Table 1.
Characteristics of the included studies.
| Authors | Country | Design | Participants, N (number of female participants) | Population | Duration of the intervention | VRa device and application | Type of VR | Outcome measurements |
| Alemanno et al [62] | Italy | QEb | 20 (11) | Adults with chronic low back pain | 1 hour per session for 12 sessions over 4-6 weeks | VR Rehabilitation System, Khymeia, Italy | Nonimmersive | Roland and Morris Disability Questionnaire, Repetition Index, SF-36 Short Form Health Survey, NRSc Pain, McGill Pain Questionnaire, Brief Pain Inventory, Beck Depression Inventory, and neuropsychological evaluations |
| Amin et al [44] | Canada | RCTd | 30 (13) | Adult patients with chronic pain | 2×10 minutes | Oculus Rift DK2 and a Cardboard VR to play InMind | Immersive | Present and retroactive pain intensity |
| Botella et al [55] | Spain | QE | 6 (6) | Adult patients with fibromyalgia | 7 weeks with ten 2-hour sessions: sessions 1 through 6 were delivered twice a week for 3 weeks, whereas sessions 7 through 10 were delivered weekly for 4 weeks | 2 PCs, a large projection screen, 2 projectors, a wireless pad, and a speaker system. Application used: EMMAe World | Nonimmersive | Beck Depression Inventory II, Positive and Negative Affect Schedule, Chronic Pain Coping Inventory, Fibromyalgia Impact Questionnaire, and VR Satisfaction Scale |
| Brown et al [63] | United States | RCT | 45 (27) | Adults with chronic low back pain, receiving spinal injections | One 5-minute session | VR immersive format in the Oculus GoÒ headset | Immersive | Anxiety thermometer, NRS pain, Patient-Reported Outcomes Measurement Information System, Modified Oswestry Disability Index, and VR Symptom Questionnaire |
| Chau et al [73] | United States | CSf | 8 (7) | Upper limb complex regional pain syndrome (adults and 1 adolescent) | 10 sessions (1-3 per week) with 45-60 minutes each session | HTC Vive VR System (virtual 3D kitchen environment) | Immersive | Short Form McGill Pain Questionnaire, VASg, Wong-Baker Faces Scale, and Subjective feedback |
| Collado-Mateo et al [56] | Spain | RCT | 83 (83) | Adult patients with fibromyalgia | Twice a week for 1 hour per session over 8 weeks | An exergame called VirtualEx-FM based on Microsoft Kinect | Nonimmersive | Timed up and go test, functional reach, Clinical Test of Sensory Integration of Balance, fear of falling using VAS |
| Darnall et al [81] | United States | RCT | 88 (NDh) | Adults with chronic nonmalignant low back pain or fibromyalgia | 21 days | Oculus Go VR Headset (visual biofeedback in relaxation training) | Immersive | Defense and Veterans Pain Rating Scale; pain interference on activity, mood, sleep, and stress; pain catastrophizing scale; pain self-efficacy; global impression of change; satisfaction with treatment; and motion sickness and nausea |
| Fowler et al [45] | United States | QE | 16 (3) | Veterans with chronic pain | 19-day program with 20 minutes per VR session | Oculus Rift and Samsung Oculus Gear VR | Immersive | VR feasibility, Pain Outcomes Questionnaire-VA, Fear of Daily Activities, questionnaire for kinesiophobia, Pain Catastrophizing Scale, and patient-specific functional scale |
| Garcia-Palacios et al [57] | Spain | RCT | 61 (61) | Adults with fibromyalgia | Six 2-hour group sessions delivered twice a week | 2 PC computers with an EMMA VR environment | Nonimmersive | Fibromyalgia Impact Questionnaire, Brief Pain Inventory, Chronic Pain Coping Inventory, Beck Depression Inventory II, Quality of Life Index, and acceptability and satisfaction |
| Garrett et al [46] | Canada | CS | 8 (6) | Adults with chronic pain conditions | 1 month with 12 sessions of 30 minutes each | Oculus Rift DK2 1100 field of view stereoscopic HMDi | Immersive | NRS pain, Brief Pain Inventory, Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs, cybersickness, and individual interviews |
| Griffin et al [80] | United States | QE | 17 (13) | Pediatric patients with chronic pain | 1-8 sessions of 30 minutes (once a week) | HTC Vive VR system | Immersive | Presence, child daily questionnaire, and interviews |
| Gromala et al [47] | Canada | RCT | 13 (7) | Adult patients with chronic pain | 1 moment | Technology’s DeepStream VR with virtual meditative walk | Immersive | NRS pain |
| Guarino et al [48] | Italy | CS | 11 (8) | Adult patients with chronic pain | 8 VR sessions of 30 minutes, 2 times a week | VR scenarios were run in a PC, and the environments were visualized on a monitor | Nonimmersive | McGill Pain Questionnaire, Brief Pain Inventory Severity and Interference, State trait Anxiety Inventory, Beck Depression Inventory, VAS, and subjective units of distress scales |
| Harvie et al [68] | Australia | CS | 12 (3) | Adults with chronic neck pain | 36-70 days with 10 minutes of VR twice a day | Samsung Gear VR system with Motor Offset Visual Illusion | Immersive | Pain threshold and NRS pain |
| Herrero et al [58] | Spain | QE | 40 (40) | Adults with fibromyalgia | 3 sessions of 20 minutes each | 2 PC computers, a 3.4-m screen made of reflective material, 2 projectors, and a Dolby 7.1 surround sound audio system with EMMA | Nonimmersive | Mood State, NRS pain, NRS fatigue, NRS motivation, NRS self-efficacy, and NRS of several emotions (joy, sadness, anger, surprise, anxiety, calmness, and vigor/energy) |
| House et al [82] | United States | QE | 12 (12) | Adults with persistent pain in shoulder and arm following postsurgical breast cancer | 20-50 minutes twice week for 8 weeks | BrightArm Duo technology with 3D custom integrative rehabilitation games | Nonimmersive | NRS pain, upper limb range of motion, Beck Depression Inventory II, Neurophysiological Assessment Battery, Revised Hopkins Verbal Learning Test, Revised Brief Visuospatial Memory Test, and Trail Making Test |
| Jin et al [49] | Canada | RCT | 20 (16) | Adults with chronic pain | 1 moment, 35-45 minutes per participant with 10-minute VR | Oculus Rift DK2 with Cryoslide game | Immersive | Pain intensity (VAS) and distraction |
| Jones et al [50] | United States | QE | 30 (20) | Adults with chronic pain conditions | Single 5-minute exposure to VR | Oculus rift DK2 and Deepstream VR with cool! | Immersive | NRS pain, engagement, and side effects |
| Matamala-Gomez et al [74] | Spain | QE | 19 (14) | Adults with neuropathic chronic pain in the upper limb | Single session of 55 minutes | HMD rift development kit 2, Oculus | Immersive | Ownership, agency, mental representation, NRS pain, and VR questionnaire |
| Matheve et al [64] | Belgium | RCT | 84 (54) | Adults with chronic low back pain | 2×2 minutes with 30 seconds of rest in between | Valedo Pro, Hocom | Nonimmersive | NRS pain, Roland and Morris Disability Questionnaire, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, pain intensity, time spent thinking about pain, and pelvic tilts |
| Monteiro et al [65] | Portugal | RCT | 34 (34) | Adults with chronic low back pain | 8 weeks with sessions 3 times a week for 90 minutes | Nintendo Wii motion and Wii balance board | Nonimmersive | NRS pain, balance, sit-to-stand test, and profile of mood states |
| Mortensen et al [59] | Denmark | QE | 15 (15) | Adults with fibromyalgia | 15 sessions of 30 minutes | Motion-controlled video games, Wii, Ps3, and Xbox Kinect | Nonimmersive | Pain VAS, Brief Fatigue Inventory, Activities of Daily Life Questionnaire, test of playfulness, and interviews |
| Mouraux et al [76] | United States and Belgium | QE | 22 (12) | Adults with chronic neuropathic pain in unilateral upper extremity | 5 sessions of 20 minutes over 1 week | 3D augmented reality system with a 3D display (Kit Nvidia 3D Vision) and 3D camera (Xbox 360 Kinect) | Nonimmersive | Pain VAS, McGill Pain Questionnaire, and Douleur Neuropathique 4 Questions |
| Ortiz-Catalan et al [77] | Sweden and Slovenia | QE | 14 (ND) | Adults with chronic intractable phantom limb pain | Twice per week, 12 sessions of 2 hours each | Neuromotus and Integrum AB | Nonimmersive | NRS intensity, frequency, duration, and quality of phantom limb pain; Pain Rating Index Scale; Short form of McGill questionnaire; and interviews |
| Pamment and Aspell [51] | United Kingdom | QE | 18 (12) | Adults with chronic pain | 4 conditions, each lasting 2 minutes | HMD (WRAP 1200, Vuzix) connected to a video camera | Immersive | McGill Pain Questionnaire and illusion and control questions |
| Phoon Nguyen et al [83] | Australia | QE | 9 (7) | Adults with burning mouth syndrome | 1 session of 3 experimental conditions of 1 minute each | MIRAGE-mediated reality system; computer screen displaying live digitally manipulated video feed of their own face | Nonimmersive | Pain VAS, Wong-Baker Faces Pain Rating Scale, and VAS burning pain/sensation |
| Rezaei et al [69] | Iran | RCT | 44 (ND) | Adults with chronic neck pain | 8 training sessions over 4 weeks with 21 minutes each | Cervigame head mouse extreme | Nonimmersive | Pain VAS, Neck Disability Index, and Y-balance test |
| Rutledge et al [78] | United States | QE | 14 (1) | Adults with phantom limb pain | 57 treatment sessions with 40-60 minutes per session | VR treatment based on mirror therapy with an Oculus Rift Headset | Immersive | Phantom Limb Pain Questionnaire, Trinity Amputation and Prosthetic Experience Scale-Short Form-12, Patient Health Questionnaire-9, Posttraumatic Stress Disorder Checklist-Military version, and Present Questionnaire |
| Sarig-Bahat et al [70] | Australia | RCT | 32 (22) | Adults with chronic neck pain | 4-6 supervised intervention sessions for 30 minutes each over a period of 5 weeks+home training sessions of 30 minutes for at least three times a week | HMD with a Wrap 1200VR by Vuzix | Immersive | VAS pain, Neck Disability Index, Tampa Scale for Kinesiophobia, static and functional balance, satisfaction, global perceived effect, and range of motion |
| Sarig-Bahat et al [71] | Australia and Israel | RCT | 90 (63) | Adults with chronic neck pain | 5 minutes, 4 times a day, 4 days per week, for 4 weeks | Oculus Rift DK1 HMD with 3D motion tracking | Immersive | Neck disability Index, global perceived effect, VAS pain, self-rated health status in the European life quality questionnaire, velocity, Tampa scale for kinesiophobia |
| Sato et al [75] | Japan | CS | 5 (4) | Adults with complex regional pain syndrome | 5-8 weeks with 1 session each week | FASTRAK and cyberglove, PC desktop with a CyberGlove as hand input, FASTRAK as real-time position and motion tracker, and computer screen | Nonimmersive | VAS pain and range of motion |
| Shahrbanian et al [52] | Canada | QE | 12 (5) | Adult stroke patients with chronic pain | 1 moment with 3-5 minutes of each VR condition | HMD Kaiser Optical System with Nvidia Quadro FX 4500 graphics card | Immersive | Pain threshold, engagement, VAS mood, and NRS pain |
| Solca et al [84] | Switzerland | QE | 15 (5) | Adults with chronic leg pain with a spinal cord implant | 1 moment | Oculus Rift CV1 with RealiSM software | Immersive | Analgesia and embodiment |
| Tejera et al [72] | Spain | RCT | 44 (23) | Adults with nonspecific chronic neck pain | 2 sessions per week for 4 weeks | VR Vox Play glasses used with an HMD clamping system | Immersive | VAS pain, pain pressure threshold, temporal summation, range of motion, neck disability index, pain catastrophizing scale, Tampa scale for kinesiophobia, fear-avoidance beliefs questionnaire, and Pain Anxiety Symptoms Scale |
| Thomas et al [66] | United States | RCT | 53 (ND) | Adults with chronic low back pain | 3 consecutive days | Samsung 3D shutter glasses with Vizard software | Nonimmersive | Changes in lumbar spine flexion, VAS expectations of pain and harm, and game experience survey |
| Tong et al [79] | China | CS | 5 (0) | Adults with phantom limb pain | 10 sessions over 6 weeks | Immersive room-scale VR system and HMD from HTC Vive with Unity 3D | Immersive | Short Form McGill Pain Questionnaire, VAS pain, NRS embodiment, NRS ownership, and hospital anxiety and depression scale |
| Trujillo et al [67] | United States | CS | 2 (0) | Adults with chronic low back pain | 7 sessions with 2 sessions per week of 30-45 minutes each | Virtual embodiment training with Virtual Embodiment Training (KVET); HTC Vive with a VR HMD | Immersive | Simulator Sickness Questionnaire; VAS pain and Pain Catastrophizing Scale |
| Villafaina et al [60] | Spain | RCT | 55 (55) | Adults with fibromyalgia | 2 sessions of 1 hour per week for 24 weeks | VirtualEx-FM | Nonimmersive | Chair-stand test, 10-step stair test, 6-minute walk test, Fibromyalgia impact questionnaire, and International Physical Activity Questionnaire |
| Villafaina et al [61] | Spain | RCT | 55 (55) | Adults with fibromyalgia | 2 sessions of 1 hour per week for 24 weeks | VirtualEx-FM | Nonimmersive | Electroencephalography |
| Wiederhold et al [53] | United States | QE | 31 (ND) | Adults with chronic pain | 5-minute pain focus session followed by a 20-minute intervention session | Mobile phone VR therapy and an HMD | Immersive | Simple Descriptive Pain Intensity Scale, Numerical Pain Intensity Scale, VAS pain, and physiological measures (heart rate, peripheral skin temperature, respiration, and skin conductance) |
| Wiederhold et al [54] | Belgium and United States | QE | 40 (ND) | Adults with chronic pain | 15-minute exposure session | VR exposure while wearing HMD | Immersive | Pain reduction, pain focus, and skin temperature |
aVR: virtual reality.
bQE: quasi-experimental.
cNRS: Numeric Rating Scale.
dRCT: randomized controlled trial.
eEMMA: Engaging Media for Mental Health Applications.
fCS: case series.
gVAS: visual analog scale.
hND: not displayed.
iHMD: head-mounted display.