Can VR and a tiny ear ZAP ease shoulder pain and anxiety?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Aged over 18. * Ability to understand English * Ability to provide informed consent and attend in-person sessions * Chronic shoulder pain (pain lasting for at least 6 months) waiting on surgical pathway. * Comorbid mild-to-moderate anxiety or depression * Referred by a consultant orthopaedic surgeon. * Unresponsive to conventional treatment for 6 months including antidepressants, physiotherapy, and/ or oral analgesics * Mean NRS pain score ≥ 5 on most or all days either continuously or in motion Exclusion Criteria:● Inability to understand English and consent process * History of significant neurological or psychiatric conditions unrelated to chronic pain (e.g., epilepsy, psychosis, schizophrenia). * Skin lesions or piercing or extensive tattooing of the concha or Skin disease: infection, eczema or cancer of the ears or skin in region where VR headset or taVNS would sit * Presence of active implants (e.g. cochlear implant, implanted vagus nerve stimulator, cardiac pacemaker, implantable cardioverter defibrillator (ICD) deep brain stimulations or spinal cord stimulators, ventriculoperitoneal (VP) shunt). * Inability to tolerate VR (e.g., severe motion sickness, vertigo or balance issues, claustrophobia). * Fear of heights * Active infections, significant trauma, or other acute conditions affecting the shoulder. * Pregnancy and women trying actively to conceive * Pre-existing Persistent post-surgical pain-(\>6 months) from surgeries other than shoulder replacements * On- going alcohol and/ or drug problem * Widespread chronic pain conditions (fibromyalgia, complex regional pain syndrome) * Involvement in any clinical studies within the last 28 days prior to assessment * Other therapies such as other psychological interventions for A/D and pain in the shoulder are not allowed for the period of the study and follow up unless there is a psychiatric emergency. Participants may also not be involved in any trial on pain management or related to shoulders while participating in this VR/VNS trial.