Testing the Timing and Application of Virtual Reality Distraction During Knee Injections in a VA Pain Clinic

The goal of this clinical trial is to learn whether virtual reality (VR) can be added to routine knee injection appointments at a VA outpatient pain clinic without slowing down or disrupting clinic operations. The study will enroll 45 adult veterans who are scheduled for a knee injection at the Atlanta VA Arcadia pain clinic. The main questions it aims to answer are * Can a VR headset be set up and used during a knee injection with minimal time disruptions? * How many patients agree to take part, how many need to stop using the headset early, and how satisfied are patients and clinicians with the experience? Researchers will compare patients who wear a VR headset during their injection to patients who receive the usual injection without VR. This will show whether VR may change anxiety, time spent thinking about pain, satisfaction, and memory of the procedure. Participants will: * Be assigned by chance to one of two groups. Two out of every three participants will use VR, and one out of every three will receive usual care only. * If in the VR group, wear a headset showing a virtual environment with little motion. A research team member will place the headset before the needle goes in and remove it after the injection is finished. * Receive their scheduled knee injection as usual from their clinician. * Complete a short survey right after the procedure. Taking part happens during one clinic visit and takes about 30 minutes. The knee injection itself is standard care and is not changed by the study.

Inclusion Criteria: * Adults aged 18 years or older * Presenting to the Atlanta VA Health Care System Arcadia outpatient pain clinic for a scheduled intra-articular knee injection * Able to provide written informed consent Exclusion Criteria: * Inability to read, write, and comprehend English * Inability to complete study measures or questionnaires * Any physical or mental health condition that, in the opinion of the principal investigator or research staff, precludes or may negatively impact the ability to participate * History of severe claustrophobia * Pregnancy * Any medical condition that may prevent the use of virtual reality, including current or prior diagnosis of epilepsy or seizure disorder, hypersensitivity to flashing light or motion, migraines, any medical condition predisposing to nausea or dizziness (e.g., vertigo, inner ear conditions, motion sickness susceptibility), dementia, absence of stereoscopic vision, or severe hearing impairment * Injury to the eyes, face, or neck that prevents comfortable use of a VR headset * Open facial skin lesions, rashes, or draining wounds in headset contact areas