This systematic review and meta-analysis included 25 randomized controlled trials (RCTs) with data from 1261 patients with CLBP and 261 patients with CNP. The study compared virtual reality-based therapy (VRBT) against therapeutic exercise (TE), sham treatment, or no intervention (NI). Pooled outcomes of interest included pain intensity, kinesiophobia, associated disability, and hr-QoL. Results showed that VRBT significantly reduced pain intensity in both CLBP and CNP patients immediately after the intervention, with effects persisting at 1- and 6-month follow-ups for CLBP but not CNP. VRBT also improved disability and hr-QoL in CLBP, with no significant difference between immersive and non-immersive VRBT. The study suggests that VRBT is an effective complementary therapy to conventional physiotherapy, particularly for CLBP.