More than 12 million people in Germany suffer from long-term chronic pain. The gold standard is interdisciplinary, multimodal pain therapy, in which medicine, psychotherapy, and physical therapy work closely together.

The problem: There are too few local therapists, costs are often inadequately reimbursed, and patients frequently have to endure long commutes and lengthy wait times. Demographic trends are exacerbating the situation and creating a gap in care for patients with chronic pain.

A gap that could be closed, at least in part, by virtual reality (VR), said Stefan Lindner, physical therapist and sports scientist at the Center for Interdisciplinary Pain Medicine (ZiS) at the University Hospital Würzburg in Würzburg, Germany. This is because all components of multimodal therapy (exercise therapy, psychoeducation, relaxation, and behavioral therapy) can be implemented in VR, Lindner explained at the press conference of the German Pain Society and the German Migraine and Headache Society.

No Longer a Niche Topic

VR is no longer a niche topic in pain therapy. A meta-analysis of 122 randomized controlled trials involving 9138 patients showed a significant reduction in pain (standardized mean difference, -0.65; P < .001) through the use of VR. Greater VR effects were expected with higher intensity of baseline pain.

While VR-based treatment of acute pain primarily targets analgesia, for patients with chronic pain, the focus is on modulating cognitive and behavioral dimensions of the pain condition, such as mobility, relaxation, motivation, and social functioning.

Two key developments in VR have led to broader adoption and greater scalability in pain medicine:

• VR pain treatment has evolved from clinical prototypes such as SnowWorld, developed to help patients cope with pain during medical procedures, to digital therapies designed for use at home. In November 2021, the FDA granted marketing authorization to EaseVRx, a prescription VR program for adults with chronic low back pain. It uses principles of cognitive-behavioral therapy — a structured approach to changing unhelpful thought and behavior patterns — alongside immersive exercises.
• VR hardware has shifted from bulky, expensive headsets tethered to powerful computers toward smaller, lighter, wireless devices that can run many experiences on their own. For example, the Meta Quest 3, launched in 2023, is a stand-alone headset with built-in sensors that track the user’s movement and position. These advances have made VR easier to set up and use in homes, clinics, and other settings, although prices, availability, and technical capabilities still vary across regions and devices.

The expansion of VR into extended reality may help patients move more safely in physical spaces while creating new opportunities for therapy, including applications such as ReliefVR.

ReliefVR: Body Illusions, Movement, and Distraction

ReliefVR is a VR application developed for the treatment of chronic pain. It is being studied as part of a trial at ZiS.

By altering body perception in VR, the application aims to modify neural networks, change avoidance behaviors, and facilitate the learning of new movement patterns. This could reduce perceived pain and increase the range of motion. Specifically tailored physical therapy exercises are integrated into the concept.

ReliefVR utilizes several mechanisms:

• Body illusions. VR is used to create whole-body illusions that can influence the brain’s perception. This supports pain management.
• Movement exercises. Through targeted movements on the basis of physical therapy, users are actively engaged in the healing process.
• Distraction and gamification. VR provides a distraction from pain sensations, while game-like elements boost patient motivation and adherence to therapy.

Unexpected Mobility Through Gaming

In practice, it works like this: A patient with chronic back pain puts on the VR headset, takes a joystick in each hand, and is ready to go. The patient then chases, for example, colored balls flying toward them in the virtual world. In the heat of the game, they develop unexpected mobility — squatting, bending, stretching, and turning — actions they have avoided for months out of fear of pain. Lindner observed such effects time and again.

He emphasizes that VR is not necessarily just a distraction from pain but can integrate various mechanisms. The spectrum ranges from fully virtual applications to solutions that combine real and virtual elements. Which approach makes sense depends on the therapeutic goal.

Where VR Headsets Are Used in Care

For nearly 2 years, a hypno-VR headset has been in use in the Psycho-Oncology Department at Saarland University Medical Center in Homburg, Germany. Psycho-oncologist Wolfgang Merda offers the headset to patients who must remain bedridden for an extended period after surgery and are struggling with back pain.

The VR headset enables a journey into another world. Whether walking in the woods, strolling along the beach, or flying through space — patients can choose their environment and immerse themselves in a 360-degree world. The idea behind this is to alleviate anxiety and pain and promote relaxation.

Breaking through the pain memory with VR — that’s the approach taken at the Pain Day Clinic at Sana Klinikum Coburg in Coburg, Germany. There, VR is offered as a component of a 5-week outpatient pain therapy program. The goal is to provide patients with new, positive experiences and, step by step, restore their ability to function.

“Many of our patients don’t need yet another explanation for why they’re in pain. They need to experience that they’re capable of acting again. VR can facilitate exactly this experience as a complementary component of multimodal pain therapy,” explained Klaus Post, chief physician.

VR Headsets as a Break From Daily Hospital Life

The University Medical Center Schleswig-Holstein in northern Germany also uses VR headsets to provide a “break from hospital life” for pain relief and relaxation. With the VR headsets, patients can experience a brief trip to the beach or the mountains. The method provides targeted distraction and thereby reduces stress. As a specialized nurse explained in a video on TikTok, the nursing staff offers the headsets to patients in pain.

The München Klinik in Schwabing, Germany, uses VR headsets to help children manage pain. Thanks to a donation, the München Klinik Schwabing has had six VR headsets since February, allowing young patients to immerse themselves in underwater worlds with dolphins and octopuses during procedures. Curiosity and wonder allow the fear of painful scar treatment to fade into the background for a while, making the treatment easier.

The VR headsets aren’t just used for painful scar treatments; during their hospital stay, children can also immerse themselves in virtual worlds — for example, by taking a virtual ride on a Ferris wheel.

Experience to date shows that many children perceive procedures as less painful when using VR headsets and subjectively feel that the time spent undergoing treatment passes more quickly. Often, the amount of pain medication or anesthetics can be reduced — a major benefit.

Limitations and Side Effects

However, evidence on the effectiveness of VR-based therapies remains limited. Data are sparse, applications vary, and methodological challenges — including the inability to blind participants to treatment — limit the strength of conclusions. The long-term effects also remain unclear.

A possible side effect of VR headsets is cybersickness, characterized by dizziness, headaches, nausea, or general discomfort. Impaired vision is a standard exclusion criterion, as eyeglasses do not fit under the head-mounted display. Vision problems involving blurred vision can, in turn, trigger cybersickness.

“VR is a promising addition to pain therapy — not a silver bullet, but a tool,” Lindner concluded. The ultra-lightweight Meta VR Glasses, scheduled to hit the market in the spring of 2027, could potentially enable even broader access to pain management.

The idea behind this is to move VR and mixed reality out of the bulky headset and turn them into devices that people actually want to wear for extended periods in their everyday lives.

This story was translated from Medscape’s German edition.