Effects of Virtual Reality Distraction on Pain, Stress, and Heart Rate during Pediatric Ingrown Toenail Surgery: A Randomized Controlled Trial

Immersive virtual reality (VR) shows efficacy in reducing pediatric procedural pain and stress, yet studies remain heterogeneous and conflate stress with anxiety while neglecting physiological measures such as heart rate (HR). The role of goal-directed attention remains underexplored, as no studies have controlled for VR-interactivity to isolate its contribution under clinically relevant conditions. Thus, this RCT investigates the effects of goal-directed VR vs. free-interaction VR vs. standard-of-care (SoC) distraction (controls) on self-reported pain, stress, and HR during ingrown toenail surgery under local anesthesia in children and adolescents