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Virtual reality shows statistically significant superiority over exercise-based interventions for chronic spinal painVirtual reality shows potential for managing chronic spinal pain

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Key Takeaway
Note that VR shows statistical superiority for pain and kinesiophobia but does not meet clinical significance thresholds.

This meta-analysis evaluated the efficacy of virtual reality (VR) compared to exercise-based interventions in 659 adults with chronic spinal pain. The analysis focused on pain scores, kinesiophobia, functional disability, and quality of life.

Findings indicated that VR was statistically superior to exercise-based interventions for pain measured by VAS (MD -1.05; 95% CI -1.92 to -0.18; p = 0.02) and NPRS (MD -0.95; 95% CI -1.59 to -0.31; p = 0.003). Additionally, VR showed statistically significant superiority for kinesiophobia (MD -3.52; 95% CI -6.08 to -0.96; p = 0.007). No significant difference was found for functional disability (p = 0.50), and results for quality of life were heterogeneous and inconclusive.

Several limitations impact the clinical application of these findings. The authors noted a high risk of bias in most included RCTs and substantial statistical heterogeneity. Crucially, none of the statistically significant reductions for pain or kinesiophobia met the MCID thresholds. The evidence is characterized as very low-certainty, suggesting that while statistical differences exist, clinical significance remains uncertain.

How this fits prior evidence

This meta-analysis addresses a gap in non-pharmacological interventions for chronic spinal pain. It extends the evidence base regarding pain intensity, which was previously shown to improve with active tDCS combined with rehabilitation. While this study shows statistical superiority for VR over exercise-based interventions, it differs from the prior finding that neuroscience-based approaches improve pain and function in older adults by highlighting that VR's statistically significant improvements did not meet MCID thresholds.

Living with chronic spinal pain can be exhausting, often making people afraid to move or exercise for fear of making the pain worse. A review of data from 659 adults looked at whether virtual reality (VR) could offer a better way to manage these symptoms compared to traditional exercise programs.

The study found that VR led to statistically significant improvements in pain scores and kinesiophobia, which is the medical term for the fear of movement. While the VR group saw better results than those doing only exercise, the researchers noted that these improvements were small. Specifically, the improvements did not reach the threshold of being large enough for a patient to notice a meaningful change in their daily life.

It is important to note that the evidence for these findings is currently very low in certainty. The researchers found a high risk of bias in the original studies and a lot of variation in the data. While the results are promising, they are not yet strong enough to replace standard care, but they suggest VR could be a helpful tool to explore.

What this means for you:
Virtual reality may reduce pain and fear of movement, but current evidence is still weak and results are small.

Common questions

Does virtual reality actually reduce pain?

The study found that virtual reality was statistically superior to exercise-based interventions for reducing pain. However, the researchers noted that these improvements did not meet the threshold for a change that a patient would notice in their daily life. Because the evidence is of very low certainty, talk to your doctor about how this might fit your specific needs.

Can virtual reality help with the fear of moving?

Yes, the study showed that virtual reality was significantly better than exercise alone at reducing kinesiophobia, which is the fear of movement. While the results were statistically significant, the overall certainty of the evidence is very low, and the study did not find a significant difference in functional disability.

Is virtual reality a proven replacement for exercise?

The study does not suggest it is a replacement. While virtual reality showed some advantages in pain and fear of movement, the evidence is currently weak and the results were not large enough to be considered a major clinical change. You should consult a healthcare professional before changing your current treatment plan.

Study Details

Study typeMeta analysis
Sample sizen = 659
EvidenceLevel 1
Follow-up120.0 mo
PublishedOct 2026
View Original Abstract ↓
BACKGROUND/PURPOSE: This systematic review and meta-analysis assessed the comparative effectiveness of virtual reality (VR) versus exercise-based interventions for pain, disability, fear of movement, and quality of life in patients with chronic spinal pain. METHODS: Five databases were searched for randomized control trials (RCTs) in the last 10 years, comparing VR versus exercise-based interventions (with or without passive adjunct modalities) for adults (≥ 18 years) with chronic spinal pain. Risk of bias and certainty of evidence were assessed using the Cochrane RoB 2.0 tool and GRADE framework, followed by random-effect meta-analyses. RESULTS: Fifteen RCTs comprising 659 participants were included, with most presenting a high risk of bias. Based on very low-certainty evidence, VR showed statistically significant superiority over exercise-based interventions for pain (VAS: MD -1.05, 95% CI -1.92 to -0.18; p = 0.02; I = 94%; NPRS: MD -0.95, 95% CI -1.59 to -0.31; p = 0.003; I = 14%) and kinesiophobia (MD -3.52, 95% CI -6.08 to -0.96; p = 0.007; I = 0%). None of these statistically significant reductions met the commonly established thresholds for Minimal Clinically Important Difference (MCID) for chronic spinal pain populations. Very low-certainty evidence found no significant differences for functional disability (MD -1.38, 95% CI -5.43 to 2.67; p = 0.50; I = 0%), and results on quality of life were heterogeneous and inconclusive. DISCUSSION: Although VR may offer statistical advantages over exercise-based interventions for pain and kinesiophobia, the overall certainty of the evidence remains very low. The non-attainment of the MCID thresholds, coupled with high risk of bias and substantial statistical heterogeneity, underscores the need for strict caution. TRIAL REGISTRATION: PROSPERO (CRD420251101584).
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