Virtual reality-based systems and their analgesic effects in the treatment of phantom limb pain: A scope review
DOI:
https://doi.org/10.21527/2176-7114.2026.51.16944Keywords:
virtual reality, virtual reality exposure therapy, phantom limb painAbstract
Objective: To synthesize the available scientific evidence on treatment of phantom limb pain using virtual reality and its effects on pain. Method: This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) guidelines and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) instructions. The search was conducted using five databases, as well as sources of unpublished studies and gray literature. The selection was done by two independent researchers and observed the following inclusion criteria: full-text primary articles; freely available (open-access); with no restrictions on time, language, or country; and which applied virtual reality to adult amputees with phantom pain. The results were analyzed qualitatively regarding the outcome of interest – pain – and presented descriptively in tables and graphs. Results: A total of 29 articles published between 2006 and 2024 were selected for the evidence synthesis. Most of the studies analyzed applied the concepts of mirror therapy and phantom limb movement. The immersive experience favored the use of 3D gamification. There is a tendency to assess its use in the home setting. The customized games and equipment used hamper the replication of the intervention in clinical practice. Conclusions: Although the studies under review show that virtual reality reduces phantom limb pain, their design limits the ability to determine causal relationships between virtual reality and pain reduction. Future research must employ more rigorous methodologies and larger sample sizes.
References
1International Association for the Study of Pain (IASP). https://www.iasp-pain.org/publications/pain-research-forum/papers-of-the-week/paper/210389-current-understanding-phantom-pain-and-its-treatment/.
2Perry BN, Armiger RS, Wolde M, McFarland KA, Alphonso AL, Monson BT, Pasquina PF, Tsao JW. Clinical Trial of the Virtual Integration Environment to Treat Phantom Limb Pain With Upper Extremity Amputation. Frontiers in Neurology. 2018;9:770.https://doi.org/10.3389/fneur.2018.00770.
3DATASUS. Departamento de Informática do SUS – DATASUS. Informações de Saúde (TABNET). Brasília, DF: Ministério da Saúde. 2022. http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/qiuf.def.
4Aternali A, Katz J. Recent advances in understanding and managing phantom limb pain. F1000Research. 2019;8:1167. https://doi.org/10.12688/f1000research.19355.1.
5Wong KP, Tse MMY, Qin J. Effectiveness of Virtual Reality-Based Interventions for Managing Chronic Pain on Pain Reduction, Anxiety, Depression and Mood: A Systematic Review. Healthcare. 2022; 0(10):2047. https://doi.org/10.3390/healthcare10102047.
6Erlenwein J, Diers M, Ernst J, Schulz F, Petzke F. Clinical updates on phantom limb pain. Pain Reports. 2021:6(1):e888. https://doi.org/10.1097/PR9.0000000000000888.
7Donegan T, Ryan BE, Sanchez-Vives MV, Świdrak J. Altered bodily perceptions in chronic neuropathic pain conditions and implications for treatment using immersive virtual reality. Frontiers in Human Neuroscience. 2022;16. https://doi.org/10.3389/fnhum.2022.1024910.
8Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis. JBI; 2024. Available from: https://synthesismanual.jbi.global.
9Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews BMJ 2021; 372:71. doi:10.1136/bmj.n71
10Rothgangel A, Braun S, Winkens B, Beurskens A, Smeets R. Traditional and augmented reality mirror therapy for patients with chronic phantom limb pain (PACT study): results of a three-group, multicentre single-blind randomized controlled trial. Clinical Rehabilitation. 2018;32(12):1591-1608. doi:10.1177/0269215518785948.
11Cole J, Crowle S, Austwick G, Henderson Slater D. Exploratory findings with virtual reality for phantom limb pain; from stump motion to agency and analgesia. Disability and Rehabilitation. 2009;31(10):846–854. https://doi.org/10.1080/09638280802355197.
12Kulkarni J, Pettifer S, Turner S, Richardson C. An investigation into the effects of a virtual reality system on phantom limb pain: a pilot study. British Journal of Pain. 2020;14(2):92-97. https://doi.org/10.1177/2049463719859913.
13Lendaro E, Middleton A, Brown S, Ortiz-Catalan M. Out of the Clinic, into the Home: The in-Home Use of Phantom Motor Execution Aided by Machine Learning and Augmented Reality for the Treatment of Phantom Limb Pain. J Pain Res. 2020;13:195-209. https://doi.org/10.2147/JPR.S220160.
14Ta PA, Chi B, Chau BL. Poster 318: Treatment of Phantom Limb Pain in Recent Amputee with Virtual Reality Mirror Therapy: A Case Report. PM&R. 2018;10(9S1):S105–S106. https://doi.org/10.1016/j.pmrj.2018.08.330.
15Ambron E, Buxbaum LJ, Miller A, Stoll H, Kuchenbecker KJ, Coslett HB. Virtual reality treatment displaying the missing leg improves phantom limb pain: A small clinical trial. Neurorehabilitation and neural repair. 2021;35(12):1100–1111. https://doi.org/10.1177/15459683211054164.
16Annaswamy TM, Bahirat K, Raval G, Chung YY, Pham T, Prabhakaran B. Clinical feasibility and preliminary outcomes of a novel mixed reality system to manage phantom pain: a pilot study. Pilot and Feasibility Studies. 2022;8(1):232. https://doi.org/10.1186/s40814-022-01187-w.
17Desmond DM, O’Neill K, De Paor A, McDarby G, MacLachlan M. Augmenting the Reality of Phantom Limbs: Three Case Studies Using an Augmented Mirror Box Procedure. JPO: Journal of Prosthetics and Orthotics. 2006;18(3):74. https://journals.lww.com/jpojournal/fulltext/2006/07000/augmenting_the_reality_of_phantom_limbs__three.5.aspx.
18Ichinose A, Sano Y, Osumi M, Sumitan M, Kumagaya S, Kuniyoshi Y. Somatosensory Feedback to the Cheek During Virtual Visual Feedback Therapy Enhances Pain Alleviation for Phantom Arms. Neurorehabilitation and Neural Repair. 2017;31(8):717–725. https://doi.org/10.1177/1545968317718268.
19Mercier C, Sirigu A. Training With Virtual Visual Feedback to Alleviate Phantom Limb Pain. Neurorehabilitation and Neural Repair. 2009;23(6):587-594. https://doi.org/10.1177/1545968308328717.
20Murray CD, Patchick E, Pettifer S, Howard T, Caillette F, Kulkarni J, Bamford, C. Investigating the efficacy of a virtual mirror box in treating phantom limb pain in a sample of chronic sufferers. International Journal on Disability and Human Development. 2006;5(3): 227-234. https://doi.org/10.1515/IJDHD.2006.5.3.227.
21Murray CD, Pettifer S, Howard T, Patchick EL, Caillette F, Kulkarni J, Bamford C. The treatment of phantom limb pain using immersive virtual reality: Three case studies. Disability and Rehabilitation. 2007;29(18):1465–1469. https://doi.org/10.1080/09638280601107385.
22Osumi M, Ichinose A, Sumitani M, Wake N, Sano Y, Yozu A, Kumagaya S, Kuniyoshi Y, Morioka S. Restoring movement representation and alleviating phantom limb pain through short-term neurorehabilitation with a virtual reality system. European Journal of Pain. 2017;21(1):140–147. https://doi.org/10.1002/ejp.910.
23Osumi M, Inomata K, Inoue Y, Otake Y, Morioka S, Sumitani M. Characteristics of Phantom Limb Pain Alleviated with Virtual Reality Rehabilitation. Pain Medicine. 2019;20(5):1038–1046. https://doi.org/10.1093/pm/pny269.
24Sano Y, Ichinose A, Wake N, Osumi M, Sumitani M, Kumagaya S, Kuniyoshi Y. Reliability of phantom pain relief in neurorehabilitation using a multimodal virtual reality system. In: 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). 2015:2482–2485. DOI 10.1109/EMBC.2015.7318897. http://ieeexplore.ieee.org/document/7318897/.
25Sano Y, Wake N, Ichinose A, Osumi M, Oya R, Sumitani M, Kumagaya S, Kuniyoshi Y. Tactile feedback for relief of deafferentation pain using virtual reality system: a pilot study. Journal of NeuroEngineering and Rehabilitation. 2016;13(1):61. https://doi.org/10.1186/s12984-016-0161-6.
26Tong X, Wang X, Cai Y, Gromala D, Williamson O, Fan B and Wei K. “I Dreamed of My Hands and Arms Moving Again”: A Case Series Investigating the Effect of Immersive Virtual Reality on Phantom Limb Pain Alleviation. Front. Neurol. 2020;11:876. doi: 10.3389/fneur.2020.00876.
27Wake N, Sano Y, Oya R, Sumitani M, Kumagaya S, Kuniyoshi Y. Multimodal virtual reality platform for the rehabilitation of phantom limb pain. In: 2015 7TH International IEEE/EMBS Conference on Neural Engineering (NER). 2015:787–790. DOI 10.1109/NER.2015.7146741.
28Yoshimura M, Kurumadani H, Hirata J, Senoo K, Hanayama K, Sunagawa T, Uchida K, Gofuku A, Sato K. Case Report: Virtual reality training for phantom limb pain after amputation. Frontiers in Human Neuroscience. 2023;17:1246865. https://doi.org/10.3389/fnhum.2023.1246865.
29Ambron E, Miller A, Kuchenbecker KJ, Buxbaum LJ, Coslett HB. Immersive Low-Cost Virtual Reality Treatment for Phantom Limb Pain: Evidence from Two Cases. Frontiers in Neurology. 2018;9(19). https://doi.org/10.3389/fneur.2018.00067.
30Chau B, Phelan I, Ta P, Humbert S, Hata J, Tran D. Immersive Virtual Reality Therapy with Myoelectric Control for Treatment-resistant Phantom Limb Pain: Case Report. Innovations in Clinical Neuroscience. 2017;14(7–8):3–7. https://pmc.ncbi.nlm.nih.gov/articles/PMC5880370/.
31Ortiz-Catalan M, Sander N, Kristoffersen MB, Håkansson B and Brånemark R. Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient. Front. Neurosci. 2014;8:24. doi: 10.3389/fnins.2014.00024.
32Ortiz-Catalan M, Guðmundsdóttir RA, Kristoffersen MB, Zepeda-Echavarria A, Caine-Winterberger K, Kulbacka-Ortiz K, Widehammar C, Eriksson K, Stockselius A, Ragnö C, Pihlar Z, Burger H, Hermansson L. Phantom motor execution facilitated by machine learning and augmented reality as treatment for phantom limb pain: a single group, clinical trial in patients with chronic intractable phantom limb pain. Lancet. 2016;388(10062):2885–2894. https://doi.org/10.1016/S0140-6736(16)31598-7.
33Rutledge T, Velez D, Depp C, McQuaid JR, Wong G, Jones RCW, Atkinson JH, GIAP B, Quan A, Giap H. A Virtual Reality Intervention for the Treatment of Phantom Limb Pain: Development and Feasibility Results. Pain Med. 2019;20(10):2051–2059. https://doi.org/10.1093/pm/pnz121.
34Snow PW, Sedki I, Sinisi M, Comley R, Loureiro RCV. Robotic therapy for phantom limb pain in upper limb amputees. In: International Conference on Rehabilitation Robotics (ICORR). jul. 2017:1019–1024. DOI 10.1109/ICORR.2017.8009383.
35Snow PW, Dimante D, Sinisi M, Loureiro RCV. Virtual Reality combined with Robotic facilitated movements for pain management and sensory stimulation of the upper limb following a Brachial Plexus injury: A case study. In: International Conference On Rehabilitation Robotics (ICORR). jul. 2022:1–6. DOI 10.1109/ICORR55369.2022.9896552.
36Thogersen M, Andoh J, Milde C, Graven-Nielsen T, Flor H, Petrini L. Individualized Augmented Reality Training Reduces Phantom Pain and Cortical Reorganization in Amputees: A Proof of Concept Study. The Journal of Pain. 2020;21(11):1257–1269. https://doi.org/10.1016/j.jpain.2020.06.002.
38Rothgangel A, Braun S, Smeets R, Beurskens A. Design and Development of a Telerehabilitation Platform for Patients With Phantom Limb Pain: A User-Centered Approach. JMIR Rehabil Assist Technol. 2017;4(1):e2. https://doi.org/10.2196/rehab.6761.
37Steckel BM, Schwertner R, Bücker J, Nazareth ACDP, Bizarro L, Oliveira AAD. Immersive virtual reality applied to the rehabilitation of patients with lower limb amputation: a small randomized controlled trial for feasibility study. Virtual Reality. 2024;28(2):1-15. https://doi.org/10.1007/s10055-024-01015-x.
39Kintschner NR, Corrêa AGD, Figueiredo PSF, Cymrot R, Blascovi-Assis SM. Effects of a game therapy program with leap motion sensor on the manual function in adults with cerebral palsy. Rev. Contexto & Saúde. 2024;24(48):e14345. https://www.revistas.unijui.edu.br/index.php/contextoesaude/article/view/14345.
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