Why Needles Feel Bigger Before They Happen

For many people, the most difficult part of a needle procedure begins before the needle appears. Worry can build in the waiting room, while equipment is prepared, or simply from remembering a previous experience. By the time the procedure starts, attention may already be fixed on what could happen next.

The experience of a needle procedure is shaped not only by physical sensation, but also by anticipation, attention, fear and the surrounding environment.

Why anticipation can make a needle feel bigger

Fear encourages us to watch closely for possible threats. In a clinical setting, that can mean noticing every sound, movement and piece of equipment connected with the procedure. When attention narrows in this way, even a brief routine moment can feel much larger.

Needle fear is also common across different ages. A systematic review and meta-analysis of needle fear found that it affects children and adults and can contribute to avoidance of vaccination and other healthcare.

This is why a reassuring voice helps, but may not always be enough. The person may understand that the procedure is routine while still feeling a strong emotional and physical response to it.

Attention is part of the experience

Attention is limited. When it is centred on the needle, the surrounding cues and the expected sensation, there is less room for anything else. Distraction approaches aim to give attention a different destination.

Traditional options can include conversation, toys, music or a video. These may be useful, but a person can still look away from a screen and immediately reconnect with the clinical environment. Immersive virtual reality creates a stronger separation from those visual and auditory cues.

What makes immersive VR different?

A VR headset can engage several channels at the same time:

• Visual attention: the clinical room is replaced by a virtual environment.
• Sound: audio can reinforce focus on the experience.
• Presence: the person may feel as though they are inside the virtual world rather than simply watching it.
• Interaction: simple actions can help sustain attention through the procedure.

Researchers use the term presence to describe the feeling of being inside a virtual environment. In experimental research, a stronger sense of presence has been associated with greater reductions in reported pain during VR distraction. Read the study on presence and VR distraction.

What does the research show?

A 2024 systematic review and meta-analysis examined virtual reality during needle-related procedures in children and adolescents. It included 21 studies and 2,663 participants.

Across the included studies, results favoured VR for measures of:

• reported pain intensity;
• fear during needle-related procedures; and
• procedure-related anxiety.

The authors concluded that VR appears to be a valuable distraction strategy, while also noting substantial variation between studies and the need for more rigorous, standardised research. This distinction matters: the findings are encouraging, but they do not mean that every person or every procedure will produce the same result.

Read the full systematic review on PubMed.

What can a positive VR experience look like?

Another 2024 pilot study explored VR during routine immunisation for 30 children with needle phobia, including children with and without developmental disabilities. Twenty-seven children were successfully immunised. Among the 17 who continued using VR during immunisation, 16 reported a more positive overall experience.

Because this was a small feasibility study rather than a randomised effectiveness trial, its findings should be interpreted carefully. Even so, it offers a useful picture of how VR may be incorporated before and during a real procedure. Read the pilot study.

Designing for the short moment that matters

Needle-related procedures are often brief, so a comfort tool must fit the moment rather than extend it. In practice, that means an experience should be:

• quick to begin without introducing unnecessary setup;
• easy for staff to control while they remain focused on care;
• engaging from the start rather than requiring a long introduction;
• optional and appropriate for the individual; and
• used alongside standard clinical practice, not in place of it.

A more human moment of care

The goal is not to pretend that the procedure is not happening. It is to give the person something calmer and more engaging to experience while qualified professionals continue to provide care as usual.

SendorVR is being designed as an optional, non-clinical comfort and engagement aid for routine procedures. It is not a medical treatment or a replacement for pain management, professional judgement or standard care. The studies discussed above evaluate virtual reality generally and do not constitute evidence about SendorVR specifically.

To learn more about the evidence informing our approach, visit the SendorVR science page.