Chronic musculoskeletal pain: digital care could help, with no winning technology

Comparing the digital platform and the content of care

Access to ongoing support remains difficult for people with chronic musculoskeletal pain. Digital interventions could extend care beyond consultations, but does their value depend on the technology used or the therapeutic content offered?

To examine this question, the researchers pooled 92 randomized trials involving 12,595 adults. Their literature search covered publications available up to January 29, 2026. Digital interventions were compared with control conditions, details of which are not specified in the abstract provided.

The interventions were classified along two dimensions: their format, such as an app or virtual reality, and their content, such as exercise, education or cognitive behavioral therapy. The outcomes studied included pain, functional limitations and health-related quality of life.

Average benefits that are not guaranteed

Analyses directly comparing interventions with their controls suggest small to moderate favorable average effects of apps, virtual reality and telerehabilitation on pain and functional limitations. Estimates for wearable devices and multimodal interventions were imprecise.

However, the prediction intervals included no effect. In other words, an average benefit across the pooled trials does not guarantee that a similar intervention will be beneficial in another care setting. The abstract does not provide absolute results that would allow these effects to be translated into a concrete reduction in pain.

Exercise looks promising, but rankings are unreliable

Analyses by content suggest larger effects when the intervention is based on exercise or motor function training than when it mainly focuses on education or cognitive behavioral therapy. However, several subgroups included few studies.

The network meta-analysis, which combines direct and indirect comparisons, highlights motor function-oriented virtual reality and exercise-based telerehabilitation. Their favorable rankings remain uncertain because of study heterogeneity, imprecision and a lack of direct comparisons.

These findings therefore do not justify systematically favoring virtual reality or choosing an app solely on the basis of its technology. Above all, they encourage a distinction between the digital platform and the care it delivers. Higher-quality comparative trials are still needed to establish long-term effects.

What we can take away

Digital care could offer modest improvements in pain and functional ability. Exercise-based content appears promising, but no modality can be considered superior on the basis of these data.