Virtual Reality Interventions for Spinal Cord Injury-Related Neuropathic Pain: A Comprehensive Scoping Review of Multidimensional Outcomes.

Background: Virtual reality (VR) technology represents a novel non-pharmacological intervention demonstrating unique advantages in treating neuropathic pain (NP) following spinal cord injury (SCI). However, systematic clinical guidelines for its application remain lacking.

Objective: To systematically sort out the application patterns of VR in SCI-NP treatment, elucidate its underlying mechanisms of action, evaluate its advantages and limitations, and provide evidence-based recommendations for SCI-NP rehabilitation practice.

Methods: Following PRISMA scoping review protocols, we conducted a comprehensive search. Relevant literature was retrieved from PubMed, Cochrane Library databases, and Web of Science spanning from January 2005 to February 2025, using search terms including "virtual reality", "VR", "virtual walking", "spinal cord injury/SCI", "neuropathic pain", "central pain", "neuralgia", "chronic pain", and "pain." Studies examining VR applications in SCI-NP, including experimental and clinical investigations, were included. Narrative synthesis was employed to summarize VR application characteristics and therapeutic outcomes.

Results: Of the 126 articles retrieved, we included 15 articles involving more than 400 participants. Research designs encompassed randomized controlled trials (n=8), clinical trials (n=2), pilot studies (n=2), feasibility studies (n=2), and exploratory study (n=1). Assessment parameters included pain intensity, pain characteristics, pain interference, emotional status, and immersion experience. Twelve of 15 studies reported significant improvements in neuropathic pain intensity, while most studies assessing pain characteristics, pain Interference, emotional status and intervention quality demonstrated positive effects. However, given the methodological constraints of most studies, such as limited sample sizes, incomplete assessment measures, and insufficient follow-up durations, the widespread use and long-term effectiveness of VR intervention still require further validation.

Conclusion: Current evidence suggests VR technology may serve as an effective adjunct to, rather than replacement for, conventional treatment. Despite limited evidence, VR demonstrates promising analgesic efficacy and emotional enhancement potential in SCI-NP management. Critical knowledge gaps were identified regarding intervention modalities, treatment duration, and participant characteristics, providing recommendations for future research focusing on intervention protocol standardization, outcome measure harmonization, and mechanistic understanding advancement.