Virtual reality technology may relieve pain through neurophysiologic changes related to conditioning and exposure, in addition to mechanisms involving distraction, according to the results of a recent selective review published in Pain Medicine.

The researchers evaluated articles published between 2000 and 2016 that investigated the mechanisms underlying the effects of virtual reality on pain relief. Of the 6 studies that were identified, 4 were small randomized controlled studies, and 2 were prospective studies. The mechanisms of virtual reality were considered to be distraction-based or nondistraction-based.

The review results confirmed that distraction plays a key role in the ability of virtual reality to relieve acute pain. Both the quality of virtual reality and the amount of immersion were associated with measures of pain relief.

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Nondistraction methods of pain alleviation were tested primarily in patients with chronic pain. In those patients, the goal of virtual reality interventions was to condition patients to acquire better control over their pain. For example, visuals representing pain that transitioned to visuals representing calm or happiness were used in one study.

These nondistraction-based virtual reality methods were reported to improve the perception of control over pain, increase pain awareness and bodily reaction to pain, and promote emotions and motivations related to nonpharmacologic pain management (eg, exercise for fibromyalgia).

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According to the study authors, the novel mechanisms discussed in the article may lead to the development of new virtual reality treatments, expanding options for patients with pain, and ultimately reducing opioid use.

Anita Gupta, DO, PharmD, anesthesiologist and pain specialist at the Woodrow Wilson School of Public and International Affairs at Princeton University and first author on the study, explained that “guided imagery has long been a treatment for psychological disorders, and virtual reality is a more immersive way to provide guided imagery.” She concluded that, “virtual reality is a potential option to consider for complementing the wide treatment toolbox for pain.”

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Gupta A, Scott K, Dukewich M. Innovative technology using virtual reality in the treatment of pain: Does it reduce pain via distraction, or is there more to it? [published online August 31, 2017] Pain Medicine. doi: 10.1093/pm/pnx109