Table 1. . Characteristics of included studies.
| Study (year), country | Study design, study duration, and post-intervention follow-up | Sample size and population | Interventions (I) and control condition or comparator (C) included in the study | Outcomes reported | Ref. |
|---|---|---|---|---|---|
| Randomized controlled trials | |||||
| Austin et al. Australia | Randomized, cross-over trial; 1 day; no follow-up | 16 adults (≥18 years old) with spinal cord injury and chronic neuropathic pain | I: 3D, head-mounted delivery of virtual environment C: 2D screen application of virtual environment |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[28] |
| Darnall et al. USA | Pilot RCT investigating feasibility and efficacy; 21 days; follow-up at 1 day post intervention | 74 adults (ages 25–74 years old) with chronic back pain and fibromyalgia | I: 21-day, skills-based, self-management program based on principles of CBT, biofeedback, and mindfulness delivered via VR C: Audio delivery of 21-day, skills-based, self-management program |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: Yes Efficacy: Yes Cost–effectiveness: No |
[29] |
| Garcia et al. USA | Randomized, placebo-controlled trial; 56 days; no follow-up | 179 community-dwelling adults (ages 18–81 years old) with chronic low back pain | I: 8-week, 3D, immersive, VR pain self-management program that incorporates principles of CBT, mindfulness, and pain neuroscience education C: 8-week, non-immersive delivery of 2D nature footage and neutral music via Sham VR headset |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[30] |
| Garcia-Palacios et al. Spain | Pilot RCT investigating feasibility, acceptability, and preliminary efficacy; 3 weeks; follow-up at 3 weeks post intervention | 61 adults (ages 23–70 years old) with fibromyalgia syndrome | I: Group CBT program with VR as an addition to activity pacing C: Treatment as usual (follow-up sessions with a rheumatologist for review of medication treatment) |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[19] |
| Jeon et al. Korea | Pilot pre-test and post-test study; 1 day; no follow-up | 10 adults (ages 28–50 years old) with complex regional pain syndrome type I | I: Body swapping training video presented via VR, with mental rehearsal C: Body swapping training video presented via VR, without mental rehearsal |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[31] |
| Jin et al. Canada | Randomized, controlled crossover study; 1 day; no follow-up | 20 adults (ages 30–75 years old) with chronic pain | I: Immersive VR game C: Self-mediated control with typical pain distraction activities used daily (e.g., reading, meditating, and playing a mobile game) |
Pain: Yes Pain-related outcomes: No Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[32] |
| Lewis et al. United Kingdom | RCT; 6 weeks; follow-up at 2 weeks post intervention | 45 adults (ages 18–78 years old) with complex regional pain syndrome and body perception disturbance | I: Visual illusions with digital manipulation of participants' hands using a mediated VR device C: Display of visual images, via a mediated VR device, without digital manipulation of participants' hands |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[33] |
| Matheve et al. Belgium | RCT; 1 day; no follow-up | 48 adults (ages 18–65 years old) with chronic, nonspecific low back pain | I: Non-immersive VR games controlled by performing pelvic tilt exercises C: Performing pelvic tilt exercises, without VR games, according to a beep tone |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[34] |
| Nambi et al. Saudi Arabi | RCT; 4 weeks; follow-up at 6 months post intervention | 60 adult university football players (ages 18–25 years old) with chronic low back pain | I #1: VR training (physical therapy using VR) with a VR game controlled by trunk movements I #2: Isokinetic training performed in an isokinetic dynamometer C: Conventional training of core muscles of the trunk, with stretching |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[35] |
| Nambi et al. Saudi Arabi | RCT; 4 weeks; follow-up at 6 months post intervention | 54 adult university soccer players (ages 18–25 years old) with chronic low back pain | I #1: VR balance training, focused on core stability muscles, with a VR game controlled by trunk movements I #2: Combined physical rehabilitation using a Swiss ball for balance training of core stability muscles C: Conventional balance training (isotonic and isometric exercises) for core muscles, with stretching |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[36] |
| Nambi et al. Saudi Arabia | RCT; 4 weeks; follow-up at 8 weeks post intervention and 6 months post intervention | 45 adult university football players (ages 18–45 years old) with chronic low back pain | I #1: VR balance training, focused on core stability muscles, with a VR game controlled by trunk movements I #2: Isokinetic training performed in an isokinetic dynamometer C: Conventional balance training (isotonic and isometric exercises) for core muscles, with stretching |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[37] |
| Nusser et al. Germany | RCT; 3 weeks; no follow-up | 55 adults (≥18 years old) with non-traumatic chronic neck pain | I #1: Standard rehabilitation program (involving individual and group, general and neck-specific exercise therapy) and individual neck-specific sensorimotor training using a VR device I #2: Standard rehabilitation program and general sensorimotor training (skill exercises, balance exercises, and games) C: Standard rehabilitation program |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[38] |
| Rezaei et al. Iran | RCT; 4 weeks; follow-up at 5 weeks post intervention | 42 adults (ages 22–46 years old) with non-specific chronic neck pain | I: VR video game, with increasing stages of difficulty, controlled by participants' head movements C: Conventional proprioceptive training (exercises included eye-follow, gaze stability, eye–head coordination and position sense, and movement sense) |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[39] |
| Rothgangel et al. The Netherlands | RCT; 10 weeks; follow-up at 6-months post intervention | 75 adults (ages 44–74 years old) with a unilateral lower limb amputation who experience phantom limb pain | I #1: Traditional mirror therapy followed by tele-treatment at home with AR mirror therapy I #2: Traditional mirror therapy followed by self-delivered mirror therapy C: Sensorimotor exercises without mirror therapy followed by self-delivered sensorimotor exercises |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[20] |
| Sarig Bahat et al. Australia | RCT; 4 weeks; follow-up at 3 months post intervention | 90 adults (≥18 years old) with chronic neck pain | I #1: VR kinematic training, with activity in the virtual environment controlled by participants' head movements I #2: Kinematic training using a head-mounted laser beam and wall poster C: Wait-list control |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[40] |
| Sarig Bahat et al. Australia | Pilot RCT; 5 weeks; follow-up at 3 months post intervention | 32 adults (ages 26–55 years old) with chronic neck pain | I: Kinematic and VR training, with activity in the virtual environment controlled by participants' head movements C: Kinematic training using a head-mounted laser beam and wall poster |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[41] |
| Tejera et al. Spain | RCT; 4 weeks; Follow-up at 1 month post intervention and at 3 months post intervention | 44 adults (ages 18–65 years old) with non-specific chronic neck pain | I: VR treatment, with activity in the virtual environment controlled by participants' neck movements C: Exercise treatment, with flexion, extension, rotation, and tilt exercises |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[42] |
| Venuturupalli et al. USA | Pilot, randomized, cross-over study investigating feasibility; 1 day; no follow-up | 17 adults (≥18 years old) with physician-diagnosed autoimmune disorders and chronic pain | I: VR respiratory biofeedback environment C: VR guided mediation environment |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[43] |
| Yilmaz Yelvar et al. Turkey | RCT; 2 weeks; no follow-up | 44 adults (ages 35–64 years old) with subacute and chronic, non-specific low back pain | I: Traditional physical therapy program (involving hot pack, TENS, deep heat with ultrasound, and therapeutic exercises) with integration of a 15-minute VR walking video C: Traditional physical therapy program |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[44] |
| Quasi-experimental studies | |||||
| Alemanno et al. Italy | Pre-test and post-test study; 4–6 weeks; no follow-up | 20 adults (ages 19–72 years old) with chronic low back pain | I: VR-based sensorimotor rehabilitation using an avatar C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[45] |
| Botella et al. Spain | Pre-test and post-test study; 7 weeks; follow-up at 6 months post intervention | 6 adults (47–65 years old) with fibromyalgia | I: Group CBT program with VR-based relaxation and mindfulness C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[46] |
| Fowler et al. USA | Implementation-effectiveness, pre-test and post-test study; 3 weeks; no follow-up | 16 adult veterans (ages 28–63 years old) with chronic pain | I: VR distraction and exposure therapy, with increasing intensity of stimulation and movement C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[47] |
| Glavare et al. Sweden | Pre-test and post-test study; 6 weeks; no follow-up | 12 adults (ages 18–65 years old) with chronic neck pain |
I: Neck range of motion exercises using VR, with increasing levels of difficulty C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[48] |
| Hennessy et al. USA | Pilot study investigating content, usability, safety, and acceptance; 1 week; follow-up at 3–5 days post-intervention | 12 adults (ages 43–60 years old) with chronic low back pain | I: VR walking modules with progressive movement exposure C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[49] |
| House et al. USA | Feasibility study; 8 weeks; follow-up at 8 weeks post intervention | 6 adults (ages 22–78 years old), with upper body chronic pain post breast cancer surgery | I: Integrative VR rehabilitation games, with increasing stages of difficulty C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[50] |
| Igna et al. Romania | Pre-test and post-test study; 3 weeks; no follow-up | 68 adults (ages 24–74 years old) with chronic back pain | I #1: Physiotherapy, medication, and mindfulness-based CBT I #2: Physiotherapy, medication, and VR-enhanced CBT C: Usual pharmacological and physiotherapy treatment |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[51] |
| Jones et al. USA | Pre-test and post-test study; 1 day; no follow-up | 30 adults (ages 35–79 years old) with various chronic pain conditions | I: Immersive, 360-degree, VR fantasy landscape C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[52] |
| Liu et al. USA | Preliminary study investigating efficacy; 1 day; no follow-up | 31 adults (ages 20–81 years old) with migraines, headaches, or other forms of chronic pain (not specified) | I: VR-guided meditation C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[53] |
| Matamala-Gomez et al. Spain | Pre-test and post-test study; 1 day; no follow-up | 19 adults (ages 40–55 years old) with complex regional pain syndrome type 1 or type 2 | I: Observation of virtual arm, with varying levels of transparency and size C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[54] |
| Mouraux et al. Belgium | Preliminary, pre-test and post-test study; 1 week; follow-up at 24 hours post intervention | 22 adults (ages 18–75 years old) with chronic neuropathic pain | I: 3D, AR, mirror visual feedback therapy, with training exercises and virtual games of increasing levels of difficulty C: None |
Pain: Yes Pain-related outcomes: No Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[55] |
| Ortiz-Catalan et al. Sweden and Slovenia | Pre-test and post-test study; 6 weeks; follow-up at 1 month post intervention, 3 months post intervention, and 6 months post intervention | 14 adults (ages 26–74 years old) with chronic, intractable phantom limb pain | I: Phantom motor execution using myoelectric pattern recognition, AR, and VR, with virtual games controlled by phantom movements C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[56] |
| Putrino et al. USA | Pilot study; duration was not reported; no follow-up | 8 adults (ages 44–71 years old) with neuropathic pain | I: Exposure to a scenic VR environment and a somatic VR environment (involving upper and lower extremity movements) C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[57] |
| Roosink et al. Canada | Proof-of-principle and feasibility study; 2 weeks; no follow-up | 9 adults (ages 25–72 years old) with spinal cord injury and neuropathic pain |
I: Interactive VR walking using an avatar, with virtual feedback C: Static presentation of a virtual scene |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[58] |
| Rutledge et al. USA | Feasibility study; duration was not reported; no follow-up | 14 adult veterans (ages 37–76 years old) with an upper or lower extremity amputation, who experience phantom limb pain | I: Bicycling through a VR environment, as an avatar, using a bicycle pedaler and a customized pedal for prosthesis C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[59] |
| Shiri et al. Israel | Pre-test and post-test study; duration was not reported; follow-up at 1 month post intervention and 3 months post intervention | 10 adolescents (ages 10–17 years old) with chronic headache | I: VR relaxation combined with biofeedback (tracking of galvanic skin response) C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[60] |
| Solcà et al. Switzerland | Pre-test and post-test, crossover study; 1 day; no follow-up | 48 adults (ages 23–80 years old) with complex regional pain syndrome | I: Mirror therapy using synchronous heartbeat-enhanced VR (virtual hand flashing in synchrony with heartbeat) C: Mirror therapy using asynchronous heartbeat-enhanced VR |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[61] |
| Trost et al. USA | Pilot study investigating feasibility and preliminary efficacy; 2 weeks; follow-up at 7 days post intervention and at 2 weeks post intervention | 27 adults (ages 23–70 years old) with complete paraplegia after spinal cord injury and neuropathic pain | I: Immersive, spatially tracked, VR walking (using an avatar), with virtual games C: View of avatar in 360-degree virtual scene with no control over virtual walking |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[62] |
| Villiger et al. Switzerland | Pre-test and post-test study; 4 weeks; follow-up at 12–16 weeks post intervention | 14 adults (ages 28–71 years old) with neuropathic pain from chronic, incomplete spinal cord injury | I: VR-augmented neurorehabilitation, with VR tasks (of increasing stages of difficulty) for muscle training C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[63] |
| Won et al. USA | Pilot study investigating usability, acceptance, ease of use, and engagement; duration was not reported; follow-up at 1 month post intervention | 9 adults (ages 19–60 years old) with complex regional pain syndrome | I: VR mirror visual feedback module, with avatar hands C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[64] |
| Zauderer et al. France | Pilot and feasibility study; 3 months; no follow-up | 18 adults (≥18 years old) with non-specific chronic neck pain | I: Standardized, immersive, VR exercise therapy (including active cervical spine range of motion and eye-neck coordination exercises) and non-immersive VR exercise therapy (aerobic, mobility, and muscle strengthening exercises, and a personalized, home-based exercise program) C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[65] |
| Analytical cross-sectional study | |||||
| Solcà et al. USA | Cross-sectional, prospective, intervention study; 2 days; no follow-up | 15 adults (ages 33–61 years old) with chronic leg pain | I #1: Personalized, visual, VR feedback of perceived SCS-induced paresthesia displayed on patient's virtual body I #2: Personalized, visual, VR feedback with rotation of the virtual body and spatial misalignment between visual VR feedback and SCS-induced paresthesia C: VR illumination of body with no SCS-induced paresthesia |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[66] |
| Case reports | |||||
| Ambron et al. USA | Pre-test and post-test study; 6 weeks; no follow-up | 2 adults (specific ages were not provided) with unilateral transtibial amputation who experience phantom limb pain | I: VR games, of increasing levels of difficulty, using robot avatar legs controlled by participants' lower limb movements C: None |
Pain: Yes Pain-related outcomes: No Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[67] |
| Oneal et al. USA | Pre-test and post-test study; 6 months; follow-up at 1 month post intervention | 1 adult (age 36 years old) with chronic neuropathic pain from spinal cord injury | I: VR hypnosis and self-hypnosis at home between VR sessions C: Previous trial of standard hypnosis conducted with participant |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[68] |
| Ortiz-Catalan et al. Sweden | Pre-test and post-test study; 18 weeks; no follow-up | 1 adult (age 72 years old) with an amputated limb who experiences phantom limb pain | I: AR, with the use of a virtual limb to play a game controlled by phantom motions C: None |
Pain: Yes Pain-related outcomes: No Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[69] |
| Case series | |||||
| Garrett et al. Canada | Exploratory, mixed-methods, pre-test and post-test study; 4 weeks; follow-up at 6 hours post intervention and 24 hours post intervention | 8 adults (ages 31–71 years old) with chronic pain | I: VR-based mindfulness and meditation, exposure to a VR fantasy landscape and a scenic VR environment, and virtual problem-solving games C: None |
Pain: Yes Pain-related outcomes: Yes Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[14] |
| Sato et al. Japan | Pre-test and post-test study; duration was not reported; no follow-up | 5 adults (ages 46–74 years old), with complex regional pain syndrome | I: Non-immersive, VR mirror visual feedback therapy, using an avatar hand, with hand exercises C: None |
Pain: Yes Pain-related outcomes: No Mechanism of action: No Efficacy: Yes Cost–effectiveness: No |
[70] |
AR: Augmented reality; C: Control condition or comparator; CBT: Cognitive behavioral therapy; I: Interventions; RCT: Randomized controlled trials; SCSVR: Virtual reality.