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Extended reality (XR) physical activity interventions may have benefits for some conditions (eg, chronic neck pain) but the evidence is very uncertain for others (eg, chronic low back pain, post-surgical pain and rehabilitation). While XR psychological skills interventions may have benefit for chronic low back pain, studies generally did not compare with analogous non-XR treatments. Limitations of the evidence include small study sizes, methodological concerns, and lack of adverse events reporting. Future research should evaluate mechanisms of XR therapies, assess patient experiences and technology acceptance, apply implementation frameworks, and include more diverse participant populations.
Non-drug therapies are first-line treatments for common pain conditions. XR is a spectrum of digital technologies and software that can deliver different types of non-drug therapies for pain, such as teaching self-management psychological skills or guiding physical activity. The ways in which XR may improve pain outcomes remain under investigation. Understanding current evidence on effects of XR interventions for chronic pain is critically needed to inform potential implementation in clinical settings and guide future research. We synthesized evidence on benefits and harms of XR interventions for treating chronic pain or preventing development of chronic pain (from acute pain).
We identified 59 RCTs and 1 cohort study evaluating XR interventions for chronic pain or to prevent development of chronic pain. Studies were generally very small (eg, 30 studies with total n = 50, only 4 with total n >100). Twenty-two studies addressed chronic low back pain, while fewer examined chronic neck pain (k=6), fibromyalgia (k=5), chronic knee pain (k=5), and post-surgical pain (k=7). A variety of other pain conditions had only 1 eligible study (eg, headache or phantom limb pain). For chronic low back pain, virtual reality (VR) psychological skills interventions may result in greater improvement in pain intensity and pain-related functioning, compared with VR sham or usual care. For chronic neck pain, VR physical activity may result in greater improvement in pain intensity but little to no difference in pain-related functioning at 3-6 weeks; the evidence is very uncertain for effects at 3-4 months. The evidence is also very uncertain for effects of other VR and augmented reality (AR) interventions for chronic back pain, neck pain, and knee pain, along with other examined conditions. Furthermore, few studies reported on adverse events. Another important gap is the lack of studies comparing XR psychological skills interventions with analogous non-XR treatments.
Extended Reality Interventions for Chronic Pain: A Systematic Review (Management Brief)
