What is the impact of virtual reality on pain in elective orthopaedic patients? A systematic review and meta-analysis of randomised controlled trials (RCTs).

Aim

To evaluate the impact of Virtual Reality (VR) interventions on pain in elective orthopaedic patients.

Background

VR is an immersive tool that modulates nociceptive perception, potentially alleviating acute pain and perioperative distress.

Design

Systematic review and meta-analysis of randomised controlled trials (RCTs) following PRISMA 2020 guidelines.

Methods

Seven electronic databases (PubMed, Scopus, Cochrane Library, CINAHL, MEDLINE, Embase, and APA PsycINFO) were searched from inception to November 2025. RCTs comparing VR with control conditions on pain using validated assessment tools in adult elective orthopaedic procedures were included. Methodological quality was appraised using Cochrane RoB2, and evidence certainty was evaluated using the GRADE approach. Quantitative data analysis utilised RevMan software.

Results

Twenty-three RCTs met inclusion criteria (N = 1224; median study sample size 48, IQR 30-60), with 21 studies (n = 1169) quantitatively synthesised. VR was associated with a statistically significant reduction in acute postoperative pain compared to control (MD -0.59, 95% CI [-0.92, -0.26], p = 0.0005; I2 = 79%). Subgroup analysis indicated benefits were restricted to major surgeries (MD -0.71, 95% CI [-1.22, -0.20], p = 0.007), but not minor procedures (p = 0.11). VR was also associated with a decreased in perioperative anxiety (MD -0.90, 95% CI [-1.75, -0.06], p = 0.04). Narrative synthesis indicated reduced rescue opioid requirements and high patient satisfaction.

Conclusions

VR may moderately reduce acute pain and anxiety in major orthopaedic surgery. However, given substantial heterogeneity, alongside overall low-certainty evidence and high risk of bias, standardised VR intervention protocols and rigorous trials are required.