Table 1.

Current Research of Virtual Reality (VR) Treatment of Chronic Pain

Title	Method	Result
Do Neck Kinematics Correlate with Pain Intensity, Neck Disability or with Fear of Motion?16	Twenty-five patients (19 females, 6 males; mean age 39±12.7 years) with chronic neck pain participated in this cross-sectional study. A customized VR system was employed to evaluate cervical range of motion (ROM) and kinematics, using an interactive game controlled by cervical motion via electromagnetic tracking. Self-reported outcome measures included pain intensity (visual analog scale), disability (Neck Disability Index), and fear of motion (TAMPA scale of kinesiophobia). Kinematic measures included cervical ROM, mean and peak velocity, and number of velocity peaks (NVP) reflecting smoothness of motion.	Results showed significant correlations of approximately 0.4–0.6 between ROM and fear of motion, pain intensity, and disability. All 12 kinematic measures were correlated with fear of motion, but only a few were correlated with pain intensity, and with disability. The results emphasize fear of motion as a subjective measure primarily correlated with neck kinematics, including range, velocity, and smoothness of cervical motion. The level of neck disability was found to be partly related to ROM or to other kinematic impairments. However, ROM by itself remains a valid measure related to pain intensity and to fear of motion in patients with chronic neck pain. All correlations demonstrated were moderate, indicating that these measures involve other factors in need of further research.
A Virtual Reality System Combined with Biofeedback for Treating Pediatric Chronic Headache—A Pilot Study17	Ten children attending an outpatient pediatric neurology clinic were treated by the proposed system. Participants practiced relaxation with biofeedback and learned to associate successful relaxation with positive pain-free virtual images of themselves.	Nine patients completed the 10-session intervention. Ratings of pain, daily functioning, and quality of life improved significantly at 1 and at 3 months post-treatment. Most patients reported applying their newly acquired relaxation and imagery skills to relieve headache outside the lab.
Virtual Visual Effect of Hospital Waiting Room on Pain Modulation in Healthy Subjects and Patients with Chronic Migraine18	Sixteen CM and 16 controls underwent 62 channels LEPs from the right hand, during a fully immersive VR experience, where two types of waiting rooms were simulated. The RH simulated a classical hospital waiting room while the IH represented a room with sea viewing.	CM patients showed a reduction of laser pain rating and vertex LEPs during the IH vision. The sLORETA analysis confirmed that in CM patients the two VR simulations induced a different modulation of bilateral parietal cortical areas (precuneus and superior parietal lobe), and superior frontal and cingulate girus, in respect to controls.
Virtual Reality in the Treatment of Fibromyalgia: A Pilot Study19	The sample comprised six women diagnosed with fibromyalgia (FM) according to the American College of Rheumatology guidelines (1990). The treatment program consisted of 10 sessions of group CBT with the support of an adaptive virtual environment (VE) containing a specific content for developing relaxation and mindfulness skills. Patients were assessed at pretreatment, post-treatment, and at a 6 months follow-up for the following outcome variables: functional status related to pain, depression, a negative and positive affect, and coping skills.	The results showed the long-term benefits of significantly reduced pain and depression and an increased positive affect and use of healthy coping strategies.
Using Mirror Visual Feedback and Virtual Reality to Treat Fibromyalgia20	We have previously used noninvasive mirror visual feedback to treat subjects with chronic pain from phantom limbs and suggested its use for complex regional pain syndrome: once considered intractable pain. We wondered whether such methods would work to alleviate the chronic pain of FM. We tested mirror visual feedback on one FM patient.	On 15 trials, the patient's lower limb pain rating (on a scale from 1 to 10) decreased significantly. These preliminary results suggest that noninvasive dissociative anesthetics such as VR goggles, ketamine, and mirror visual feedback could be used to alleviate chronic pain from FM.
Nonimmersive Virtual Reality Mirror Visual Feedback Therapy and Its Application for the Treatment of Complex Regional Pain Syndrome: An Open-Label Pilot Study21	A small open-label case series. Five patients with complex regional pain syndrome received VR mirror visual feedback therapy once a week for five to eight sessions on an outpatient basis. Patients were monitored for continued medication use and pain intensity.	Four of the five patients showed >50% reduction in pain intensity. Two of these patients ended their visits to our pain clinic after five sessions.
Neck Pain Assessment in a Virtual Environment22	Cervical range of motion (CROM) measures were collected from 25 symptomatic and 42 asymptomatic individuals using VR and conventional assessments. Analysis of variance was used to determine differences between groups and assessment methods. Logistic regression analysis, using a single predictor, compared the diagnostic ability of both methods.	Results obtained by both methods demonstrated significant CROM limitations in the symptomatic group. The VR measures showed greater CROM and sensitivity while conventional measures showed greater specificity. A single session exposure to VR resulted in a significant increase in CROM.
Virtual Reality Hypnosis for Pain Associated with Recovery from Physical Trauma23	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 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.
Effects of Virtual Reality Immersion and Audiovisual Distraction Techniques for Patients with Pruritus24	Twenty-four patients suffering from chronic pruritus—16 due to atopic dermatitis and eight due to psoriasis vulgaris—were randomly assigned to play an interactive computer game using a special visor or a computer screen. Pruritus intensity was self-rated before, during, and 10 minutes after exposure using a visual analog scale ranging from 0 to 10. The interviewer rated observed scratching on a three-point scale during each distraction program.	Student's t tests were significant for reduction of pruritus intensity before and during VRI and AVD (p=0.0002 and p=0.01 respectively), and were significant only between ratings before and after VRI (p=0.017). Scratching was mostly absent or mild during both programs.
Exploratory Findings with Virtual Reality for Phantom Limb Pain: From Stump Motion to Agency and Analgesia25	A sample of subjects with “arm” (n=7) and “leg” (n=7) amputations underwent trials of a VR system, controlled by motion captured from their stump, which was translated into movements of a virtual limb within the VR environment. Measures of pain in the phantom limb were elicited from patients before and during this exercise as they attempted to gain agency for the movement they saw, and feel embodied within the limb. After this, each subject was interviewed about their experiences.	Five subjects in each group felt the virtual limb to be moved by them and felt sensations of movement within it. With this, they also reported reductions in their phantom limb pain greater than expected from distraction alone. No carry over effect was seen.