A synthesis of meta-analyses of immersive virtual reality interventions in pain
Tessa Rooney, Louise Sharpe, Natalie Winiarski, Jemma Todd, Ben Colagiuri, Dimitri Van Ryckeghem, Geert Crombez, Stefan Carlo Michalski
Abstract
The severity and impact of pain can vary greatly, even in individuals with the same physical injury. This variation underscores the need for a variety of treatment strategies in effective pain management. Virtual reality (VR) is an emerging technology that has been used as a treatment in diverse pain populations and for diverse indications. In recent decades, many trials, systematic reviews, and meta-analyses have examined the impact of VR for pain management. While there is some evidence for efficacy in terms of distraction, pre-exposure, and physical therapy; populations, comparators and interventions differ significantly between existing meta-analyses. Thus, the present umbrella review was conducted to determine the overall strength of evidence for all identified populations, comparators, and interventions by synthesising available meta-analyses. Fifty-four meta-analyses reporting on the effect of immersive VR interventions in pain management were identified. Overall, VR interventions appeared efficacious for procedural pain conditions, where used for distraction, and when compared to standard care. While there was some evidence for efficacy in chronic pain populations, this only indicated short-term improvement in pain intensity. We also identified numerous areas for future research wherein the available results were inconclusive, such as examining long term interventions and outcomes for chronic pain populations, reporting of adverse events, and examining the efficacy of VR interventions designed for physical therapy, augmented cognitive therapies, or pre-exposure. • Immersive VR shows strong efficacy for improving pain intensity and anxiety in procedural pain populations of all ages. • Immersive VR appears most efficacious in pain when used for distraction, with some evidence for efficacy in physical therapy. • Immersive VR is efficacious when compared to standard care, however there is no evidence for symptom improvement relative to active non-VR. • Evidence for efficacy of immersive VR in chronic pain is mixed, with a lack of evidence for long term outcomes and pain interference.