Virtual reality pain control during burn wound debridement in the hydrotank

OBJECTIVE: Most burn-injured patients rate their pain during burn wound debridement as severe to excruciating. We explored the adjunctive use of water-friendly, immersive virtual reality (VR) to distract patients from their pain during burn wound debridement in the hydrotherapy tank (hydrotank). SETTING: This study was conducted on inpatients at a major regional burn center. PATIENTS: Eleven hospitalized inpatients ages 9 to 40 years (mean age, 27 y) had their burn wounds debrided and dressed while partially submerged in the hydrotank. INTERVENTION: Although a nurse debrided the burn wound, each patient spent 3 minutes of wound care with no distraction and 3 minutes of wound care in VR during a single wound care session (within-subject condition order randomized). OUTCOME MEASURES: Three 0 to 10 graphic rating scale pain scores (worst pain, time spent thinking about pain, and pain unpleasantness) for each of the 2 treatment conditions served as the primary dependent variables. RESULTS: Patients reported significantly less pain when distracted with VR [eg, "worst pain" ratings during wound care dropped from "severe" (7.6) to "moderate" (5.1)]. The 6 patients who reported the strongest illusion of "going inside" the virtual world reported the greatest analgesic effect of VR on worst pain ratings, dropping from severe pain (7.2) in the no VR condition to mild pain (3.7) during VR. CONCLUSIONS: Results provide the first available evidence from a controlled study that immersive VR can be an effective nonpharmacologic pain reduction technique for burn patients experiencing severe to excruciating pain during wound care. The potential applications of VR analgesia to other painful procedures (eg, movement or exercise therapy) and other pain populations are discussed.     

Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study

OBJECTIVE: The pain experienced by burn patients during physical therapy range of motion exercises can be extreme and can discourage patients from complying with their physical therapy. We explored the novel use of immersive virtual reality (VR) to distract patients from pain during physical therapy. SETTING: This study was conducted at the burn care unit of a regional trauma center. PATIENTS: Twelve patients aged 19 to 47 years (average of 21% total body surface area burned) performed range of motion exercises of their injured extremity under an occupational therapist's direction. INTERVENTION: Each patient spent 3 minutes of physical therapy with no distraction and 3 minutes of physical therapy in VR (condition order randomized and counter-balanced). OUTCOME MEASURES: Five visual analogue scale pain scores for each treatment condition served as the dependent variables. RESULTS: All patients reported less pain when distracted with VR, and the magnitude of pain reduction by VR was statistically significant (e.g., time spent thinking about pain during physical therapy dropped from 60 to 14 mm on a 100-mm scale). The results of this study may be examined in more detail at www.hitL.washington.edu/projects/burn/. CONCLUSIONS: Results provided preliminary evidence that VR can function as a strong nonpharmacologic pain reduction technique for adult burn patients during physical therapy and potentially for other painful procedures or pain populations.     

Sustained Efficacy of Virtual Reality Distraction

The current study tested whether the effectiveness of distraction using virtual reality (VR) technology in reducing cold pressor pain would maintain over the course of 8 weekly exposures. Twenty-eight adults, 18 to 23 years of age, underwent 1 baseline cold pressor trial and 1 VR distraction trial in randomized order each week. VR distraction led to significant increases in pain threshold and pain tolerance and significant decreases in pain intensity, time spent thinking about pain, and self-reported anxiety, relative to baseline. Repeated exposure did not appear to affect the benefits of VR. Implications for the long-term use of VR distraction as a nonpharmacological analgesic are discussed.PerspectiveThis article addresses the concern that the efficacy of virtual reality–assisted distraction from pain could potentially decrease with repeated exposure. The current finding that efficacy did not diminish over several repeated exposures provides support for the use of virtual reality as an adjuvant treatment of pain.     

Music Provided Through a Portable Media Player (iPod) Blunts Pain During Physical Therapy

This research studied, 25 adult patients who underwent physical therapy to assess the analgesic effect of distraction with the use of music during physical therapy. Patients randomly underwent physical therapy once with music provided by an iPod and once without music. In both sessions patients underwent identical physical procedures. At end of both sessions patients filled in 5-item questionnaire where they scored pain and other parameters, such as stress, enjoyment, interaction, and satisfaction, on 10-cm visual analog scale. The mean scores (range, 0-10) of the two sessions were statistically compared. Mean pain scores were significantly lower (p = .031) during the session in which patients received music (4.8 ± 2.5) than during the session without music (5.8 ± 2.3). The other items of the questionnaire did not disclose any statistically significant difference when the sessions with versus without music were compared. Enjoyment (8.5 ± 1.6), interaction (8.3 ± 1.9), and satisfaction (8.6 ± 1.7) scores with music did not significantly differ in the sessions without music (8.5 ± 2.1, 8.5 ± 1.9, and, 8.5 ± 1.5, respectively); mean stress score was, 3.9 in both sessions. The conclusion of the study is that music provided through a portable media player has an analgesic effect. This can be an effective analgesic strategy during painful physical therapy.     

Effects of Hypnotic Analgesia and Virtual Reality on the Reduction of Experimental Pain Among High and Low Hypnotizables

This research compared a no-treatment control condition and 3 experimentally induced pain treatment conditions: (a) virtual reality distraction (VRD), (b) hypnotic analgesia (HA), and (c) HA + VRD in relieving finger-pressure pain. After receiving baseline pain stimulus, each participant received hypnosis or no hypnosis, followed by VRD or no VRD during another pain stimulus. The data analysis indicated that, overall, all 3 treatments were more effective compared to the control group, irrespective of whether it involved hypnotic analgesia, virtual reality distraction, or both (hypnosis and virtual reality). Nevertheless, the participants responded differently to the pain treatment, depending on the hypnotizability level. High hypnotizables reported hypnotic analgesia, but low hypnotizables did not show hypnotic analgesia. VR distraction reduced pain regardless of hypnotizability.     

Virtual reality helmet display quality influences the magnitude of virtual reality analgesia.

Immersive Virtual Reality (VR) distraction can be used in addition to traditional opioids to reduce procedural pain. The current study explored whether a High-Tech-VR helmet (ie, a 60-degree field-of-view head-mounted display) reduces pain more effectively than a Low-Tech-VR helmet (a 35-degree field-of-view head-mounted display). Using a double-blind between-groups design, 77 healthy volunteers (no patients) aged 18-23 were randomly assigned to 1 of 3 groups. Each subject received a brief baseline thermal pain stimulus, and the same stimulus again minutes later while in SnowWorld using a Low-Tech-VR helmet (Group 1), using a High-Tech-VR helmet (Group 2), or receiving no distraction (Group 3, control group). Each participant provided subjective 0-10 ratings of cognitive, sensory, and affective components of pain, and amount of fun during the pain stimulus. Compared to the Low-Tech-VR helmet group, subjects in the High-Tech-VR helmet group reported 34% more reduction in worst pain (P < .05), 46% more reduction in pain unpleasantness (P = .001), 29% more reduction in "time spent thinking about pain" (P < .05), and 32% more fun during the pain stimulus in VR (P < .05). Only 29% of participants in the Low-Tech helmet group, as opposed to 65% of participants in the High-Tech-VR helmet group, showed a clinically significant reduction in pain intensity during virtual reality. These results highlight the importance of using an appropriately designed VR helmet to achieve effective VR analgesia (see ). PERSPECTIVE: Pain during medical procedures (eg, burn wound care) is often excessive. Adjunctive virtual reality distraction can substantially reduce procedural pain. The results of the present study show that a higher quality VR helmet was more effective at reducing pain than a lower quality VR helmet.     

Repetitive Transcranial Magnetic Stimulation Is Efficacious as an Add-On to Pharmacological Therapy in Complex Regional Pain Syndrome (CRPS) Type I

Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is effective in the treatment of chronic pain patients, but the analgesic effect of repeated sessions is still unknown. We evaluated the effects of rTMS in patients with refractory pain due to complex regional pain syndrome (CRPS) type I. Twenty-three patients presenting CRPS type I of 1 upper limb were treated with the best medical treatment (analgesics and adjuvant medications, physical therapy) plus 10 daily sessions of either real (r-) or sham (s-) 10Hz rTMS to the motor cortex (M1). Patients were assessed daily and after 1 week and 3 months after the last session using the Visual Analogical Scale (VAS), the McGill Pain Questionnaire (MPQ), the Health Survey-36 (SF-36), and the Hamilton Depression (HDRS). During treatment there was a significant reduction in the VAS scores favoring the r-rTMS group, mean reduction of 4.65 cm (50.9%) against 2.18 cm (24.7%) in the s-rTMS group. The highest reduction occurred at the tenth session and correlated to improvement in the affective and emotional subscores of the MPQ and SF-36. Real rTMS to the M1 produced analgesic effects and positive changes in affective aspects of pain in CRPS patients during the period of stimulation.     

Virtual reality as an adjunctive pain control during burn wound care in adolescent patients

For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16-year-old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the 'real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.     

Does cartoon movie distraction decrease burned children's pain behavior?

The purpose of this study was to evaluate cartoon movie viewing as a practical and low-cost intervention to decrease burned children's pain behavior during dressing changes. Thirteen children, 4 to 12 years of age, with a mean TBSA burn of 7.9% were assessed using a reversal, single-subject experimental design. The experimental condition consisted of the presentation of a cartoon movie as a nonpharmacologic intervention in conjunction with a standardized analgesic medication. In the control condition children's pain was treated with the standardized analgesic medication only. Behavioral distress was measured during the first six dressing changes postburn with the Observational Scale of Behavioral Distress. No significant effect of cartoon movie distraction on observed behavioral distress in patients was found. Interrater reliability of the Observational Scale of Behavioral Distress was good (kappa =.87-.98). Wound debridement was found to be the most painful part of the dressing change. A simple, easily applicable, and low-cost distraction intervention such as presenting cartoon movies does not seem to be sufficiently powerful to measurably reduce burned children's distress during dressing changes. Findings are based on purely observational data. Inclusion of self-report measures in future studies might reveal intervention effects on anxiety and subjective pain perception.     

Percutaneous neuromodulation therapy; does the location of electrical stimulation effect the acute analgesic response? (University of Texas Southwestern Medical Center at Dallas,Dallas, TX) Anesth Analg 2000;91:949–954.

This article studied the effect of the location of electrical stimulation on the acute analgesic response to percutaneous neuromodulation therapy in patients with nonradiating neck pain. Sixty‐eight patients received 3 different nonpharmacologic modalities, namely “needles only (neck), local (neck) dermatomal stimulation, and remote (lower back) dermatomal stimulation in a random sequence over the course of an 11‐week study period. All treatments were given for 30 min, 3 times per week for 3 weeks with 1 week “off” between each modality. The assessment tools included the health status survey short form (SF‐36) questionnaire as well as 10‐cm visual analog scales for assessing pain, physical activity, and quality of sleep. The pain visual analog scale was repeated 5‐10 min after each treatment session. The daily oral nonopioid analgesic requirements were recorded in the patient diary during the entire study period. At the end of each 3‐week treatment block, the SF‐36 questionnaire was repeated. Compared with needles only and remote dermatomal stimulation, local dermatomal stimulation produced a significantly greater decrease in pain, increase in physical activity, and improvement in the quality of sleep compared with baseline values (P < 0.05). The posttreatment SF‐36 test results revealed that all 3 modalities produced improvements compared with the prestudy scores for both the physical component summary and mental component summary. However, the magnitude of the changes in the physical component summary and mental component summary with local dermatomal stimulation was significantly greater than needle only or remote dermatomal stimulation. No side effects were reported at the needle insertion sites. Conclude that electrical stimulation at the specific dermatomal levels corresponding to the local pathology produces greater short‐term improvements in pain control, physical activity, and quality of sleep in patients with chronic neck pain. Comment by Alan Kaye, M.D. Percutaneous neuromodulation is a therapy in which percutaneous electrical nerve stimulation is applied for short‐term relief of various pain syndromes. In this study involving 68 patients by White et al, the effects of neuromodulation therapy were studied with nonradiating neck pain. Local dermatomal stimulation consisted of placement of 10 32‐gauge stainless steel acupuncture needle probes to a depth of 2‐4 cm into the soft tissue and paraspinous muscles in the cervical region. For electrical therapy, 10 probes were connected to 5 bipolar leads from a low‐output electrical generator and stimulated for 30 min at 15 and 30 cycles/s. Finally, remote dermatomal electrical therapy consisted of placement of 10 32‐gauge stainless steel acupuncture‐like needle probes to a depth of 2‐4 cm into the soft tissue and/or paraspinous muscle in the lower back region. Each modality was administered to all patients 3 times per week for 3 consecutive weeks with 1 week off between each modality. Most parameters compared after demonstrated improvement locally and a reduction in daily usage of oral nonopioid analgesic medications. Future studies are warranted, in particular those in which long‐term benefits are assessed. The authors should be commended for studying this alternative treatment strategy and its role in mediating or modulating complex pain syndromes.     

Real Bodies Not Required? Placebo Analgesia and Pain Perception in Immersive Virtual and Augmented Reality

Pain represents an embodied experience, wherein inferences are not only drawn from external sensory inputs, but also from bodily states. Previous research has demonstrated that a placebo administered to an embodied rubber hand can effectively induce analgesia, providing first evidence that placebos can work even when applied to temporarily embodied, artificial body parts. Using a heat pain paradigm, the present study investigates placebo analgesia and pain perception during virtual embodiment. We examined whether a virtual placebo (a sham heat protective glove) can successfully induce analgesia, even when administered to a virtual body. The analgesic efficacy of the virtual placebo to the real hand (augmented reality setting) or virtual hand (virtual reality setting) was compared to a physical placebo administered to the own, physical body (physical reality setting). Furthermore, pain perception and subjective embodiment were compared between settings. In this mixed design experiment, healthy participants (n = 48) were assigned to either an analgesia-expectation or control-expectation group, where subjective and objective pain was measured at pre- and post-intervention time points. Results demonstrate that pre-intervention pain intensity was lower in the virtual reality setting, and that participants in the analgesia-expectation group, after the intervention, exhibited significantly higher pain thresholds, and lower pain intensity and unpleasantness ratings than control-expectation participants, independent of the setting. Our findings show that a virtual placebo can elicit placebo analgesia comparable to that of a physical placebo, and that administration of a placebo does not necessitate physical bodily interaction to produce analgesic responses.PerspectiveThis study demonstrates that a virtual placebo treatment, even when administered to a virtual body, can produce placebo analgesia. These findings indicate that the efficacy of a virtual placebo is comparable to that of a physical placebo, which could pave the way for effective new non-pharmacological approaches for pain management.     

Can virtual reality reduce pain and anxiety in pediatric emergency care and promote positive response of parents of children? A quasi-experimental study

AimTo evaluate the effectiveness of virtual reality to reduce pain and anxiety in pediatric patients during venipuncture procedure in emergency care and the behavioral response of their parents/companions.BackgroundVirtual reality is being used as a source of distraction in children undergoing invasive procedures.MethodsQuasi-experimental study with 458 children (from 2 to 15 years) who attended a pediatric emergency service from September 2019 to April 2021. An intervention based on virtual reality as a distraction method during venipuncture procedure was applied. The level of pain and anxiety of children and attitude of parents/companions were assessed. Ordinal and binary logistic regressions were applied.ResultsA protective effect of using virtual reality was observed in the intervention group both for the absence of pain (−4.12; 95 % CI: −4.85 to −3.40) and anxiety (−1.71; 95 % CI: −2.24 to −1.17) in children aged between 2 and 15 years. A significant reduction in the blocking response of the accompanying parents (−2.37; 95 % CI: −3.017 to −1.723) was also observed.ConclusionsVR is effective in reducing pain and anxiety in children during venipuncture in emergency care. A positive attitude of the parents during the invasive procedure to their children was found.     

Catastrophizing delays the analgesic effect of distraction

Behavioral analgesic techniques such as distraction reduce pain in both clinical and experimental settings. Individuals differ in the magnitude of distraction-induced analgesia, and additional study is needed to identify the factors that influence the pain relieving effects of distraction. Catastrophizing, a set of negative emotional and cognitive processes, is widely recognized to be associated with increased reports of pain. We sought to evaluate the relationship between catastrophizing and distraction analgesia. Healthy participants completed three sessions in a randomized order. In one session (Pain Alone), pain was induced by topical application of a 10% capsaicin cream and simultaneous administration of a tonic heat stimulus. In another session (Pain + Distraction), identical capsaicin + heat application procedures were followed, but subjects played video games that required a high level of attention. During both sessions, verbal ratings of pain were obtained and participants rated their degree of catastrophizing. During the other session (Distraction Alone) subjects played the video games in the absence of any pain stimulus. Pain was rated significantly lower during the distraction session compared to the “Pain Alone” session. In addition, high catastrophizers rated pain significantly higher regardless of whether the subjects were distracted. Catastrophizing did not influence the overall degree of distraction analgesia; however, early in the session high catastrophizers had little distraction analgesia, though later in the session low and high catastrophizers rated pain similarly. These results suggest that both distraction and catastrophizing have substantial effects on experimental pain in normal subjects and these variables interact as a function of time.     

Virtual Reality Hypnosis for Pain Associated With Recovery From Physical Trauma

Pain following traumatic injuries is common, can impair injury recovery and is often inadequately treated. In particular, the role of adjunctive nonpharmacologic analgesic techniques is unclear. The authors report a randomized, controlled study of 21 hospitalized trauma patients to assess the analgesic efficacy of virtual reality hypnosis (VRH)—hypnotic induction and analgesic suggestion delivered by customized virtual reality (VR) hardware/software. Subjective pain ratings were obtained immediately and 8 hours after VRH (used as an adjunct to standard analgesic care) and compared to both adjunctive VR without hypnosis and standard care alone. VRH patients reported less pain intensity and less pain unpleasantness compared to control groups. These preliminary findings suggest that VRH analgesia is a novel technology worthy of further study, both to improve pain management and to increase availability of hypnotic analgesia to populations without access to therapist-provided hypnosis and suggestion.     

Effects of Patient Education and Distraction Approaches Using Virtual Reality on Pre-operative Anxiety and Post-operative Pain in Patients Undergoing Laparoscopic Cholecystectomy

BackgroundFear of post-operative pain often contributes to pre-operative anxiety; accordingly, pain and anxiety are among the most common complications in patients undergoing laparoscopic cholecystectomy (LC).AimThe present study aimed to determine the effects of patient education and distraction using virtual reality (VR) on pre-operative anxiety and post-operative pain in patients undergoing LC.MethodThis randomized clinical trial included 150 patients in the surgery wards of educational hospitals in Mashhad, Iran, in 2020. The participants were randomly assigned to three groups of education, distraction, and control. The education and distraction groups watched two five-minute animations and three 360-degree images of nature using VR glasses 2 hours before and 4 hours after the surgery, respectively. On the other hand, the control group received routine care. Anxiety was measured using Spielberger's State Anxiety Inventory before and half an hour after the intervention. Moreover, the pain was measured using the visual analog scale and McGill Pain Questionnaire.ResultsThe results demonstrated a significant reduction in the two VR groups regarding the pre-operative anxiety mean scores, compared with the control group (p < .001). Furthermore, a significant reduction was observed in post-operative pain scores of patients in the two intervention groups compared with the control group (p = .001).ConclusionsAs evidenced by the results, both VR approaches of patient education and distraction equally decreased pre-operative anxiety and post-operative pain in patients undergoing LC.     

Virtual Reality as a Clinical Tool for Pain Management

Purpose of Review

To evaluate the use of virtual reality (VR) therapies as a clinical tool for the management of acute and chronic pain.

Recent Findings

Recent articles support the hypothesis that VR therapies can effectively distract patients who suffer from chronic pain and from acute pain stimulated in trials. Clinical studies yield promising results in the application of VR therapies to a variety of acute and chronic pain conditions, including fibromyalgia, phantom limb pain, and regional specific pain from past injuries and illnesses.

Summary

Current management techniques for acute and chronic pain, such as opioids and physical therapy, are often incomplete or ineffective. VR trials demonstrate a potential to redefine the approach to treating acute and chronic pain in the clinical setting. Patient immersion in interactive virtual reality provides distraction from painful stimuli and can decrease an individual’s perception of the pain. In this review, we discuss the use of VR to provide patient distraction from acute pain induced from electrical, thermal, and pressure conditions. We also discuss the application of VR technologies to treat various chronic pain conditions in both outpatient and inpatient settings.

     

虚拟现实技术在术后疼痛管理中的应用进展

术后疼痛管理越来越受人关注。目前针对术后疼痛的治疗,常见的方式是药物疗法,与单用药物镇痛相比,非药物疗法辅助镇痛在疼痛管理中效果显著。虚拟现实技术辅助镇痛兼具趣味性与实用性,是近年来备受推崇的非药物疗法。本文综述了虚拟现实技术的分类、镇痛机制、在术后急慢性疼痛管理中的应用现状,存在问题等,为虚拟现实技术在术后疼痛管理的临床实践提供参考     

Percutaneous electrical nerve stimulation: an alternative to TENS in the management of sciatica.

Sciatica is a common pain problem and current pharmacologic therapies have proven inadequate for many patients. The objective of this sham-controlled investigation was to compare a novel non-pharmacologic technique, percutaneous electrical nerve stimulation (PENS), to transcutaneous electrical nerve stimulation (TENS) in the management of the radicular pain associated with sciatica. Sixty-four consenting patients with sciatica due to lumbar disc herniation were treated with PENS, TENS and sham-PENS according to a randomized, single-blinded, cross-over study. All patients had been maintained on a stable oral non-opioid analgesic regimen for at least 6 weeks prior to entering the study. Each treatment modality was administered for a period of 30 min three times per week for 3 weeks, with 1 week 'off' between each modality. Both PENS and TENS treatments were administered using a stimulation frequency of 4 Hz. The pre-treatment assessment included the health status survey short form (SF-36), as well as visual analog scales (VAS) for radicular pain, physical activity and quality of sleep. The pain VAS was also repeated after each treatment session. At the end of each 3-week treatment block, the SF-36 was repeated. After receiving all three treatment modalities, a global assessment questionnaire was completed. Both PENS (42%) and TENS (23%) were significantly more effective than the sham (8%) treatments in decreasing VAS pain scores. The daily oral analgesic requirements were also significantly reduced compared to the pre-treatment values with PENS (P<0.01) and TENS (P<0.05). However, PENS was significantly more effective than TENS (and sham-PENS) in improving physical activity and quality of sleep. The SF-36 evaluation confirmed the superiority of PENS (versus TENS and sham-PENS) with respect to post-treatment functionality. In the overall assessment, 73% of the patients reported that PENS was the most desirable modality (versus 21% for TENS and 6% for sham-PENS). Finally, 71% of the patients stated that they would be willing to pay extra to receive PENS therapy compared to 22% and 3% for TENS and sham-PENS, respectively. In this sham-controlled study, we concluded that PENS was more effective than TENS when administered at a stimulation frequency of 4 Hz in providing short-term pain relief and improved functionality in patients with sciatica.     

Exposure to an Immersive Virtual Reality Environment can Modulate Perceptual Correlates of Endogenous Analgesia and Central Sensitization in Healthy Volunteers

Virtual reality (VR) has been shown to produce analgesic effects during different experimental and clinical pain states. Despite this, the top-down mechanisms are still poorly understood. In this study, we examined the influence of both a real and sham (ie, the same images in 2D) immersive arctic VR environment on conditioned pain modulation (CPM) and in a human surrogate model of central sensitization in 38 healthy volunteers. CPM and acute heat pain thresholds were assessed before and during VR/sham exposure in the absence of any sensitization. In a follow-on study, we used the cutaneous high frequency stimulation model of central sensitization and measured changes in mechanical pain sensitivity in an area of heterotopic sensitization before and during VR/sham exposure. There was an increase in CPM efficiency during the VR condition compared to baseline (P < .01). In the sham condition, there was a decrease in CPM efficiency compared to baseline (P < .01) and the real VR condition (P < .001). Neither real nor sham VR had any effect on pain ratings reported during the conditioning period or on heat pain threshold. There was also an attenuation of mechanical pain sensitivity during the VR condition indicating a lower sensitivity compared to sham (P < .05). We conclude that exposure to an immersive VR environment has no effect over acute pain thresholds but can modulate dynamic CPM responses and mechanical hypersensitivity in healthy volunteers.PerspectiveThis study has demonstrated that exposure to an immersive virtual reality environment can modulate perceptual correlates of endogenous pain modulation and secondary hyperalgesia in a human surrogate pain model. These results suggest that virtual reality could provide a novel mechanism-driven analgesic strategy in patients with altered central pain processing.