# Virtual reality for the management of musculoskeletal pain: an umbrella review

## TL;DR

This paper reviews how virtual reality can help manage musculoskeletal pain, showing it can reduce pain and improve mental and physical health, but more research is needed.

## Contribution

The paper provides a comprehensive umbrella review of VR's effectiveness for musculoskeletal pain, highlighting multimodal approaches and gaps in current research.

## Key findings

- VR significantly reduces musculoskeletal pain compared to standard therapies for neck, knee, and back pain.
- Multimodal VR approaches, including exercises and gamification, show promise in patient acceptance and effectiveness.
- Heterogeneity in study results highlights the need for standardized methodologies and personalized approaches.

## Abstract

Musculoskeletal pain (MSK) is a condition that affects multiple parts of the musculoskeletal system, including limbs, neck, and back, leading to deterioration in both mental and physical health and overall quality of life. Despite the available treatments, they are not considered effective enough to eradicate pain symptoms, thereby requiring new methods as a substitute. This review comprehensively summarizes virtual reality (VR) technology as an adjunct or an alternative treatment for MSK pain and aims to explore the most suitable conditions and settings of VR.

Pubmed, Scopus, and Cochrane databases were searched for recent systematic reviews and meta-analyses investigating VR and MSK pain. The search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and revealed 17 relevant articles. The AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) analysis was conducted to assess the quality of included studies. The Corrected Covered Area was calculated to identify the degree of overlap.

The results found significant pain reduction and mental and physical improvements in patients with MSK pain in comparison to standard therapies in treating neck, knee, and back pain. Nevertheless, the heterogeneity and inconsistencies in results among papers were recognized. The promising aspects are multimodality, namely, VR in combination with exercises, patient acceptance of VR, and the effectiveness of immersive, non-immersive, and gamified versions. These findings also revealed the need for more research on underexplored regions, standardized methodologies, and personalized approaches.

To summarize, VR poses the potential to treat MSK pain as an adjunct, and future research is recommended to focus on improving methodological rigor and multimodal approaches.

OSF (https://osf.io/uyc7z).