Virtual reality as a treatment for chronic musculoskeletal pain syndromes

• Published in: Joint, bone, spine : revue du rhumatisme bone, spine : revue du rhumatisme, 2025-01, Vol.92 (1), p.105769, Article 105769
• Main Authors: Pretat, Tiffany, Koller, Cinja, Hügle, Thomas
• Format: Article
• Language: English
• Subjects: Chronic musculoskeletal pain syndrome; Chronic pain; Fibromyalgia; Virtual reality
• ISSN: 1297-319X; 1778-7254; 1778-7254
• DOI: 10.1016/j.jbspin.2024.105769

•Chronic musculoskeletal pain syndromes like fibromyalgia often resist traditional medical treatments, leading to widespread pain and psychosomatic symptoms. Virtual Reality (VR) has shown promise in reducing pain during and after treatment for such conditions, with mechanisms involving distraction, immersion, and cognitive behavioral therapy that promote neuroplasticity and alter pain perception.•The use of VR in medicine, particularly for chronic pain, is growing, with applications ranging from anxiety treatment to adjunctive use in surgical anesthesia. VR's effectiveness against pain involves several mechanisms that are under continuous investigation.•There is growing evidence that VR is an efficient and safe option for treating chronic musculoskeletal pain, suggesting it could become part of multimodal treatment programs or be used as a standalone application. Current research suggests VR mainly has short-term effects on pain, but there is also evidence suggesting potential long-term benefits and effects on other symptoms like anxiety. The integration of VR with other technologies may increase its effectiveness, and more research is necessary to identify patients who would benefit most from VR therapy. Chronic musculoskeletal pain syndromes, including fibromyalgia, are often resistant to conventional medications and invasive therapies. Central hypersensitization, neurotransmitter dysregulation, and autonomic nervous system abnormalities are key pathomechanisms, frequently resulting in widespread pain and a variety of psychosomatic symptoms. Virtual Reality (VR) applications have demonstrated effectiveness in reducing pain, both during and after interventions, and in chronic conditions such as fibromyalgia and back pain. The proposed mechanisms behind VR's effectiveness include distraction and immersion, coupled with cognitive behavioral therapy, which promote neuroplasticity and alter pain perceptions. Functional MRI studies have shown the impact of VR interventions on specific brain regions. Advances in hardware and software, potentially combined with treatments like biofeedback, could enhance VR's role in managing chronic pain. Currently, VR for musculoskeletal pain syndromes is primarily used within multimodal programs, but it is also available for home use as a standalone health application. Future research should focus on the ‘drug-like’ effects of VR, requiring controlled trials with comparable study populations and appropriate sham interventions