Currently submitted to: Journal of Medical Internet Research
Date Submitted: Jun 6, 2026
Open Peer Review Period: Jun 8, 2026 - Aug 3, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effects of virtual reality on pain, anxiety and fear during thyroid fine-needle aspiration biopsy: a randomized controlled trial
ABSTRACT
Background:
Thyroid fine-needle aspiration biopsy (FNAB) is a commonly used diagnostic procedure in patients with suspected thyroid cancer; however, it may induce pain, anxiety, and fear during the procedure.
Objective:
This randomized controlled study aimed to evaluate the effect of virtual reality (VR) on pain, anxiety, and fear of pain in patients undergoing diagnostic thyroid procedures.
Methods:
The study was conducted between October 15, 2024, and April 30, 2025, at Gaziantep City Hospital, Türkiye. A total of 100 patients with suspected thyroid nodules were randomly assigned to either a VR intervention group (n = 50) or a control group (n = 50). Data were collected using a Patient Information Form, the Beck Anxiety Inventory (BAI), the Fear of Pain Questionnaire III (FPQ-III), and the Visual Analog Scale (VAS). Between-group comparisons were performed using ANCOVA adjusting for relevant baseline covariates, and effect sizes were calculated using Cohen’s d with 95% confidence intervals.
Results:
After adjustment for baseline values and relevant covariates, no statistically significant differences were found between the VR and control groups in post-intervention VAS (P =.152), BAI (P =.501), or FPQ-III scores (P =.20). Effect size analyses indicated small between-group effects across all outcomes (Cohen’s d = −0.05 to −0.29), with 95% confidence intervals including zero. Within-group analyses indicated reductions in VAS, BAI, and FPQ-III scores over time in both groups; however, these changes were not supported by statistically significant between-group differences.
Conclusions:
Virtual reality was not associated with statistically significant improvements in pain, anxiety, or fear of pain when compared with standard care after adjustment for baseline differences. Although small within-group improvements were observed, these findings do not support a strong independent effect of VR on procedural discomfort in this sample. Further well-powered randomized trials are warranted. Clinical Trial: Clinical trial registration: This study was registered at ClinicalTrials.gov (NCT06792929), https://register.clinicaltrials.gov/prs/beta/studies/S000F9GN00000034/protocol/protocolSummary?fragmentId=status
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