The effects of virtual reality on pain relief in ICU patients: meta-analysis and systematic review

Background: Pain is common in conscious ICU patients, with over 50% experiencing mild to severe pain from procedures, disease, or routine care. Virtual reality (VR) interventions may help reduce pain, but evidence remains inconsistent, and their effect on analgesic use is unclear. The purpose of this systematic review and meta-analysis is to evaluate the impact of virtual reality technology or intervention on pain levels and analgesic dosage in adult ICU patients. Methods: Relevant literature published from January 2015 to February 2026 in PubMed and eight other electronic databases has been comprehensively searched. The Cochrane Risk of Bias Tool and Joanna Briggs Institute checklist were applied for quality assessment of randomized controlled trials (RCTs) and quasi-experimental studies (QES), respectively. The data analysis was conducted using R studio (4.5.2). The GRADE system was employed to evaluate the certainty of evidence. Results: = 0.032; low-certainty evidence]. The effect was most pronounced during acute procedural pain, particularly postoperative chest drain removal. Only 5 studies reported post-enrolment analgesic and sedative doses, and heterogeneity of reporting precluded pooled estimates of opioid- or sedative-sparing effects. Conclusion: Nature-based, distraction-focused VR appears to confer additional analgesic benefit for ICU patients, especially around brief high-intensity procedures. However, given the complexity of pain sources in the ICU, variations in study design, and the diversity of VR content, its true impact on ICU pain and the demand for analgesic medications should still be continually validated. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251231605, PROSPERO, registration number: CRD420251231605.