Carvajal-Parodi Claudio, Rossel Pedro O, Rodríguez-Alvarado Alejandra, Guede-Rojas Francisco, Ponce-González Jesús G
Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Lientur #1457, Concepción 4030000, Chile.
Programa de Doctorado en Ciencias de la Actividad Física y del Deporte, Universidad de Cádiz, Campus Puerto Real, Avda. República Saharaui s/n, 11519 Cádiz, Spain.
J Clin Med. 2025 May 28;14(11):3782. doi: 10.3390/jcm14113782.
: Chronic pain affects millions worldwide, influenced by biological, psychological, and social factors. Catastrophizing predicts chronic pain outcomes, increased pain intensity, and worsening recovery. Virtual reality (VR) interventions offer innovative pain management strategies, but their effects on catastrophizing remain unclear. : This systematic review and meta-analysis followed the PRISMA guidelines. Studies involving adults with chronic musculoskeletal pain, VR-based interventions, and randomized controlled trials were included. The primary outcome was pain catastrophizing. Searches were conducted in PubMed, CINAHL, Scopus, WoS, and PEDro until May 2025. The risk of bias was assessed using Cochrane RoB-2. Meta-analysis calculated effect sizes using mean differences (MD) and standardized mean differences (SMD) with fixed and randomized-effects models. : Of 306 records, 244 were screened, 19 underwent full-text review, and two additional studies were identified via Google Scholar. Nine studies were included, eight of which were meta-analyzed. The interventions included eight immersive and one non-immersive VR studies, lasting 3 to 12 weeks. A small but statistically significant effect was found when comparing VR-based interventions with controls (SMD = -0.26 [-0.48; -0.04]). Psycho-cognitive VR-based interventions had a significant effect (SMD = -0.32 [-0.56; -0.09]), while exercise-based VR did not (MD = -0.11 [-4.36; 4.14]). Immersive VR showed a small but significant effect when compared to non-intervention or sham controls (SMD = -0.37 [-0.75; -0.00]). However, when compared to all types of comparators, the effect was not statistically significant (SMD = -0.25 [-0.51 to -0.00]). Heterogeneity was moderate and not significant ( > 0.05). : VR-based interventions, particularly immersive with psycho-cognitive approaches, show potential in reducing pain catastrophizing. Future randomized trials are needed to elucidate VR's efficacy in managing pain catastrophizing.
慢性疼痛影响着全球数百万人，受生物、心理和社会因素的影响。灾难化思维预示着慢性疼痛的结果、疼痛强度增加以及恢复情况恶化。虚拟现实（VR）干预提供了创新的疼痛管理策略，但其对灾难化思维的影响仍不明确。
本系统评价和荟萃分析遵循PRISMA指南。纳入了涉及患有慢性肌肉骨骼疼痛的成年人、基于VR的干预措施以及随机对照试验的研究。主要结局是疼痛灾难化。截至2025年5月，在PubMed、CINAHL、Scopus、WoS和PEDro中进行了检索。使用Cochrane RoB-2评估偏倚风险。荟萃分析使用固定效应模型和随机效应模型，通过平均差（MD）和标准化平均差（SMD）计算效应量。
在306条记录中，筛选出244条，19条进行了全文审查，并通过谷歌学术又确定了两项研究。纳入了9项研究，其中8项进行了荟萃分析。干预措施包括8项沉浸式VR研究和1项非沉浸式VR研究，持续时间为3至12周。将基于VR的干预措施与对照组进行比较时，发现了一个虽小但具有统计学意义的效应（SMD = -0.26 [-0.48; -0.04]）。基于心理认知的VR干预措施有显著效果（SMD = -0.32 [-0.56; -0.09]），而基于运动训练的VR干预措施则没有（MD = -0.11 [-4.36; 4.14]）。与无干预或假对照相比，沉浸式VR显示出一个虽小但显著的效应（SMD = -0.37 [-0.75; -0.00]）。然而，与所有类型的对照相比，该效应无统计学意义（SMD = -0.25 [-0.51至-0.00]）。异质性为中度且无显著性（I² > 0.05）。
基于VR的干预措施，特别是采用心理认知方法的沉浸式VR，在减轻疼痛灾难化方面显示出潜力。未来需要进行随机试验，以阐明VR在管理疼痛灾难化方面的疗效。
