Modulating Pain via Virtual-Reality-based Interoceptive Modeling: A Randomized Crossover Experiment in an All-Female...

Pain is a complex, multidimensional experience rooted in interoceptive processing. Interoceptive Modeling - overwriting interoceptive pain representations via multisensory feedback - may be effectively implemented using virtual reality (VR) and as such may provide a novel avenue for pain management, yet empirical testing is lacking. This multicenter randomized crossover basic experimental study set out to determine the effects of VR-based Interoceptive Modeling on perceived pain (intensity, unpleasantness, coping) and autonomic nervous system activity in response to an acute thermal pain stimulus. 60 healthy females (M_age=25.13, SD_age=3.04) were assigned to two VR-based exposures in randomized order with a one-week washout period in between: an experimental condition featuring VR-Interoceptive Modeling, and a control condition featuring VR-based pain visualization without interoceptive modeling. Pain was induced using Capsaicin cream applied to the volar forearm. Following the intervention, the experimental condition reported significantly lower pain intensity compared to the control condition (Mdiff=5.30, 95% CI, 0.34 to 10.27, p=.037). In the control condition, pain intensity and unpleasantness increased significantly during the procedure. Conversely, in the experimental condition, both pain intensity (Mdiff=1.33, 95% CI, -2.62 to 5.28; p>.99) and unpleasantness (Mdiff=0.97, 95% CI, -3.34 to 5.28; p>.99) stabilized during the interoceptive modeling phase. Moreover, the experimental condition demonstrated superior vagal recovery (higher RMSSD; Mdiff=6.97, 95% CI, 3.12 to 10.83, t(199)=3.57, p<.001) and HF Power (Mdiff=252.1; 95% CI, 119.7 to 384.4, t(357)=3.75, p<.001) immediately post-intervention. Although further research is necessary, these findings support Interoceptive Modeling as a novel mechanism that leverages VR technology to enable personalized modulation of pain symptoms. PERSPECTIVE: This experimental study in an all-female sample demonstrates that VR-based Interoceptive Modeling can stabilize and reduce experimentally induced pain while enhancing autonomic recovery, suggesting modulation of interoceptive representations as a key mechanism. These findings provide a first indication that Interoceptive Modeling constitutes a promising approach for personalized, non-pharmacological pain management.