Shahnaz Shahrbanian, Xiaoli Ma, Najaf Aghaei, Nicol Korner-Bitensky, Keivan Moshiri and Maureen J. Simmonds
Pain impacts negatively on physical, psychological, and social function and reduces quality of life. Over the past decade there has been a growing increase in the use of virtual reality (VR) in rehabilitation in general and for pain management specifically. To determine the scientific evidence for the effectiveness of VR therapy (immersive vs. non immersive) for pain management in individuals with acute (less than or equal to 6 weeks clinical pain or thermal procedural pain), or chronic pain (more than 12 weeks). An extensive review of the scientific literature involving all major health care databases was performed by two of the investigators in a systematic way within the framework of the Cochrane Collaboration to identify studies focusing on the effectiveness of VR therapy as an intervention aimed at pain reduction in children and adults with acute (less than or equal to 6 weeks, or thermal procedural pain), or chronic (more than 12 weeks) pain. Randomized controlled trials (RCT), quasi-randomized trials, crossover studies, clinical controlled trials, observational study, pre-post studies, cohort studies, descriptive studies, and case- control studies were included. Retrieved articles were rated for methodological quality using PEDro scoring to assess the internal validity of randomized trials. Levels of evidence were from the Sackett criteria. 42 studies were identified that fulfilled the inclusion criteria. Inter-rater agreement for all stages of the studies selection and quality assessment was moderate to perfect (Crude agreement ranged from 85- 100%; kappa's coefficient from 0.8- 1). For adults, there was level 1a evidence exploring the effectiveness of immersive VR therapy in reducing acute pain, level 2a evidence suggesting the potential role of immersive VR for reducing chronic pain and non-immersive VR for reducing acute pain, and level 5 evidence indicating that there is no study to investigate the effectiveness of nonimmersive VR for chronic pain. For children, a level 5 of evidence indicates that there are no experimental studies to investigate the effectiveness of either immersive or non-immersive VR compared to conventional therapy or no therapy for chronic pain; however, level 2a evidence suggesting an advantage of immersive and non-immersive VR in reducing acute pain. Results of the present study recommend VR therapy as a clinical intervention for pain reduction with minimal side effects.
