<p>Pain and anxiety are frequent issues that can significantly reduce patient comfort during extracorporeal shock wave lithotripsy. Virtual reality has recently gained attention as a non-pharmacological approach to improve the patient experience in various clinical procedures. This study was conducted to examine how the use of virtual reality during extracorporeal shock wave lithotripsy influences patients’ perceived pain, anxiety, and comfort levels. This single-blind randomized controlled trial was conducted between February 1, 2025, and September 1, 2025. Patients in the virtual reality group received the standard protocol supplemented with virtual reality glasses throughout the procedure, whereas those in the control group received only standard care during the procedure. Study data were obtained through the “Descriptive Information Form,” the “Visual Analog Scale,” the “Visual Analog Scale-Anxiety,” and the “State-Trait Anxiety Inventory.” (NCT06804928). At baseline, the VR and control groups were homogeneous with respect to descriptive variables (<i>p</i> &gt; 0.05). Following ESWL, pain scores increased in the control group, whereas a significant reduction was observed in the VR group, while comfort scores improved significantly only in the VR group (<i>p</i> &lt; 0.05). Anxiety levels showed no significant change in the control group but were significantly reduced in the VR group (<i>p</i> &lt; 0.05). Between-group comparisons confirmed lower post-procedure pain and anxiety and higher comfort in the VR group (<i>p</i> &lt; 0.05). This study revealed that the use of virtual reality glasses during ESWL reduces pain and anxiety levels and enhances patient comfort, suggesting that VR may serve as a promising and feasible non-pharmacological method in clinical nursing practice.</p>