The Current State of Virtual Reality in the Management of Musculoskeletal Conditions and Associated Chronic Pain: Terminology, Technology, and Associations
Source abstract
Abstract
Virtual reality (VR) demonstrates significant potential to improve rehabilitation outcomes for musculoskeletal conditions and associated chronic pain. However, the field faces notable challenges, including inconsistent terminology, a lack of specialized/comprehensive software solutions, and an overwhelming variety of hardware options, which can make it difficult for healthcare professionals without technical expertise to identify the most suitable tools for clinical use. This article explores the current state of VR in the rehabilitation of musculoskeletal conditions and chronic pain, focusing on terminology discrepancies, available hardware and software solutions, and key professional associations shaping the field. A review of the current state of terminology is essential to address inconsistencies that risk perpetuating misuse and to facilitate clearer communication. Building on this review, we propose a conceptual framework for understanding VR that aligns more closely with the capabilities of current VR technology. A comprehensive overview of VR hardware and software can assist healthcare professionals in selecting appropriate technologies for clinical practice, guide researchers in designing interventions, and inform developers on unmet needs in the field. Furthermore, understanding key professional associations provides valuable direction for those engaged in virtual rehabilitation, enabling them to access resources, foster collaboration, and stay informed about the latest advancements in the domain. This review addresses the significant confusion regarding the understanding of VR, particularly in relation to its classification based on levels of immersion. Accordingly, it proposes a framework that contributes to a standardized approach to understanding VR. Additionally, it highlights the lack of VR solutions tailored to the needs of patients with musculoskeletal conditions and associated chronic pain, emphasizing the necessity for further development in this area.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Musculoskeletal pain and rehabilitation · Virtual Reality Applications and Impacts · Surgical Simulation and Training
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia
Andrej Marušič Institute, University of Primorska, SI-6000 Koper, Slovenia
Motor Control and Motor Behaviour Laboratory, S2P, Ltd., SI-4000 Kranj, Slovenia
Ludwig Boltzmann Institute for Rehabilitation Research, A-1090 Vienna, Austria
Funding
Slovenian Research and Innovation Agency
References (100+)
Show source-provided references
1. Virtual Reality as an Adjunctive Non-Pharmacologic Analgesic for Acute Burn Pain during Medical Procedures10.1007/s12160-010-9248-7 ↗
2. Noble, T., Boone, L., and El Helou, A. (2023). The Role of Virtual Reality as Adjunctive Therapy to Spinal Cord Stimulation in Chronic Pain: A Feasible Concept?. Front. Pain Res., 4.10.3389/fpain.2023.1094125 ↗
3. An Orthopaedic Robotic-Assisted Rehabilitation Method of the Forearm in Virtual Reality Physiotherapy
4. Chaplin, E., Karatzios, C., and Benaim, C. (2023). Clinical Applications of Virtual Reality in Musculoskeletal Rehabilitation: A Scoping Review. Healthcare, 11.10.3390/healthcare11243178 ↗
5. Implementation of Virtual Reality in Healthcare: A Scoping Review on the Implementation Process of Virtual Reality in Various Healthcare Settings10.1186/s43058-023-00442-2 ↗
6. Cost Effectiveness of Virtual Reality Game Compared to Clinic Based McKenzie Extension Therapy for Chronic Non-Specific Low Back Pain10.1177/20494637221109108 ↗
7. The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain10.1016/j.jpain.2016.01.001 ↗
8. Patient Kinesiophobia Affects Both Recovery Time and Final Outcome after Total Knee Arthroplasty10.1007/s00167-015-3898-8 ↗
9. Elevated Kinesiophobia Is Associated with Reduced Recovery from Lower Extremity Musculoskeletal Injuries in Military and Civilian Cohorts10.1093/ptj/pzab262 ↗
10. Psychological Predictors of Anterior Cruciate Ligament Reconstruction Outcomes: A Systematic Review10.1007/s00167-013-2699-1 ↗
11. La Touche, R., Pardo-Montero, J., Grande-Alonso, M., Paris-Alemany, A., Miñambres-Martín, D., and Nouvilas-Pallejà, E. (2023). Psychological, Pain, and Disability Factors Influencing the Perception of Improvement/Recovery from Physiotherapy in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional Study. Healthcare, 12.10.3390/healthcare12010012 ↗
12. The Patient–Physician Relationship in Patients with Chronic Low Back Pain as a Predictor of Outcomes after Rehabilitation10.1007/s10865-012-9419-z ↗
13. Targeting Cortical Representations in the Treatment of Chronic Pain10.1177/1545968311433209 ↗
14. Kragting, M., Voogt, L., Coppieters, M.W., and Pool-Goudzwaard, A.L. (2023). Visual Feedback Manipulation in Virtual Reality to Influence Pain-Free Range of Motion. Are People with Non-Specific Neck Pain Who Are Fearful of Movement More Susceptible?. PLoS ONE, 18.10.1371/journal.pone.0287907 ↗
15. Effectiveness of Virtual Reality in Reducing Kinesiophobia. A Systematic Review10.12680/balneo.2023.629 ↗
16. The Effectiveness of Virtual Reality Distraction for Pain Reduction: A Systematic Review10.1016/j.cpr.2010.07.001 ↗
17. Video Games in Health Care: Closing the Gap10.1037/a0019441 ↗
18. The Technology to Enhance Patient Motivation in Virtual Reality Rehabilitation: A Review10.1089/g4h.2023.0069 ↗
19. Ahmadpour, N., Randall, H., Choksi, H., Gao, A., Vaughan, C., and Poronnik, P. (2019). Virtual Reality Interventions for Acute and Chronic Pain Management. Int. J. Biochem. Cell Biol., 114.10.1016/j.biocel.2019.105568 ↗
20. Maselli, A., and Slater, M. (2013). The Building Blocks of the Full Body Ownership Illusion. Front. Hum. Neurosci., 7.10.3389/fnhum.2013.00083 ↗
21. Lin, J.-H.T., Wu, D.-Y., and Yang, J.-W. (2021). Exercising with a Six Pack in Virtual Reality: Examining the Proteus Effect of Avatar Body Shape and Sex on Self-Efficacy for Core-Muscle Exercise, Self-Concept of Body Shape, and Actual Physical Activity. Front. Psychol., 12.10.3389/fpsyg.2021.693543 ↗
22. The Proteus Effect: The Effect of Transformed Self-Representation on Behavior10.1111/j.1468-2958.2007.00299.x ↗
23. The Proteus Effect: Implications of Transformed Digital Self-Representation on Online and Offline Behavior10.1177/0093650208330254 ↗
24. Harvie, D.S., Rio, E., Smith, R.T., Olthof, N., and Coppieters, M.W. (2020). Virtual Reality Body Image Training for Chronic Low Back Pain: A Single Case Report. Front. Virtual Real., 1.10.3389/frvir.2020.00013 ↗
25. A Randomized Controlled Pilot Study Examining Immediate Effects of Embodying a Virtual Reality Superhero in People with Chronic Low Back Pain10.1080/17483107.2022.2129846 ↗
26. Chronic Pain and Distorted Body Image: Implications for Multisensory Feedback Interventions10.1016/j.neubiorev.2016.08.009 ↗
27. My Body Is Not Working Right: A Cognitive Behavioral Model of Body Image and Chronic Pain10.1097/j.pain.0000000000001822 ↗
28. Opara, M., and Kozinc, Ž. (2023). Which Muscles Exhibit Increased Stiffness in People with Chronic Neck Pain? A Systematic Review with Meta-Analysis. Front. Sports Act. Living, 5.10.3389/fspor.2023.1172514 ↗
29. Cortés-Pérez, I., Desdentado-Guillem, J.M., Camacho-Delgado, M.S., Del Rocío Ibancos-Losada, M., Obrero-Gaitán, E., and Lomas-Vega, R. (2024). Virtual Reality-Based Therapy after Anterior Cruciate Ligament Injury Effectively Reduces Pain and Improves Knee Function, Movement Patterns, and Dynamic Balance: A Systematic Review and Meta-Analysis. Knee Surg. Sports Traumatol. Arthrosc., early view.10.1002/ksa.12477 ↗
30. The Effectiveness of Extended Reality on Relieving Pain after Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials10.1007/s00402-024-05440-0 ↗
31. Virtual Reality Is Effective in the Management of Chronic Low Back Ache in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials10.1007/s00586-023-08040-5 ↗
32. Virtual Reality-Based Training in Chronic Low Back Pain: Systematic Review and Meta-Analysis of Randomized Controlled Trials10.2196/45406 ↗
33. The Use of Virtual Reality in the Rehabilitation of Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis10.1097/AJP.0000000000001134 ↗
34. The Efficacy of Virtual Reality Training in the Rehabilitation of Orthopedic Ankle Injuries: A Systematic Review and Meta-Analysis
35. García-Sánchez, M., García-Robles, P., Osuna-Pérez, M.C., Lomas-Vega, R., Obrero-Gaitán, E., and Cortés-Pérez, I. (2023). Effectiveness of Virtual Reality-Based Early Postoperative Rehabilitation after Total Knee Arthroplasty: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Appl. Sci., 13.10.3390/app13074597 ↗
36. Wei, W., Tang, H., Luo, Y., Yan, S., Ji, Q., Liu, Z., Li, H., Wu, F., Yang, S., and Yang, X. (2024). Efficacy of Virtual Reality Exercise in Knee Osteoarthritis Rehabilitation: A Systematic Review and Meta-Analysis. Front. Physiol., 15.10.3389/fphys.2024.1424815 ↗
37. Virtual Reality Training for Management of Chronic Neck Pain: A Systematic Review with Meta-Analysis10.1080/21679169.2023.2215831 ↗
38. Effects of Virtual Reality on Pain, Disability and Kinesiophobia in Patients with Chronic Low Back Pain: A Systematic Review with Meta-Analysis
39. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews10.1136/bmj.n71 ↗
40. What Is XR? Towards a Framework for Augmented and Virtual Reality10.1016/j.chb.2022.107289 ↗
41. Laato, S., Xi, N., Spors, V., Thibault, M., and Hamari, J. (2024, January 3–6). Making Sense of Reality: A Mapping of Terminology Related to Virtual Reality, Augmented Reality, Mixed Reality, XR and the Metaverse. Proceedings of the 57th Hawaii International Conference on System Sciences, Waikiki, HI, USA.10.24251/HICSS.2024.793 ↗
42. Skarbez, R., Smith, M., and Whitton, M.C. (2021). Revisiting Milgram and Kishino’s Reality-Virtuality Continuum. Front. Virtual Real., 2.10.3389/frvir.2021.647997 ↗
43. What Is Virtual Reality? A Healthcare-Focused Systematic Review of Definitions10.1016/j.hlpt.2023.100741 ↗
44. Rethinking Realities: A Call for Accurate Terminology in EXtended Reality Studies10.1016/j.resplu.2024.100558 ↗
45. (2024, December 10). Apple Vision Pro. Available online: https://www.apple.com/apple-vision-pro/.
46. Exploring the Relationship Between Offline Cultural Environments and Toxic Behavior Tendencies in Multiplayer Online Games10.1145/3580346 ↗
47. Effects of Gaming on Pain-Related Fear, Pain Catastrophizing, Anxiety, and Depression in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis10.1089/g4h.2021.0232 ↗
48. Virtual Reality in Rehabilitation10.1136/bmj.312.7022.4 ↗
49. Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study10.2196/17293 ↗
50. Fu, H., Garrett, B., Tao, G., Cordingley, E., Ofoghi, Z., Taverner, T., Sun, C., and Cheung, T. (2021). Virtual Reality–Guided Meditation for Chronic Pain in Patients With Cancer: Exploratory Analysis of Electroencephalograph Activity. JMIR Biomed. Eng., 6.10.2196/26332 ↗
51. Short-Term Psychological and Hormonal Effects of Virtual Reality Training on Chronic Low Back Pain in Soccer Players10.1123/jsr.2020-0075 ↗
52. Effects of Virtual Reality Exercises and Routine Physical Therapy on Pain Intensity and Functional Disability in Patients with Chronic Low Back Pain10.47391/JPMA.3424 ↗
53. A Novel Virtual Reality Technique (Cervigame®) Compared to Conventional Proprioceptive Training to Treat Neck Pain: A Randomized Controlled Trial
54. Virtual Reality in Improving Anticipatory Postural Adjustments to Step Initiation in Individuals with Knee Osteoarthritis: A Randomized Controlled Trial10.1089/g4h.2023.0154 ↗
55. Virtual Reality-Based Therapy for Chronic Low Back and Neck Pain: A Systematic Review with Meta-Analysis10.1530/EOR-23-0197 ↗
56. Early Rehabilitation Using Virtual Reality-Based Therapy Can Enhance Hip Function and Self-Perception of Improvement Following Total Hip Arthroplasty: A Systematic Review and Meta-Analysis10.1016/j.gerinurse.2024.10.020 ↗
57. Virtual Reality in Rehabilitation10.3109/09638289809166068 ↗
58. Virtual Reality, Disability and Rehabilitation10.3109/09638289709166530 ↗
59. It Is Time to Let Go of “Virtual Reality”10.1145/3590959 ↗
60. Extended Reality in Musculoskeletal Rehabilitation and Injury Prevention—A Systematic Review10.1016/j.ptsp.2022.04.011 ↗
61. Ziker, C., Truman, B., and Dodds, H. (2021). Cross Reality (XR): Challenges and Opportunities Across the Spectrum. Innovative Learning Environments in STEM Higher Education, Springer.10.1007/978-3-030-58948-6_4 ↗
62. Integrating X-Reality and Lean into End-of-Life Aircraft Parts Disassembly Sequence Planning: A Critical Review and Research Agenda10.1007/s00170-023-11581-0 ↗
63. Extended Reality “X-Reality” for Prosthesis Training of Upper-Limb Amputees: A Review on Current and Future Clinical Potential10.1109/TNSRE.2022.3179327 ↗
64. X-Reality for Phantom Limb Management for Amputees: A Systematic Review and Meta-Analysis
65. Immersive Virtual Reality in Orthopaedics—A Narrative Review10.1007/s00264-023-05911-w ↗
66. Favre, J., Cantaloube, A., and Jolles, B.M. (2023). Rehabilitation for Musculoskeletal Disorders: The Emergence of Serious Games and the Promise of Personalized Versions Using Artificial Intelligence. J. Clin. Med., 12.10.3390/jcm12165310 ↗
67. Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review10.1007/s11916-024-01246-2 ↗
68. A Taxonomy of Mixed Reality Visual Displays
69. A Mini Review of Presence and Immersion in Virtual Reality10.1177/1071181321651148 ↗
70. Brady, N., Dejaco, B., Lewis, J., McCreesh, K., and McVeigh, J.G. (2023). Physiotherapist Beliefs and Perspectives on Virtual Reality Supported Rehabilitation for the Management of Musculoskeletal Shoulder Pain: A Focus Group Study. PLoS ONE, 18.10.1371/journal.pone.0284445 ↗
71. Virtual Rehabilitation for Patients with Osteoporosis or Other Musculoskeletal Disorders: A Systematic Review10.1007/s10055-024-00980-7 ↗
72. Virtual Reality in Health System: Beyond Entertainment. A Mini-Review on the Efficacy of VR During Cancer Treatment10.1002/jcp.25117 ↗
73. Exergaming to Improve Balance and Decrease the Risk of Falling in Adults with Knee Osteoarthritis: A Mixed-Methods Feasibility Study10.1080/09593985.2021.1952670 ↗
74. The Efficacy of Exergaming in Patients with Knee Osteoarthritis: A Randomized Controlled Clinical Trial10.1002/pri.1952 ↗
75. The Effectiveness of Serious Games for Alleviating Depression: Systematic Review and Meta-Analysis10.2196/32331 ↗
76. Hadjiat, Y., and Marchand, S. (2022). Virtual Reality and the Mediation of Acute and Chronic Pain in Adult and Pediatric Populations: Research Developments. Front. Pain Res., 3.10.3389/fpain.2022.840921 ↗
77. Ethical Challenges of Virtual Reality Technology Interventions for the Vulnerabilities of Patients With Chronic Pain: Exploration of Technician Responsibility10.2196/49237 ↗
78. Gaming in Virtual Reality: What Changes in Terms of Usability, Emotional Response and Sense of Presence Compared to Non-Immersive Video Games?10.1177/1046878119831420 ↗
79. Di Lernia, D., Zaccaro, A., Herman, A.M., Villani, V., Finotti, G., Costantini, M., Ferri, F., Tsakiris, M., and Riva, G. (2023). Sonoception: Synthetic Auditory Stimulation of the Insula Alters Proxies of Interoceptive Processing at Behavioral and Cortical Levels. PsyArXiv Preprints.10.31234/osf.io/gwt4p ↗
80. Di Lernia, D., Lacerenza, M., Ainley, V., and Riva, G. (2020). Altered Interoceptive Perception and the Effects of Interoceptive Analgesia in Musculoskeletal, Primary, and Neuropathic Chronic Pain Conditions. J. Pers. Med., 10.10.31234/osf.io/jqt3g ↗
81. Feeling Good: On the Role of C Fiber Mediated Touch in Interoception10.1007/s00221-010-2408-y ↗
82. An Interoceptive Illusion of Effort Induced by False Heart-Rate Feedback10.1073/pnas.1821032116 ↗
83. Neuroscience of Virtual Reality: From Virtual Exposure to Embodied Medicine10.1089/cyber.2017.29099.gri ↗
84. Weber, S., Weibel, D., and Mast, F.W. (2021). How to Get There When You Are There Already? Defining Presence in Virtual Reality and the Importance of Perceived Realism. Front. Psychol., 12.10.3389/fpsyg.2021.628298 ↗
85. (2024, December 10). Meta Platforms. Available online: https://www.meta.com/.
86. (2024, December 10). PICO Interactive. Available online: https://www.picoxr.com/global.
87. (2024, December 10). Varjo Technologies Oy. Available online: https://varjo.com/.
88. (2024, December 10). HTC Corporation. Available online: https://www.vive.com/eu/.
89. Effect of a Behavioral Therapy-Based Virtual Reality Application on Quality of Life in Chronic Low Back Pain10.1097/AJP.0000000000001110 ↗
90. Chronic Pain Education Delivered with a Virtual Reality Headset in Outpatient Physical Therapy Clinics: A Multi-Site Exploratory Trial
91. Liikkanen, S., Mäkinen, M., Huttunen, T., Sarapohja, T., Stenfors, C., and Eccleston, C. (2022). Body Movement as a Biomarker for Use in Chronic Pain Rehabilitation: An Embedded Analysis of an RCT of a Virtual Reality Solution for Adults with Chronic Pain. Front. Pain Res., 3.10.3389/fpain.2022.1085791 ↗
92. A Prospective, Double-Blind, Pilot, Randomized, Controlled Trial of an “Embodied” Virtual Reality Intervention for Adults with Low Back Pain10.1097/j.pain.0000000000002617 ↗
93. Virtual Reality and Motor Control Exercises to Treat Chronic Neck Pain: A Randomized Controlled Trial10.1016/j.msksp.2022.102636 ↗
94. Remote Kinematic Training for Patients with Chronic Neck Pain: A Randomised Controlled Trial10.1007/s00586-017-5323-0 ↗
95. The Feasibility and Effectiveness of Virtual Reality Meditation on Reducing Chronic Pain for Older Adults with Knee Osteoarthritis10.1111/papr.13144 ↗
96. Virtual Reality as a Therapy Adjunct for Fear of Movement in Veterans With Chronic Pain: Single-Arm Feasibility Study10.2196/11266 ↗
97. Virtual Reality as an Adjunct Home Therapy in Chronic Pain Management: An Exploratory Study10.2196/medinform.7271 ↗
98. Virtual Reality as a Pain Distraction Modality for Experimentally Induced Pain in a Chronic Pain Population: An Exploratory Study10.1089/cyber.2020.0823 ↗
99. Feasibility of In-Home Virtual Reality for Chronic Pain in Sickle Cell Disease10.1016/j.pmn.2024.04.007 ↗
100. Safy, O., Rousseaux, F., Faymonville, M.-E., Libbrecht, D., Fontaine, R., Raaf, M., Staquet, C., Tasset, H., Bonhomme, V., and Vanhaudenhuyse, A. (2024). Virtual Reality Hypnosis Prior to Radiofrequency Thermocoagulation for Patients with Chronic Pain: An Exploratory Clinical Trial. Front. Psychol., 15.10.3389/fpsyg.2024.1331826 ↗