Pozeg, P., Palluel, E., Ronchi, R., Solca, M., Al-Khodairy, A.-W., Jordan, X., … Blanke, O. (2017). Virtual reality improves embodiment and neuropathic pain caused by spinal cord injury. Neurology, 89(18), 1894–1903. https://doi.org/10.1212/WNL.0000000000004585. Download PDF

The present findings show that VR exposure using multisensory stimulation differently affected leg vs body ownership, and is associated with mild analgesia with potential for SCI neurorehabilitation protocols.

Jin, W., Choo, A., Gromala, D., Shaw, C., Squire, P. (2016). A Virtual Reality Game for Chronic Pain Management: A Randomized, Controlled Clinical Study. Medicine Meets Virtual Reality 22. Edited by J. D. Westwood et al. IOS Press. Read online

Crossover clinical study showed VR reduced pain in 20 chronic pain patients compared to baseline and control groups.

Cho, K. H., Kim, M. K., Lee, H., & Lee, W. H. (2015). Virtual Reality Training with Cognitive Load Improves Walking Function in Chronic Stroke Patients, 273–280. https://doi.org/10.1620/tjem.236.273.Correspondence.
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After the 4-week intervention, under both single (VR) and dual task conditions (VR+Cognitive Load), significant improvement on walking function was observed in VRTCL and control groups (P < 0.05). In addition, in the dual task condition, greater improvement on walking function was observed in the VRTCL group, compared with the control group (P < 0.05).

Sulea, C., Soomro, A., Boyd, C., & Wiederhold, B. K. (2014). Pain Management in Virtual Reality: A Comprehensive Research Chart. Cyberpsychology, Behavior, and Social Networking, 17(6), 402–413. https://doi.org/10.1089/cyber.2014.1514  Download PDF

a comprehensive listing of re- search done on pain management in virtual reality. MEDLINE was searched in October 2013 for the keywords
‘‘virtual reality and pain.’’

Herrero, R., García-Palacios, A., Castilla, D., Molinari, G., & Botella, C. (2014). Virtual reality for the induction of positive emotions in the treatment of fibromyalgia: a pilot study over acceptability, satisfaction, and the effect of virtual reality on mood. Cyberpsychology, Behavior and Social Networking, 17(6), 379–84. doi:10.1089/cyber.2014.0052 Download PDF

Results showed significant increases in general mood state, positive emotions, motivation, and self-efficacy. These preliminary findings show the potential of VR as an adjunct to the psychological treatment of such an important health problem as chronic pain.

Loreto-Quijada, D., Gutiérrez-Maldonado, J., Nieto, R., Gutiérrez-Martínez, O., Ferrer-García, M., Saldaña, C., & Liutsko, L. (2014). Differential effects of two virtual reality interventions: distraction versus pain control. Cyberpsychology, Behavior and Social Networking, 17(6), 353–8. doi:10.1089/cyber.2014.0057 Download PDF

Pain control was more effective than simple distraction.

Tanja-Dijkstra, K., Pahl, S., White, M. P., Andrade, J., Qian, C., Bruce, M., Moles, D. R. (2014). Improving dental experiences by using virtual reality distraction: a simulation study. PloS One, 9(3), e91276. doi:10.1371/journal.pone.0091276 Download PDF

The VR distraction had effects not only on concurrent experiences, such as perceived control, but longitudinally upon the vividness of memories after the dental experience had ended. Participants with higher dental anxiety (for whom the dental procedures were presumably more aversive) showed a greater reduction in memory vividness than lower dental-anxiety participants. “This study thus suggests that VR distractions can be considered as a relevant intervention for cycles of care in which people’s previous experiences affect their behaviour for future events.”

Czub, M., & Piskorz, J. (2014). How Body Movement Influences Virtual Reality Analgesia? 2014 International Conference on Interactive Technologies and Games, 13–19. doi:10.1109/iTAG.2014.8 Download PDF

Found that using a Kinect for large motor movement in VR reduced pain better than small motor movement with a mouse.

Wiederhold, B. K., Gao, K., Sulea, C., & Wiederhold, M. D. (2014). Virtual reality as a distraction technique in chronic pain patients. Cyberpsychology, Behavior and Social Networking, 17(6), 346–52. Download PDF

Chronic pain patients demonstrated significant relief in subjective ratings of pain that corresponded to objective measurements in peripheral, noninvasive physiological measures.

Melzack, R., & Katz, J. (2013). Pain. Wiley Interdisciplinary Reviews: Cognitive Science, 4(1), 1–15. https://doi.org/10.1002/wcs.1201. Download PDF

Neuromatrix theory of pain: Pain is not simply the end product of a linear sensory transmission system; it is a dynamic process that involves continuous interactions among complex ascending and descending systems. The neuromatrix theory guides us away from the Cartesian concept of pain as a sensation produced by injury, inflammation, or other tissue pathology and toward the concept of pain as a multidimensional experience produced by multiple influences

Furman, E., Jasinevicius, T. R., Nabil, F., Victoroff, K. Z., Skillicorn, R., & Buchner, M. (2013). Virtual Reality Distraction for Pain Control During Periodontal Scaling and Root Planing Procedures. Journal of the American Dental Association, (JADA 2009;140(12):1508-1516. Download PDF

Paired t tests revealed that VAS scores were sig- nificantly lower during VR compared with the movie (P < .001) and control (P < .001) conditions. Similarly, BP and PR were lowest during VR, followed by the movie and control conditions. Patients reported that they preferred the VR condition.

Ramachandran V.S.,& Seckel E.L. (2013). Using mirror visual feedback and virtual reality to treat fibromyalgia. Medical Hypotheses 2013; 75:495–496. Download PDF

Reductions in pain and associated anxiety.

Gordon, N. S., Merchant, J., Zanbaka, C., Hodges, L. F., & Goolkasian, P. (2011). Interactive gaming reduces experimental pain with or without a head mounted display. Computers in Human Behavior, 27(6), 2123–2128. doi:10.1016/j.chb.2011.06.006 Download PDF

VR superior to Emotion Induction Task and no difference between tracked HMD and Projector at same (low) FOV

Dahlquist, L. M., Weiss, K. E., Clendaniel, L. D., Law, E. F., Ackerman, C. S., & McKenna, K. D. (2009).. Effects of videogame distraction using a virtual reality type head-mounted display helmet on cold pressor pain in children. Journal of Pediatric Psychology, 34(5), 574–84. doi:10.1093/jpepsy/jsn023 Download PDF

There was a significant increase in pain tolerance and pain threshold in both passive and interactive distraction. Distraction helmet showed more effect.

Cole J., Crowle S., Austwick G., Henderson B., Slater D. (2009). Exploratory findings with virtual reality for phantom limb pain; from stump motion to agency and analgesia. Disabil Rehabil 31(10):846–854 Download PDF

Found that when movements of the virtual limb correspond to capture motion data measured on the patient’s stump instead of the opposite remaining limb, it allows the patients to gain agency for the movement they see, and feel embodied within the limb

Mühlberger, A., Wieser, M. J., Kenntner-Mabiala, R., Pauli, P., Wiederhold, B. K., Muhlberger, A., … Wiederhold, B. K. (2007). Pain modulation during drives through cold and hot virtual environments. Cyberpsychology & Behavior : The Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society, 10(4), 516–22. https://doi.org/10.1089/cpb.2007.9996 Download PDF

” Both VR environments reduced pain for heat and cold pain stimuli when compared to the control. No significant changes in measures of Cyber sickness were detected.”

Dahlquist, L. M., McKenna, K. D., Jones, K. K., Dillinger, L., Weiss, K. E., & Ackerman, C. S. (2007). Active and passive distraction using a head-mounted display helmet: Effects on cold pressor pain in children. Health Psychololgy. 26(6), 794-801. Download PDF

” either passive or interactive distraction caused improvements in both pain tolerance and threshold. Interactive distraction was more effective than the passive.”

Gold, J. I., Kim, S. H., Kant, A. J., Joseph, M. H., & Rizzo, A. S. (2006). Effectiveness of virtual reality for pediatric pain distraction during IV placement. CyberPsychology & Behavior, 9(2), 207-212. Download PDF

All outcome scores were reduced for children in the VR group. No simulator sickness.

Magora, F., Cohen, S., Shochina, M., & Dayan, E. (2006). Virtual reality immersion method of distraction to control experimental ischemic pain. Israel Medical Association Journal, 8, 261–265. Download PDF

Pain components were significantly lower in VR. Tolerance time in VR was significantly longer than No VR.

Gold J.I., Reger G., & Rizzo A.A., et al. (2005). Virtual reality in outpatient phlebotomy: evaluating pediatric pain distraction during blood draw. Presented at the 10th Annual Poster Session of the Saban Research Institute. Los Angeles: Children’s Hospital Los Angeles; The Journal of Pain 6(3), Supplement , Page S57, March 2005. Download Abstract

Lower frequency of moderate to severe pain intensity in VR via HMD

Wolitzky K., Fivush R., Zimand E., Hodges L., & Rothbaum B.O. (2005). Effectiveness of virtual reality distraction during a painful medical procedure in pediatric oncology patients. Psychology & Health, 20(6):817–824. Download PDF

Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson’s disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of telerehabilitation. Four major findings emerge from these studies:

(1) people with disabilities appear capable of motor learning within virtual environments;

(2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks;

(3) in the few studies (n = 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and

(4) no occurrences of cybersickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.

Lee, D. W. H., Chan, A. C. W., Wong, S. K. H., Fung, T. M. K., Li, A. C. N., Chan, S. K. C., Chung, S. C. S. (2004). Can visual distraction decrease the dose of patient-controlled sedation required during colonoscopy? A prospective randomized controlled trial. Endoscopy, 36(03), 197-201. Download PDF

The mean pain score and the dose of sedative medication required in group 2 was significantly lower compare to group 1 and 3. Notably, Visual distraction alone did not decrease the dose of sedative medication required for colonoscopy. When audio distraction was added, both the dose of sedative medication required and the pain score decreased significantly. Both visual and audiovisual distraction might improve patients’ acceptance of colonoscopy.

Melzack, R. (1999). From the gate to the neuromatrix. Pain, 82(1), S121–S126. https://doi.org/10.1016/S0304-3959(99)00145-1. Download PDF

Neuromatrix theory of pain: We have traveled a long way from the psychophysical concept that seeks a simple one-to-one relationship between injury and pain. We now have a theoretical framework in which a genetically determined template for the body-self is modulated by the powerful stress system and the cognitive functions of the brain, in addition to the traditional sensory inputs. 6 1999 International Association for the Study of Pain.

Ramachandran, V. S., & Rogers-Ramachandran, D. (1996). Synaesthesia in phantom limbs induced with mirrors. Proceedings. Biological Sciences / The Royal Society, 263(1369), 377–386. Download PDF

Phantom limb pain reduced using a “virtual reality box”.