Immersive and Nonimmersive Virtual Reality-Assisted Active Training in Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis.

Researchers looked at 28 randomized controlled trials involving over 1100 people with chronic musculoskeletal pain to see whether virtual reality training could reduce pain better than standard exercise or physiotherapy. They split the evidence two ways: immersive VR (where you wear a headset and feel fully inside a virtual world) and nonimmersive VR (like exercising while looking at a screen). For low back pain, nonimmersive VR showed meaningful reductions in pain and fear of movement both shortly after treatment and at 6-month follow-up.

For neck pain, immersive VR reduced pain but not disability or fear of movement. The findings for knee pain and other pain sites were mixed and showed no clear benefit. Overall, the evidence suggests both types of VR can help with back and neck pain when combined with active training, though the strength of this evidence varies across conditions.

This research looked at whether using virtual reality during exercise could help people manage chronic pain better than traditional physiotherapy alone. The good news for people with low back pain is that exercising while using nonimmersive VR, such as looking at a screen showing your movements or a virtual environment, showed noticeable improvements in both pain and fear of doing things that might hurt you.

People with neck pain also saw some pain relief with immersive VR headsets. However, the picture was less clear for knee pain and other areas, where the benefit was uncertain. It is worth remembering that while these findings are encouraging, the research involved relatively small numbers of people in each study, and not all the studies were high quality.

The improvements were measured over short periods and a few months, so we do not yet know how long benefits might last. Virtual reality appears to be another option to explore alongside regular exercise, though it is not yet clear whether it works better than good old-fashioned physiotherapy for everyone.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This meta-analysis consolidates 25 trials and reveals a body-region-specific pattern worth noting in your practice context. Nonimmersive VR showed the strongest evidence for low back pain, with large effect sizes for pain reduction immediately post-intervention and sustained benefits at 6 months when compared to conventional active training alone.

The effect on disability was smaller but statistically significant. Immersive VR performed better for neck pain in the short term, though it did not move the needle on functional measures or kinesiophobia. The lack of benefit across knee pain and other regions suggests that VR's utility may depend on the specific pain presentation or movement pattern being trained.

The methodological quality of included studies was mixed, with only 2 out of 28 rated as high risk of bias but many carrying "some concern," which tempers confidence in these estimates. The heterogeneity and smaller effect sizes in some domains highlight that VR-assisted training is not a one-size-fits-all intervention, and the mechanisms driving these regional differences remain unexplored in the abstract.