The analgesic effects of virtual reality therapy and its electrophysiological mechanisms: evidence from meta-analysis
Year: 2024
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: Virtual reality therapy (VRT) represents a promising non-pharmacological alternative for pain management. However, the efficacy of VRT has been shown to vary across different types of pain, including experimental pain, acute pain, and chronic pain. Additionally, the factors influencing the effectiveness of VRT remain poorly understood. To address this, a systematic review and meta-analysis were performed to summarize the analgesic effects of VRT and its influencing factors, as well as to explore the potential mechanisms underlying VRT analgesia, thus providing evidence to optimize VRT protocols for pain management. A comprehensive literature search was performed using PubMed, Web of Science, EBSCO (Academic Search Premier), and Scopus databases for articles published up to March 21, 2024. Search terms included the combinations of “pain”, “virtual reality”, “virtual simulation”, and “VR” in titles, abstracts, and keywords. We also searched in reference lists of included studies and previous reviews for studies that were not included in the present search. A total of 128 studies were identified, which compared an immersive VRT intervention to a non-VRT control group, with reporting on subjective pain ratings across the sensory-discriminative (pain intensity), affective-motivational (pain unpleasantness, pain anxiety, and fear of pain), and cognitive-evaluative dimensions (time spent thinking about pain). The pooled analyses revealed that VRT significantly reduced the subjective ratings across the multiple dimensions of pain among participants in the VRT groups when compared to the control groups (Hedges’s g=0.76–0.96). Subgroup analyses further indicated that these outcomes of multiple dimensions of pain were modulated by different factors, such as study design, type of control group, intervention patterns, intervention duration, type of pain, age, and gender (Ps<0.05). Despite these promising findings, heterogeneity was observed in all meta-analyses, and considerable risks of bias were identified in most studies. Furthermore, compared to the control groups, typical event-related potentials (ERPs) induced by pain in the VRT groups, such as N1, N2-P2, P2, and P3, exhibited a decreasing trend; Spectral analysis revealed a decrease in the power of θ and α-band oscillations, alongside an increase in the power of δ and γ-band oscillations, which suggested potential neural correlates of VRT analgesic effects. While the present meta-analysis highlights the stable analgesic effects of VRT across the multiple dimensions of pain, several limitations remain in this research field. There is still a lack of research on the persistence and potential side effects of VRT analgesia. A longitudinal design ought to be adopted to evaluate the long-term efficacy of VRT on pain management. In addition, more rigorous methodologies, including the use of well-constructed control groups, randomized designs, and high-quality blinding procedures, are needed to enhance the validity of future research. The variability of the VRT intervention strategies and outcome measures may also limit the comparability across studies. Therefore, the adoption of standardized multidimensional pain assessments is recommended to enhance the comparisons across studies. Finally, the exploration of neural mechanisms underlying VRT analgesia is still in its infancy, and future research should utilize neuroimaging techniques such as magnetic resonance imaging (MRI), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS) to further elucidate these mechanisms.
DOI: 10.1360/tb-2024-0470
Authors: Lili Zhou, Juanjuan Zhang, Manzhi Zeng, Li Zhang
Language: English
Subfield: Human-Computer Interaction
Field: Computer Science
Domain: Physical Sciences
Open Access status: bronze
OpenAlex ID: W4404340208