Immediate and Short-Term Effects of Nature-Based Immersive Virtual Reality During Dry Needling: A Single-Blinded...

Objectives: This study aimed to investigate the effects of nature-based immersive virtual reality (IVR) applied during dry needling (DN) on pain experienced during the procedure and on immediate and short-term post-intervention outcomes, compared with traditional DN, with a primary focus on immediate post-intervention pain intensity. Methods: In this single-blinded randomized controlled trial, participants were randomly assigned to the control (DN) or experimental (DN + IVR) group. Eligible participants were healthy individuals with identifiable latent myofascial trigger points (MTPs) in the quadriceps muscles. The primary outcome was pain intensity, measured using a numerical rating scale (NRS), immediately after the intervention. Secondary outcomes included pressure pain threshold (PPT) and pain intensity at follow-up time points (1, 6, and 24 h). Linear mixed-effects models were used to analyze the effects of group, time, and their interactions. Results: A total of 40 participants (control group, n = 21, 21.7 ± 3.1 years, 15 males; experimental group, n = 19, 22.4 ± 3.7 years, 11 males) were included. The DN + IVR group showed significantly lower pain intensity immediately after the intervention than the DN group (p = 0.032). Pain intensity decreased over time in both groups (p < 0.001), with no significant intergroup differences at later time points (all p > 0.05). For PPT, a significant effect of time was observed (p < 0.001), but no significant group × time interaction was observed. Conclusions: Nature-based IVR may reduce immediate procedural pain associated with dry needling, although these effects are not sustained over time. IVR may be a useful non-pharmacological strategy for pain relief during invasive physiotherapy procedures.