Immersive virtual reality for pediatric burn pain and early rehabilitation.

Burn injury is a leading cause of morbidity, hospitalization, and long-term disability in children (). Even limited injuries often necessitate repeated medical visits, wound care, and rehabilitation, while families endure significant financial and emotional strain (, ). Pediatric burns differ from adult burns due to children's thinner skin, distinct body proportions, developmental vulnerability, and greater reliance on caregivers (). Under identical thermal exposure, children are more likely than adults to sustain deeper burns, as less energy is required to damage thinner skin (). Moreover, children are at higher risk for hypothermia, fluid imbalance, infection, scarring, and psychological sequelae following burn injury (). Current pediatric burn care typically involves wound assessment, cleansing, topical treatment, dressing changes, analgesic medication, infection prevention, scar management, and rehabilitation (). Dressing changes are necessary for wound inspection, exudate removal, topical medication application, and prevention of contamination, yet they also represent one of the most painful and distressing procedures in burn care (). Procedural pain during dressing changes often triggers fear and anxiety in pediatric burn patients, with pain, fear, and anxiety serving as core outcomes that directly influence children's tolerance of wound care (, ). Moreover, repeated exposure to painful procedures such as dressing changes can reduce cooperation, heighten anticipatory distress, and complicate rehabilitation, particularly when children associate dressing rooms or treatment equipment with prior painful experiences (). Integrating pharmacological and non-pharmacological strategies can effectively manage pain in children with burn injuries, alleviating anxiety during medical procedures and ongoing care (, ). Cognitive factors, such as attention and expectation, can profoundly shape pain perception and its modulation (). Focusing on a wound or anticipating pain may amplify nociceptive input, whereas redirecting attention to competing stimuli can reduce perceived pain and distress (, ). Emerging evidence suggests that virtual reality (VR) interventions modulate sensory input and redirect attention from painful procedures through immersive visual and auditory stimulation (). VR is a novel form of nonpharmacologic analgesia that can induce a greater improvement in positive emotions during medical procedures than traditional distraction methods (). Prior studies have shown that VR intervention reduces pain unpleasantness, worst pain, and anxiety in pediatric patients undergoing needle-related procedures, with no reported side effects (–). An fMRI laboratory study comparing VR analgesia to opioid analgesia in healthy adults demonstrated that VR reduces subjective pain as effectively as a moderate dose of hydromorphone, and VR significantly decreases pain-related brain activity (). Similarly, VR alone and opioids alone produced comparable reductions in pain-related brain activity (). In pediatric burn care, VR can reduce dressing-related pain, fear, and anxiety, while recent evidence indicates that VR may improve children's emotional engagement during burn wound care (, ). Nevertheless, it remains unclear whether the benefits of VR are sustained across repeated dressing changes and whether VR can also improve observable behavioral distress, treatment cooperation, early rehabilitation participation, rescue analgesic requirement, and safety within the same clinical framework (, , ).