Can VR help Veterans with chronic pain? What the VA resources show

About this guide

The VA resources collected here offer a useful starting point. They include a study conducted at a VA facility, a systematic review of chronic pain research, and practical guides to using immersive technology. Together, they support a careful conversation about whether a particular program fits your care. They do not establish that every headset or VR program produces the same benefit.

One VA study found improvement after a session

In a 2021 paper, Caitlin Rawlins and colleagues reported on 79 Veterans at the Western North Carolina VA Health Care System. Participants had acute or chronic pain and used VR for 10 to 30 minutes. Trained nurses helped them choose experiences such as interactive activities or relaxing environments.

Average pain scores fell from 5.3 before the session to 4.1 afterward on a 0-to-10 scale. That is an average change of 1.2 points. Forty-eight of the 79 participants reported a decrease of at least one point. Rawlins et al., pages 3–4.

The anxiety finding needs a careful reading. Among 36 participants who reported stress or anxiety before VR and had both measurements, 33 reported an improvement afterward. That is about 92% of that subgroup. It does not mean anxiety severity fell by 92%, or that 92% of all Veterans will respond. The study used a locally developed stress/anxiety scale that had not been validated. Rawlins et al., pages 5 and 8.

What that study cannot tell us

This was a before-and-after evaluation without a randomized comparison group. It analyzed each Veteran's first session and measured pain shortly after the headset came off. It did not establish a lasting reduction in chronic pain, a reduction in medication needs, or better function months later.

Without a comparison group, it is also hard to separate the VR experience from attention from staff, expectations, novelty, or other changes occurring during care. The sample was predominantly male and came from one VA health system. Those limits matter when applying the result to someone else. Study methods and limitations, pages 2 and 7–9.

A pleasant or calming session can still be valuable. The next question is whether the effect helps with the goal you and your clinician have chosen.

The larger review found different answers for different conditions

VA's Evidence Synthesis Program published Extended Reality Interventions for Chronic Pain in March 2024. Its database searches ran through May 2023, and it included 60 primary studies. It examined both VR and augmented reality, including some less immersive systems. This is a dated evidence review, not a review of every study available today. Report methods and study overview, printed pages 12–15.

The review's conclusions were specific:

• For chronic low back pain, VR psychological skills programs may improve pain and pain-related function compared with VR controls or usual care. Certainty was low, and these studies did not establish superiority over comparable psychological treatment delivered without VR.
• For chronic neck pain, VR physical activity may improve pain intensity over three to six weeks compared with non-VR activity. It may make little or no difference to pain-related function over that period, and longer-term findings were less encouraging or uncertain.
• For several other applications, including rehabilitation after knee or hip replacement, evidence was very uncertain. The reviewers also found important gaps in reporting adverse events.

These conclusions come from the report's discussion, printed pages 79–83. They support asking about the exact intervention rather than treating “VR therapy” as one treatment.

A headset is a way to deliver an experience

The same kind of headset can deliver distraction, guided coping skills, movement exercises, or an experience involving a virtual body. The treatment content matters. So do the session schedule, clinical support, and the population in which it was studied.

VA's June 2024 Literature Compendium helps readers find research across nine health care areas. It lists citations and abstracts, including material on rehabilitation, mental health, and education. It is a discovery tool. Its size does not show that a specific pain treatment is proven, and a paper's inclusion is not a product endorsement. Compendium methods and instructions, page 3.

Turn the evidence into a useful appointment

Bring the name of the proposed program and ask your clinician:

• Was this program studied for my condition, or for a different kind of pain?
• Was it compared with usual care, a sham experience, or a similar treatment without VR?
• Did improvements last after treatment ended?
• What side effects and reasons for stopping were reported?
• What should we measure to decide whether it is helping me?

Your goal might be a more tolerable exercise session, less interference with a daily activity, or a coping skill you can use outside the headset. Those are examples to discuss, not promised results.

If you are considering a trial, read what to expect at a first VR session. For the original documents and their limitations, visit the VA immersive technology resource library.

Educational information only. These resources do not establish Valor-specific outcomes, VA endorsement of Valor, or eligibility for a particular service.