Virtual reality in musculoskeletal pain management

Over the past years, virtual reality has emerged as an increasingly popular treatment option for both acute and chronic musculoskeletal pain. This special report explores what virtual reality entails, its potential working mechanisms, and the current state of evidence, before outlining directions for future research. The defining feature of virtual reality is its ability to immerse users in a three-dimensional, computer-simulated environment, typically via a headset, where they can interact using body movements and handheld controllers or other devices. For musculoskeletal pain, virtual reality's potential working mechanisms include pain distraction, fear reduction and relaxation, and the opportunity to engage in physical activities in an appealing and motivating way. To date, meta-analyses suggest that virtual reality may be effective in reducing fear and pain post-intervention. To strengthen the evidence base, future randomized trials should be preceded by carefully designed preparatory studies, guided by the VR-CORE framework. These efforts should include investigations into the assumed mechanisms of virtual reality. Researchers are also encouraged to conduct well-designed placebo-controlled trials in this field and to adhere to existing reporting guidelines to enhance transparency, reproducibility, and the overall quality of virtual reality studies.