PAIN+ CPN

Doctor, I have heard about Virtual Reality being used to treat back pain. Can you tell me more about it?

Virtual reality (VR) uses electronic equipment to make a person feel like they are in an artificial environment. They can perform physical actions that they may not be able to do as easily in the real- world. It is too early to tell if VR interventions are successful at reducing back pain, but it is an interesting tool that will benefit from further research.

What is the evidence?

SUMMARY OF FINDINGS

Virtual reality (VR) interventions vs usual care or no intervention for back pain

OutcomeNumber of StudiesEffectQuality of Evidence
Pain intensity immediately after the intervention16*People who had a VR intervention had an average reduction of 0.67 points on a pain scale** compared to usual or no interventionLow

*studies in the review that compared VR with another intervention and reported results using a pain scale

** pain scale ranging from 1 to 10: 1 = minimal pain and 10 = worst pain ever. In many trials of pain treatment, the minimal difference considered to be important (patients would notice) is 1 full point.

What kind of study was this?

This was a systematic review of 24 randomized controlled trials published up to September 2020.

Who? This review included 900 adults with back pain (average age 20 to 70). People who had neck pain or spinal cord injuries were excluded.

What? The reviewers included studies that compared interventions using virtual reality with usual care or no intervention for back pain.

Virtual Reality

vs

Usual care or no intervention

Electronic equipment (e.g. computer tablet or special head-mounted display) used to make a person feel like they are in an artificial environment where they performed physical activities like exercises, horse-back riding, yoga

Many of the studies used virtual reality to turn exercises into a game




Usual care, which most often involved physical therapy in the real-world

Why was this research done?

Virtual reality can make a person feel like they are in an artificial environment. Input devices such as joysticks, handheld controllers or tracking gloves tell a computer what actions the person is performing within the virtual environment. Output devices like headphones, pressure pads, and a head-mounted video display show the person the effect of their actions. Virtual reality may reduce pain by distracting the brain from pain signals, reducing fear of movement (because you have a different "body" in virtual reality), and increasing motivation to perform physical activities. The reviewers in this paper wanted to know if interventions using virtual reality equipment would improve back pain. They found that there was a small reduction in pain. However, the quality of the evidence was low because the treatments were so different, it was difficult to compare them. Further research is needed before VR interventions can be recommended for treating back pain.

This Evidence Summary is based on the following article:

Bordeleau M, Stamenkovic A, Tardif PA, et al. The Use of Virtual Reality in Back Pain Rehabilitation: A Systematic Review and Meta-Analysis. J Pain. 2021 Aug 21. pii: S1526-5900(21)00311-4. doi: 10.1016/j.jpain.2021.08.001. PubMed

Published: Friday, January 14, 2022