Enhancing brain health through resistance exercise: the effect of set number and intensity on brain- derived neurotrophic factor in older adults.

Hospitalized pediatric hematology-oncology patients are likely to receive anxiety-inducing news regarding their diagnosis, undergo painful treatments, and experience side-effects (; ; ). However, there are few interventions available to help them cope with their day-to-day pain and anxiety and distract them from these symptoms (; ). Digital interventions may be beneficial for pain and anxiety management in children with cancer (). Indeed, digital interventions, particularly virtual reality (VR), are suited for pediatric oncology as they provide a non-pharmacological alternative to traditional psychological practices by distracting patients from painful sensory signals and drawing their attention toward immersive, calming virtual experiences. These tools have shown potential to not only reduce procedural pain during invasive treatments like chemotherapy but also to improve emotional well-being by alleviating the anxiety and distress common in hospitalized children (). A growing body of research has examined the use of virtual reality (VR) as a tool to manage pain and anxiety during painful procedures in pediatric and adolescent populations (; ; ) but also for management of anxiety, depression and fatigue (). Existing literature suggests that the inclusion of familiar or friendly characters within virtual environments could further mitigate pain and procedure-related anxiety by fostering a sense of security and enhancing emotional engagement (; ; ). The following review focuses on existing literature regarding the efficacy of virtual reality in managing pain among pediatric and adolescent patients. VR is a technology simulating an immersive virtual environment through a headset (). During a VR session, users may experience side effects such as nausea, headaches or dizziness (; ). As children with cancer have side effects due to their medical treatments, VR content must be carefully designed to avoid adding more. It is important to control VR utilization without limiting engagement in the game. Also, transmedia storytelling is the use of multiple devices to offer diverse ways to interact with the virtual environment. This strategy can be used to ensure long-term game engagement of the patient in VR, while reducing VR play time (). Further, game engagement and motivation may be improved by invoking an emotional response through a non-player character (; ). While few studies have used friendly characters in pain and anxiety management (; ), none offered high-level customization of the visual appearance of the character. The IKEA Effect bias, where individuals assign more value to the objects they build themselves, may contribute to the emotional response invoked by the customization and creation of the avatar (; ).