Systematic Reviews and Meta-Analysis Open access

An exploration into the efficacy of virtual reality for managing pain in hospitalized patients, with a focus on cancer pain

Authors

Published
17 October 2025
Section
Systematic Reviews and Meta-Analysis
DOI
10.4081/ahr.2025.41

Abstract

Cancer pain is highly complex and associated with a great global and individual burden. Due to its multifactorial nature, it must be addressed with a combination of pharmacological and non-pharmacological approaches. Many people with cancer feel their pain is inadequately managed, pointing to the critical need for new management approaches. Virtual reality (VR) is a promising management strategy for a variety of pain conditions, at the forefront of research. This study aims to explore the use of VR in the management of pain in hospitalized patients, focusing on cancer-related pain. A systematic review was carried out on all eligible articles published before July 2025, in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Randomized control trials that investigated VR in the pain management of hospitalized adult patients were included. Thirty-three (33) randomized control trials were included in the systematic review following selection processes. Outcome measures such as the visual analogue scale, the numerical rating scale, and graphic rating scale, were commonly used; 79% of articles reported a significant reduction in pain when using VR. None of the studies reported any significant adverse effects. VR is a safe and feasible option for adjunctive, non-pharmacological pain management in hospitalized patients. Few studies investigate the application of VR in the management of cancer pain, however, those available reveal promising results. Future randomized control trials that employ a double-blinded study design would be of benefit.

Keywords

References

  1. 1. International Association for the Study of Pain. IASP Announces Revised Definition of Pain. 2020. Available from: https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/
  2. 2. Caraceni A, Shkodra M. Cancer pain assessment and classification. Cancers 2019;11:510. DOI: https://doi.org/10.3390/cancers11040510
  3. 3. National Cancer Institute. Cancer Pain (PDQ®)–Patient Version. 2019. Available from: https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-pdq
  4. 4. National Institute for Health and Care Excellence Palliative cancer care - pain. 2021. Available from: https://cks.nice.org.uk/topics/palliative-cancer-care-pain/
  5. 5. Carver A., Foley KM. Types of pain. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Hamilton, BC Decker. 2003.
  6. 6. Fernández A, Rodríguez Cardona X, et al. Using a multimodal approach to manage difficult visceral cancer pain: A case study. SAGE Open Med Case Rep 2023;11:2050313X2311574. DOI: https://doi.org/10.1177/2050313X231157483
  7. 7. Yoon SY, Oh J. Neuropathic cancer pain: prevalence, pathophysiology, and management. Korean J Intern Med 2018;33:1058-69. DOI: https://doi.org/10.3904/kjim.2018.162
  8. 8. Mehta A, Chan LS. Understanding of the concept of ‘total pain’. J Hosp Palliat Nurs 2008;10:26-32. DOI: https://doi.org/10.1097/01.NJH.0000306714.50539.1a
  9. 9. National Cancer Institute. Cancer Pain (PDQ®)–Patient Version. 2022. Available from: Available from: https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-hp-pdq#_41
  10. 10. Geyer HL, Gazelka H, Mesa R. How I treat pain in hematologic malignancies safely with opioid therapy. Blood 2020;135:2354-64. DOI: https://doi.org/10.1182/blood.2019003116
  11. 11. Zis P, Paladini A, Piroli A, et al. Pain as a first manifestation of paraneoplastic neuropathies: a systematic review and meta-analysis. Pain Ther 2017;6:143-51. DOI: https://doi.org/10.1007/s40122-017-0076-3
  12. 12. World Health Organisation. WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. 2019. Available from: https://www.who.int/publications/i/item/9789241550390
  13. 13. Kettyle G. Multidisciplinary approach to cancer pain management. Ulster Med J 2023;92:55-8.
  14. 14. Fallon M, Giusti R, Aielli F, et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol 2018;29:iv166-iv91. DOI: https://doi.org/10.1093/annonc/mdy152
  15. 15. Rodriguez C, Ji M, Wang HL, et al. Cancer pain and quality of life. J Hosp Palliat Nurs 2019;21:116-23. DOI: https://doi.org/10.1097/NJH.0000000000000507
  16. 16. World Health Organization. WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. 2018. Available from: https://iris.who.int/bitstream/handle/10665/279700/9789241550390-eng.pdf?sequence=1
  17. 17. Ahmedzai SH. Cancer pain management. 2010. London, British Pain Society. Available from: https://www.britishpainsociety.org/static/uploads/resources/files/book_cancer_pain.pdf
  18. 18. Ruano A, García-Torres F, Gálvez-Lara M, Moriana JA. Psychological and non-pharmacologic treatments for pain in cancer patients: a systematic review and meta-analysis. J Pain Symptom Manage 2022;63:e505-20. DOI: https://doi.org/10.1016/j.jpainsymman.2021.12.021
  19. 19. Hassankhani H, Orujlu S, Rahmani A, et al. Enhancing cancer pain self-management: a holistic supporting model. SAGE Open Nurs 2023;9: 23779608231197581. DOI: https://doi.org/10.1177/23779608231197581
  20. 20. Viderman D, Tapinova K, Dossov M, et al. Virtual reality for pain management: an umbrella review. Front Med (Lausanne) 2023;10:1203670. DOI: https://doi.org/10.3389/fmed.2023.1203670
  21. 21. Bhayani S. Verma A, Chauhan H, Batra J. Virtual reality in pain management & rehabilitation: an update. ASRA Pain Med News 2024. Accessed: 30 Mar. 2024. Available from: https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2024/02/08/virtual-reality-in-pain-management-rehabilitation-an-update DOI: https://doi.org/10.52211/asra020124.013
  22. 22. Abbas JR, O’Connor A, Ganapathy E, et al. What is virtual reality? A healthcare-focused systematic review of definitions. Health Policy Technol 2023;12:100741. DOI: https://doi.org/10.1016/j.hlpt.2023.100741
  23. 23. Aslam S, Emmanuel P. Formulating a researchable question: A critical step for facilitating good clinical research. Indian J Sex Transm Dis AIDS 2010;31:47-50. DOI: https://doi.org/10.4103/0253-7184.69003
  24. 24. MRC Network of Hubs for Trials Methodology Research. Risk of bias tools - RoB 2 tool. 2019. Available from: https://sites.google.com/site/riskofbiastool/welcome/rob-2-0-tool?authuser=0
  25. 25. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71
  26. 26. Rousseaux F, Dardenne N, Massion PB, et al. Virtual reality and hypnosis for anxiety and pain management in intensive care units. Eur J Anaesthesiol 2021;39:58-66. DOI: https://doi.org/10.1097/EJA.0000000000001633
  27. 27. Austin PD, Siddall PJ, Lovell MR. Feasibility and acceptability of virtual reality for cancer pain in people receiving palliative care: a randomised cross-over study. Support Care Cance, 2022;30:3995-4005. DOI: https://doi.org/10.1007/s00520-022-06824-x
  28. 28. Groninger H, Violanti D, Mete M. Virtual reality for pain management in hospitalized patients with cancer: A randomized controlled trial. Cancer 2024;14:2552-60. DOI: https://doi.org/10.1002/cncr.35282
  29. 29. McSherry T, Atterbury M, Gartner S, et al. Randomized, crossover study of immersive virtual reality to decrease opioid use during painful wound care procedures in adults. J Burn Care Res 2019;39:278-85.
  30. 30. Hoffman HG, Patterson DR, Carrougher GJ. Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. Clin J Pain 2000;16:244-50. DOI: https://doi.org/10.1097/00002508-200009000-00010
  31. 31. Payne O, Smith V, Rolnik DL, et al. Virtual reality and its use in post-operative pain following laparoscopy: a feasibility study. Sci Rep 2022;12:13137. DOI: https://doi.org/10.1038/s41598-022-17183-2
  32. 32. Farra SL, Gneuhs M, Hodgson E, et al. comparative cost of virtual reality training and live exercises for training hospital workers for evacuation. Comput Inform Nurs 2019;37:446-54. DOI: https://doi.org/10.1097/CIN.0000000000000540
  33. 33. Dreesmann NJ, Su H, Thompson HJ. A systematic review of virtual reality therapeutics for acute pain management. Pain Manag Nurs 2022;23:672-81. DOI: https://doi.org/10.1016/j.pmn.2022.05.004
  34. 34. Huang Q, Lin J, Han R, et al. Using virtual reality exposure therapy in pain management: a systematic review and meta-analysis of randomized controlled trials. Value Health 2021;25:288-301. DOI: https://doi.org/10.1016/j.jval.2021.04.1285
  35. 35. Hoffman HG, Patterson DR, Carrougher GJ, Sharar SR. Effectiveness of virtual reality-based pain control with multiple treatments. Clin J Pain 2001;17:229-35. DOI: https://doi.org/10.1097/00002508-200109000-00007
  36. 36. Dalir Z, Seddighi F, Esmaily H, et al. Effects of virtual reality on chest tube removal pain management in patients undergoing coronary artery bypass grafting: a randomized clinical trial. Sci Rep 2024;14:2918. DOI: https://doi.org/10.1038/s41598-024-53544-9
  37. 37. Blockzijl SJ, Lamberts KF, Nieuwenhuis MK, et al. Virtual reality as pain relief in burn care: a pilot randomized controlled trial on the effectiveness on pain during multiple dressing changes. J Burn Care Res 2023;44:1125-33. DOI: https://doi.org/10.1093/jbcr/irad039
  38. 38. Sariköse A, Turan GB. The effects of virtual reality application on pain intensity, anxiety level and patient satisfaction in patients who undergo bronchoscopy: a randomized controlled trial. Pain Managt Nurs 2024; 26:102-10. DOI: https://doi.org/10.1016/j.pmn.2024.10.007
  39. 39. Şen H, Bakar D. The effect of virtual reality glasses on pain and patient satisfaction in arteriovenous fistula cannulation procedure. Appl Nurs Res 2024;79:151841. DOI: https://doi.org/10.1016/j.apnr.2024.151841
  40. 40. Spiegel B, Fuller G, Lopez M, et al. Virtual reality for management of pain in hospitalized patients: a randomized comparative effectiveness trial. PloS One 2019;14:e0219115. DOI: https://doi.org/10.1371/journal.pone.0219115
  41. 41. Araujo-Duran J, Kopac O, Montalvo Campana M, et al. Virtual reality distraction for reducing acute postoperative pain after hip arthroplasty: a randomized trial. Anesth Analg 2024;138:751-9. DOI: https://doi.org/10.1213/ANE.0000000000006642
  42. 42. Powers MB, Carl E, Levihn-Coon A, et al. Nonpharmacologic pain management among hospitalized inpatients. Clin J Pain 2021;37:678-87. DOI: https://doi.org/10.1097/AJP.0000000000000958
  43. 43. Maani CV, Hoffman HG, Morrow M, et al. Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. J Trauma 2011;71:S125-30. DOI: https://doi.org/10.1097/TA.0b013e31822192e2
  44. 44. Carrougher GJ, Hoffman HG, Nakamura D, et al. The effect of virtual reality on pain and range of motion in adults with burn injuries. J Burn Care Res 2009;30:785-91. DOI: https://doi.org/10.1097/BCR.0b013e3181b485d3
  45. 45. Chiu PL, Li H, Yap KY-L, Lam KC, et al. Virtual reality–based intervention to reduce preoperative anxiety in adults undergoing elective surgery: a randomized clinical trial. JAMA Netw Open 2023;6:e2340588. DOI: https://doi.org/10.1001/jamanetworkopen.2023.40588
  46. 46. Cao W, Ren F, Li T, et al. Effect of virtual reality intervention on hospitalized patients with acute pain after thoracoscopic surgery: a pilot randomized clinical trial. Int J Surg 2025;111:2752-56. DOI: https://doi.org/10.1097/JS9.0000000000002264
  47. 47. Gautama MSN, Haryani H, Huang T-W, et al. Effectiveness of smartphone-based virtual reality relaxation (SVR) for enhancing comfort in cancer patients undergoing chemotherapy: a randomized controlled trial. Support Care Cancer 2024;32;824. DOI: https://doi.org/10.1007/s00520-024-09036-7
  48. 48. Lier EJ, Smits MLM, Vissers R, et al. Virtual reality for postsurgical pain management: An explorative randomized controlled study. Surgery 2024;176:818-25. DOI: https://doi.org/10.1016/j.surg.2024.06.011
  49. 49. Özbas N, Çakmak Y, Alagha S. The effect of virtual reality application on pain and anxiety during chest tube removal following open heart surgery: randomized controlled study. Turkiye Klinikleri J Nurs Sci 2024;16:640-8. DOI: https://doi.org/10.5336/nurses.2023-101151
  50. 50. Morris NA, Wang Y, Felix RB, et al. Adjunctive virtual reality pain relief after traumatic injury: a proof-of-concept within-person randomized trial. Pain 2023;164:2122-9. DOI: https://doi.org/10.1097/j.pain.0000000000002914
  51. 51. Bozdoğan Yeşilot S, Ciftci H, Yener MK. Using a virtual reality and communication intervention to reduce pain and anxiety in patients undergoing lipoma excision with local anesthesia: a randomized controlled trial. AORN J 2022;115:437-49. DOI: https://doi.org/10.1002/aorn.13665
  52. 52. Merliot-Gailhoustet L, Raimbert C, Garnier O, et al. Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation). Critical Care 2022;26:263. DOI: https://doi.org/10.1186/s13054-022-04169-9
  53. 53. Okutan Ş, Saritaş S. The effect of virtual reality practice and music on patients’ pain, comfort, and vital signs after laparoscopic abdominal surgery. Surg Laparosc Endosc Percutan Tech 2024;34:259-67. DOI: https://doi.org/10.1097/SLE.0000000000001279
  54. 54. Mohammad E, Ahmad M. Virtual reality as a distraction technique for pain and anxiety among patients with breast cancer: A randomized control trial. Palliat Support Care 20189;17:29-34. DOI: https://doi.org/10.1017/S1478951518000639
  55. 55. Patterson DR, Jensen MP, Wiechman SA, Sharar SR. Virtual reality hypnosis for pain associated with recovery from physical trauma. Int J Clin Exp Hypn 2010;58:288-300. DOI: https://doi.org/10.1080/00207141003760595
  56. 56. Wiechman SA, Jensen MP, Sharar SR, et al. The impact of virtual reality hypnosis on pain and anxiety caused by trauma: lessons learned from a clinical trial. Int J Clin Exp Hypn 2022;70:156-73 DOI: https://doi.org/10.1080/00207144.2022.2052296
  57. 57. Bruno RR, Lin Y, Wolff G, et al. Virtual reality-assisted conscious sedation during transcatheter aortic valve implantation: a randomised pilot study. EuroIntervention 2020;16:1014-20. DOI: https://doi.org/10.4244/EIJ-D-20-00269
  58. 58. Armstrong M, Coffey R, Luna J, Xiang H. Pilot randomized clinical trial of virtual reality pain management during adult burn dressing changes: Lessons learned. PLoS Digit Health 2023;2:e0000231. DOI: https://doi.org/10.1371/journal.pdig.0000231
  59. 59. Kamada T, Ohdaira H, Nishie R, et al. Immersive virtual reality for reducing intraoperative pain: a pilot randomized controlled trial. In Vivo 2025;39:1638-46. DOI: https://doi.org/10.21873/invivo.13964
  60. 60. Kondylakis H, Giglioli IAC, Katehakis D, et al. Stress reduction in perioperative care: feasibility randomized controlled trial. J Med Internet Res 2025;27:e54049. DOI: https://doi.org/10.2196/54049
  61. 61. Wang Y, Sun J, Yu K, et al. Virtual reality exposure reduce acute postoperative pain in female patients undergoing laparoscopic gynecology surgery: A randomized control trial (RCT) study. J Clin Anesth 2024;97:111525. DOI: https://doi.org/10.1016/j.jclinane.2024.111525

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