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Updated: Sep 20, 2025

The use of Biofeedback in Clinical Virtual Reality: The INTREPID Project
Published on: November 12, 2009
Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating
Nnamdi Orakpo1, Chujun Yuan1, Olanrewaju Olukitibi1
1Department of Psychiatry, Garnet Health Medical Center, Middletown, NY, United States.
Abstract:
This case report concerns a patient with clinically diagnosed moderate-severe insomnia secondary to chronic lower back pain and sciatica, previously treated with hydrocodone, naproxen, cyclobenzaprine and nightly diazepam. He underwent a trial of 20 sessions of virtual reality neurofeedback therapy (VR-NFB) at infra-low frequency, and by the end of 20 sessions achieved sustained analgesia and consequently, a complete resolution of his pain-related insomnia. Follow-up at 1 year confirmed his improvements were sustained, and he maintained his abstinence from sedatives, as observed on the Prescription Monitoring Program for controlled substances. This case highlights the importance of understanding chronic pain and its connection with restorative sleep: incorporating endogenous neuromodulation in behavioral sleep medicine helped to diminish the risk of benzodiazepine use disorder. This may be the first case of complete resolution of chronic pain with comorbid insomnia after treatment with VR-NFB at the infra-low frequency.
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