality, and posttraumatic stress disorder in intensive care unit (ICU) settings, although pain-related findings remain heterogeneous8. In other hospital contexts, such as palliative care, VR has also shown promising results, with reductions in pain intensity and good feasibility9.
Despite growing evidence on VR in pain care, its immediate analgesic effect during hospital physiotherapy sessions remains insufficiently explored in heterogeneous inpatient populations. In addition, comparisons involving session duration and different immersive video categories are still limited. Therefore, the aim of this study was to evaluate the acute analgesic effect of VR on pain intensity in hospitalized patients and to compare session duration and pain reduction according to different categories of immersive videos.
METHODS
This was a retrospective observational study based on the analysis of data extracted from electronic medical records completed by the physiotherapy team responsible for the routine care of hospitalized patients at Hospital Santa Cruz, Curitiba, Paraná, Brazil.
The study was carried out at Hospital Santa Cruz, a private institution that provides care in several medical specialties, including oncology, cardiology, neurology, neurosurgery, orthopedics, and adult and pediatric emergency care. The hospital has 166 beds, performs over 12,000 monthly visits, and is equipped to provide both elective and emergency care.
The study included records of patients aged ≥14 years who were admitted to the adult Intensive Care Unit (ICU) or inpatient units of Hospital Santa Cruz (Rede D’Or São Luiz).
Data collection
The sample was obtained by convenience from electronic medical records and the Fisiomobile system, both routinely used by the physiotherapy team to document clinical data and therapeutic procedures.
The VR sessions were conducted and recorded during routine care by the hospital’s attending physiotherapists. Subsequently, the research team extracted the study variables from the medical records for analysis.
All physiotherapy sessions conducted between January 2023 and July 2025 were included, totaling 178 patient records. The collected variables included clinical profile (age, gender, diagnosis, and hospitalization unit) and pain level, assessed using the Numeric Pain Rating Scale (NPRS) before and after physiotherapy sessions that utilized virtual reality (VR).
During the intervention, after the initial pain assessment, patients used VR headsets to watch immersive videos across three categories of scenarios: (i) mountains and forests, (ii) sea, beach, and underwater environments, and (iii) sky and northern lights. The choice of scenario was based on each patient’s personal preference.
This study was approved by the Research Ethics Committees of the Universidade do Planalto Catarinense and the Faculdade Evangélica Mackenzie do Paraná (approval protocol number 7,661,854).
Statistical analysis
The data were tabulated in Microsoft Excel® 2010 and subsequently analyzed using IBM SPSS Statistics software, version 22.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were performed, including calculation of mean, standard deviation, and relative frequencies. The normality of variables was assessed using the Shapiro-Wilk test. For comparison of pain levels before and after the virtual reality intervention, the paired t-test for dependent samples was used or, when the assumptions of normality were not met, the nonparametric Wilcoxon signed-rank test. To compare pain reduction among the different types of videos used, one-way ANOVA was applied or, alternatively, the Kruskal–Wallis test, according to data distribution, with post hoc tests performed when necessary. The level of significance adopted was p<0.05.
RESULTS
The sample comprised 178 patient records, corresponding to 226 VR sessions. Most patients underwent only one session (81%). Participants had a mean age of 53 ± 21 years, ranging from 14 to 97 years. Women accounted for 55% of the sample, and 61% of the sessions were conducted in the ICU. Regarding clinical diagnoses, the most frequent category was “other conditions” (25.8%), which included diabetic ketoacidosis, electrolyte disturbances, upper gastrointestinal bleeding, and exogenous intoxication, followed by sepsis/infection (24.2%). The remaining clinical characteristics are presented in Table 1.
Clinical characteristics of hospitalized patients who used virtual reality during physiotherapy sessions.
Pain intensity was significantly lower immediately after VR use than before the intervention (pre = 6.1±2.5; post = 2.8±2.4; p<0.0001), indicating an acute analgesic effect associated with the session (Figure 1).
The mean duration of VR sessions was 12.4±6.7 minutes. When the analysis was stratified by immersive video category, all groups showed a significant within-group reduction in pain after the intervention (p<0.0001 for all). In the sea scenario group, pain intensity decreased from 6.4±2.5 to 3.0±2.6, corresponding to a mean reduction of 3.4 points. In the mountain/forest group, pain scores fell from 5.8±2.7 to 2.5±2.4, with a mean reduction of 3.3 points. In the sky/aurora group, pain intensity declined from 5.7±2.6 to 2.3±2.2, also corresponding to a mean reduction of 3.4 points.
No statistically significant differences were found between immersive video categories, either in session duration or in the magnitude of pain reduction (p > 0.05) (Figures 2 and 3).
DISCUSSION
The clinical profile observed in this study is consistent with that of a typical hospital population, marked by a predominance of critically ill patients, multiple comorbidities, and frequent exposure to acute pain10. In this context, complementary non-pharmacological strategies may help improve comfort during care, particularly when pain interferes with tolerance to therapeutic interventions11,12. Previous studies have also shown that ICU patients may experience moderate to severe pain even when pharmacological treatment is available, and inadequate pain control has been associated with adverse outcomes such as prolonged mechanical ventilation, longer hospital stay, and delirium13,14. In this context, VR emerges as a complementary strategy capable of modulating pain perception through sensory immersion and cognitive distraction15.
The immediate reduction in pain intensity observed after VR use is in line with previous studies suggesting that immersive distraction may be associated with short-term pain relief across different clinical settings5,6,16. In the present sample, the relatively short duration of the sessions suggests that brief VR exposure may be enough to promote an immediate decrease in pain during physiotherapy sessions. This may be especially relevant in hospital wards and ICUs, where interventions often need to be individualized, brief, and compatible with bedside care17,18.
The mean reduction of approximately 3.4 points on the NPRS observed in this study may be considered clinically meaningful, as reductions greater than 2 points are generally interpreted as relevant pain relief by patients19. This finding suggests that VR may represent a useful adjunct resource in hospital settings, particularly when the use of pharmacological analgesia requires caution.
Recent studies also support the potential usefulness of short VR sessions in painful clinical situations. Wiechman et al.20 reported a trend toward reduced pain and anxiety in hospitalized trauma patients after brief hypnotic VR sessions, with pain intensity reductions reaching up to 45%. Similarly, El Mathari et al.21 found improvements in pain and anxiety among postoperative patients after 10 minutes of VR exposure, while Server et al.22 described reduced pain during painful medical procedures after single VR sessions. Taken together, these findings suggest that short periods of immersive exposure may be sufficient to provide immediate symptom relief in some clinical scenarios.
The lack of statistically significant differences between video categories suggests that the immediate reduction in pain intensity may be more closely related to immersion and attentional engagement than to the specific visual content itself23. Although some studies indicate that natural environments may promote relaxation24, the present findings suggest that all immersive video categories were associated with comparable short-term reductions in pain. In other words, the acute analgesic effect observed here appears to have been linked more to the immersive experience itself than to any particular type of scenery.
Although much of the literature on VR analgesia has focused on pediatric populations or burn patients25, the present sample, composed predominantly of critically ill adults, adds to the discussion on the feasibility of VR use in complex hospital settings. Another relevant aspect is the possibility of allowing patients to choose their preferred immersive environment. Previous studies suggest that this may increase acceptance of and engagement with the intervention26, notably when no significant differences in pain reduction are observed between video categories.
This study has limitations. Its retrospective design and the absence of a control group limit causal inference. In addition, the sample was clinically heterogeneous, including both ICU and ward patients with different diagnoses, age groups, and potentially different pain profiles. Because the sessions were conducted and documented as part of routine clinical practice, different attending physiotherapists have been involved, which could have introduced variability in how the intervention was delivered and recorded. Information on concomitant analgesia and other potentially relevant clinical variables was not controlled. Moreover, most patients underwent only one session, which precludes conclusions about sustained effects over time.
The incorporation of VR into hospital physiotherapy practices represents a step forward in patient-centered care, promoting comfort, engagement, and adherence to therapy sessions. Beyond its analgesic effect, the interactive and playful nature of this technology contributes to a more positive hospitalization experience, reinforcing the role of physiotherapy in humanizing care within critical environments.
Overall, these findings suggest that VR may be a feasible adjunct to physiotherapy sessions in hospitalized patients and may contribute to immediate pain relief in the short term. Prospective studies with standardized protocols and appropriate comparison groups are needed to better clarify the specific contribution of VR to pain management in hospital settings.
CONCLUSION
In this retrospective sample of hospitalized patients, VR use during physiotherapy sessions was associated with an acute analgesic effect, reflected by an immediate reduction in pain intensity after the intervention. All immersive video categories showed significant within-group improvement, with no statistically significant differences between categories regarding pain reduction or session duration. These findings support the feasibility of VR as an adjunct resource for short-term pain relief in hospital care.
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Ethics statement:
Data availability
References
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Correspondence to:
Darlan Nitz darlannitz@hotmail.comConflict of interests:
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