Visual feedback manipulation in virtual reality alters movement-evoked pain perception in chronic low back pain

Movement-evoked pain in chronic low back pain (LBP) can be influenced by visual cues linked to threatening movements. This study explored whether manipulating visual proprioceptive feedback via virtual reality (VR) alters movement-evoked pain and if individuals with higher pain, kinesiophobia, disability, or catastrophising are more susceptible to these manipulations. Cross-sectional study with 50 patients with non-specific chronic LBP. Participants performed lumbar spine extension until pain onset with and without VR. VR feedback was manipulated to show 10% less (E -) or 10% more (E +) movement than actual extension. Range of motion (ROM) was measured using an electro-goniometer. Within-group differences across control (E), E -, and E + conditions were assessed with Friedman tests. VR underestimation (E -) led to a 20% increase in ROM compared to the control (E; p = 0.002) and a 22% increase compared to overestimation (E +; p < 0.001). Patients with higher kinesiophobia and disability showed greater improvement in the E - condition. Manipulating visual-proprioceptive information through VR altered pain thresholds in chronic LBP. Underestimated movement (E -) delayed pain onset by extending ROM. Kinesiophobia and disability significantly influenced susceptibility to visual feedback.