Immersive virtual reality for neuropathic pain management in spinal cord injury: A randomized controlled trial

To evaluate the efficacy of immersive virtual reality (VR) in reducing neuropathic pain (NP) in individuals with spinal cord injury (SCI).

To assess the impact of immersive VR on depersonalization symptoms in the SCI population.

Double-blind, randomized controlled trial.

Rehabilitation unit of a tertiary care teaching hospital in South India.

Fifty-two individuals with SCI (ASIA A, B, and C) who had a LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) score ≥12 and were on stable pharmacological treatment. Participants were randomized using computer-generated block randomization.

The intervention group received immersive VR exposure via a head-mounted display, involving virtual tasks such as wheelchair propulsion, cycling, and walking, for 15 min per session, twice daily, five days a week, over two weeks. The control group viewed 2D animated films of equivalent duration using the same device.

Visual Analog Scale (VAS) for neuropathic pain and Cambridge Depersonalization Scale (CDS) for depersonalization.

Forty-three participants completed the trial (intervention: n = 23; control: n = 20). The intervention group demonstrated a significant reduction in VAS scores from 59.35 to 37.61 (a 36.63% reduction), while the control group showed a reduction from 59.00 to 48.00 (an 18.64% reduction). The between-group difference in VAS score change was statistically significant. CDS scores also improved significantly in the intervention group compared to the control group.

Immersive VR is a promising nonpharmacological, non-invasive intervention for managing neuropathic pain in individuals with SCI. It is associated with improved embodiment and reduced depersonalization symptoms, offering a potential pathway to enhance quality of life. Its portability, minimal adverse effects, and ease of customization make it a viable adjunct to conventional rehabilitation strategies.