Digital gamification in chronic pain management in adulthood: a systematic review.

Background: Chronic pain is a leading cause of disability. Existing evidence on digital gamification remains mixed. This systematic review aims to explore the use of gamification in chronic pain interventions for adults. Methods: A systematic review of randomized controlled trials using digital gamification pain intervention for adults with chronic non-cancer pain was included. Data on gamification mechanisms, pain intensity, and user-related outcomes were extracted. Results: A total of 17 randomized controlled trials with 768 participants were included. The most common elements of gamification were feedback, challenges, and rewards. Twelve studies reported significant pain reduction, with virtual reality and sensor-based games showing immediate effects. Feedback and challenge-based designs were associated with improved pain outcomes and user engagement. However, adherence and long-term efficacy varied, and some studies reported adverse effects. Conclusion: Gamification, particularly virtual reality and feedback-driven interventions, shows promise in reducing chronic pain and enhancing motivation. However, heterogeneity in design, limited long-term data, and risk of bias highlight the need for interventions evaluated in high-quality randomized controlled trials with longer follow-up periods. Future research should explore personalized gamification strategies and underlying mechanisms to optimize chronic pain management. © The Author(s) 2026. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)