Overall, there is preliminary evidence that a variety of cognitive-behavioral interventions can be used with children and adolescents to successfully manage or reduce pain and distress associated with needle-related procedures. However, many of the included studies received lower quality scores because they failed to describe the randomization procedure and participant withdrawals or drop-outs from the study. Further RCTs need to be conducted, particularly for the many interventions for which we could not locate any trials.
Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer.
To determine the effects of virtual reality (VR) glasses on adolescents with cancer undergoing lumbar punctures (LPs).
                Pilot study using an experimental, control group design.
                In-hospital oncology clinic.
                30 adolescents with cancer (17 in the VR and 13 in the control group) undergoing frequent LPs.
                Subjects were randomly assigned to groups. Both groups received standard intervention during the LP, but the experimental group also wore VR glasses and watched a video. Following the LP, both groups rated their pain using a visual analog scale (VAS) and were interviewed to evaluate their experience.
                Pain, subjective evaluation of experience.
                Although VAS pain scores were not statistically different between the two groups (p = 0.77), VAS scores tended to be lower in the VR group (median VAS of 7.0, range 0-48) than in the control group (median VAS of 9.0, range 0-59). 77% of subjects in the experimental group said the VR glasses helped to distract them from the LP.
                VR glasses are a feasible, age-appropriate, nonpharmacologic adjunct to conventional care in managing the pain associated with LPs in adolescents.
                The clinical application of various age-appropriate distracters to reduce pain in adolescents undergoing painful procedures should be explored.