Virtual Reality, Music, and Pain: Developing the Premise for an Interdisciplinary Approach to Pain Management

Emily Honzel; Sarah Murthi; Barbara Brawn-Cinani; Giancarlo Colloca; Craig Kier; Amitabh Varshney; Luana Colloca


Pain. 2019;160(9):1909-1919. 

In This Article

Limitations and Future Directions

Many VR and MT studies miss either the appropriate controls (eg, nonimmersive VR, pink noise vs ambient music, and passive music listening) and/or blinding of both research staff and study participants. Moreover, most of the VR and MT studies focused on pain intensity, when VR and MT may change the nature of affect associated with pain experience (eg, distressing or frightening), pain quality (eg, sharpness of pain) and the effectiveness based on pain location (eg, distinct body representation).[38] Magnitude-based inferences related to clinical relevance are based on the examination of outcomes beyond the statistical significance. Based on the studies we reviewed (Table 1), there is a need for additional systematic meta-analyses[34] that account for heterogeneity of the studies. Only such approach allows for quantifying the efficacy of MT and VR and their potential to implement their uses routinely to optimize clinical outcomes. Future randomized placebo-controlled clinical trials and comparative effectiveness research will also help define the clinical relevance of VR, MT, and combined VR-MT. Finally, it is important to consider whether and how expectancies and contextual placebo effects may influence the effectiveness of VR-MT interventions.[51]

Despite these limitations, recent studies have illustrated increased pain tolerance especially in patients who self-selected their musical experience[62,83] or were immersed in VR contexts.[43] The hypoalgesic properties of both MT and VR could be further explored in the context of combined VR-MT applications. Virtual reality brings the unique opportunity to reach a high level of engagement on multiple sensory and cognitive levels, as well as the specialization necessary for creating MT-based clinically meaningful experiences that lead to pain reduction. This may help bridge the gap between MT and MM. The possibilities of VR-MT interventions range from minimal contact, using speakers or mobile phones, to use of spatial sound-enabled VR headsets. Stereo 360° cinematographic rendering of virtual scenes could transport patients to the stage of a rock concert, where they are able to change positions and alter which instruments they hear best, or place them in the middle of an operatic finale. Although studies have examined the effects of adding sensory components to VR interventions, exploring multiple VR-MT contents may elucidate the differential effects unique to certain pain disorders and patient predictors of beneficial outcomes.