Immersive Virtual Reality for Postoperative Pain Among Older Adults: A Scoping Review

The aim is to map out and describe, through a scoping review, the current evidence on immersive virtual reality (IVR) for postoperative pain management in surgical older adults.

Managing postoperative pain in older adults through pharmacological interventions poses inherent complexity and risk to the patient. There is a growing interest in nonpharmacological interventions, including IVR, to address postoperative pain in older adults. However, IVR use for postoperative pain across a spectrum of surgical procedures remains largely unknown in the older adult demographic.

A comprehensive literature search of 5 databases was conducted through April 2024. Inclusion criteria were: (1) mean/median age greater than 65; (2) patients underwent surgical procedures; (3) the intervention group received IVR before, during, or after surgery; and (4) numerical postoperative pain scores were collected. Study titles/abstracts underwent initial screening against inclusion/exclusion criteria, followed by full-text screening. A narrative report was compiled with the identified studies.

This scoping review yielded 10 studies. Three main findings emerged: (1) IVR for postoperative pain occurred predominantly in total joint replacement surgery; (2) while over half of the studies in this review indicated that IVR could improve postoperative pain management, weak to moderate study designs and small sample sizes limited the ability to draw firm conclusions about IVR use in older adults; and (3) there was significant heterogeneity in IVR administration and program content offered.

Despite common misconceptions that older adults are averse to new technology, this scoping review suggests that IVR for postoperative pain in older surgical adults holds potential as an acceptable and feasible intervention. This review highlights the need for more rigorous randomized clinical trials on IVR efficacy in older adults across a more diverse spectrum of surgical procedures and older adult subgroups (eg, underrepresented minority groups or those with physical/cognitive limitations).