Managing pediatric pain during needle procedures: a narrative review of virtual reality and Buzzy as distraction-based interventions

Background: Needle-induced pain is common in children and can contribute to negative healthcare experiences. While pharmacological treatments can be effective, they may involve delayed onset and potential side effects. This narrative review explores two non-pharmacological alternatives, virtual reality and Buzzy (a device that combines cold therapy and vibration), as pain management tools during pediatric needle procedures. While there have been many studies using these methods, results have been mixed. The overall goal of this narrative review is to summarize higher quality studies on the use of virtual reality and Buzzy for managing needle-related pain in pediatric populations, with particular attention to how concurrent analgesic use, age, and study design may explain the variability observed in previous findings. Methods: Eligible articles included randomized controlled trials with a sample size ≥30 per group, typically developing children and youth, a control group, both a pre- and post-procedural self-reported measure of pain, published between 2015 and 2025, and available in English. Results: Ninety-nine articles were identified and 86 were excluded, of which 46 (53%) did not report pre-procedural pain. Thirteen articles met the inclusion criteria: ten on virtual reality and three on Buzzy. Results were mixed, however virtual reality and Buzzy were generally more effective in reducing needle-related pain when standard of care did not include analgesics. When examined by age, younger children showed more consistent benefits, particularly with virtual reality, whereas older children and adolescents demonstrated smaller or non-significant effects regardless of analgesic use. Conclusion: Virtual reality and Buzzy appear to be effective in managing needle-related pain in children; however, their effectiveness may be influenced by concurrent analgesic use, age, and intervention design. More research is needed to better understand when these interventions are most effective and for whom.