Clinical question: Can virtual reality be an effective adjunctive to conventional treatment in patients with chronic...

Chronic low back pain is the most prevalent chronic pain condition worldwide, accounting for 15-20% of physician visits and costing billions of dollars. Without adequate treatment, it can lead to substance use disorder and increased risk of suicide. Current treatments include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, surgery, and non-pharmacological adjuncts. Evidence suggests cognitive behavioral therapy (CBT) as adjunctive therapy can improve patient commitment to treatment but not pain intensity. However, CBT is limited due to availability, location and shortage of trained personnel. Virtual reality (VR) has been growing in interest in providing affordable, digital, home-based, and self-directed CBT to address the psychosocial aspect of pain.

We searched the literature for meta-analysis, randomized control trials (RCT), and systemic reviews using the PubMed database with the terms virtual reality and chronic low back pain.

The review identified 31 studies. Six were chosen that were applicable to our clinical questions, one systematic review, two meta-analysis and three RCTs. The RCTs showed that virtual reality can improve pain in patients with chronic lower back pain as an effective adjunctive to pharmacological and surgical intervention. The systemic review and meta-analysis also concluded that VR is beneficial in pain management however, due to inconsistent results and the multifactorial aspect of chronic pain.

Thus further research is required. The number of randomized trials, evidence on long-term application, and the efficacy of self-directed versus guided VR treatment limit our understanding of this topic.