Virtual Reality as a Treatment for Chronic Pain
Is virtual reality a viable option for chronic pain management? A new scoping review suggests it has potential. Here, key findings for primary care.
Virtual reality (VR) is considered to be one of the most promising technological advances in he past decade. Although much of the focus has been on the use of VR for entertainment and educational purposes, it may have benefits for certain medical conditions including chronic pain.
A recent scoping review published in the journal Pain Medicine aimed to provide a summary of VR approaches examined in chronic primary and secondary pain conditions. In the slides below, find key findings of interest to primary care clinicians.
Review author screened studies performed prior to January 2021. A total of 2118 articles were identified, of which 44 fit inclusion criteria. Most studies used head-mounted devices with 3D-enabled glasses, sensory input devices, headphones for noise canceling and sound, head-, and/or body-tracking sensors to provide multisensory experience.
Studies Analyzed VR for the Following Painful Conditions:
- Chronic low back pain (CLBP)
- Chronic cervical pain
- Cancer related pain
- Chronic widespread pain
- Complex regional pain syndrome (CRPS)
- Spinal cord injury pain (SCIP)
- Phantom limb pain (PLP)
Chronic low back pain (CLBP): VR was associated with reductions in pain intensity and increasing lumbar spine flexion when combined with other standard treatment modalities (eg, physical therapy).
- Chronic cervical pain: Results were mixed. Some studies found VR-enhanced exercise to be beneficial while others found it was not superior to exercise alone.
- Chronic widespread pain (fibromyalgia): VR potentially enhanced effects of other therapies, such as relaxation and biofeedback.
- Chronic cancer-related pain: VR may offer some pain relief.
- CRPS: VR appeared to be effective for pain reduction, but data on its effects on other CRPS symptoms (eg, vasomotor symptoms such as temperature and skin changes) were limited.
- Spinal cord injury pain (SCIP): VR may reduce pain.
- Phantom limb pain (PLP): VR appeared to be especially promising for PLP.
Overall results: VR was well tolerated with few adverse events.
Caveats:
- Under the general heading of VR, many different techniques were used in the studies reviewed, making it difficult to identify which specific techniques may be most effective for each type of pain.
- VR was often used in combination with other therapies and information was limited on which combinations were optimal.
- The outcome measure used in most of the studies was pain reduction rather than improvement in function which is considered the optimal measure of therapeutic success in the management of chronic pain.
Caveats:
- Despite studying chronic pain conditions, most of the studies only briefly followed subjects, calling the potential long-term benefits of VR into question.
- To date, studies on VR are limited and those that have been performed had small patient samples.
VR is a promising therapy particularly for conditions such as CRPS, PLS, and SCIP, which are among the most difficult pain syndromes to manage and have limited effective treatments. Potential efficacy of VR for these conditions fits with other treatments, such as mirror therapy, that appear promising and focus on creating the illusion of a healthy limb while performing tasks.
Rather than replacing any single therapeutic modality, VR may be most beneficial when used to enhance the benefits of other treatments shown to be effective for chronic pain management (eg, physical therapy, cognitive behavioral therapy). Exactly how VR exerts its beneficial effects for chronic pain conditions is unclear. Whether it results in changes in the brain due to neuroplasticity, modifies learned pain behaviors through distraction, or a combination of both requires further study.
Reference: Austin PD: The analgesic effects of virtual reality for people with chronic pain: a scoping review. Pain Med. 2022;23:105-121.
