Size and Viewpoint of an Embodied Virtual Body Affect the Processing of Painful Stimuli

  • Daniele Romano
    Address reprint requests to Daniele Romano, Università degli studi di Milano Bicocca, Department of Psychology, Piazza Ateneo Nuovo 1, Milano 20126, Italy.
    University of Milan-Bicocca, Department of Psychology, Milan, Italy

    NeuroMi, Milan Center for Neuroscience, Milan, Italy

    Laboratory of Cognitive Neuroscience, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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  • Joan Llobera
    Laboratory of Cognitive Neuroscience, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Immersive Interaction Group, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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  • Olaf Blanke
    Laboratory of Cognitive Neuroscience, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Published:December 02, 2015DOI:


      • We studied physiological responses to pain under conditions of illusory embodiment.
      • We manipulated the avatar viewpoint and size.
      • We induced illusory ownership for the avatar seen from a first-person viewpoint.
      • We found smaller SCR for the avatar seen from a first-person viewpoint.
      • We found a negative correlation between the perceived avatar size and SCR to pain.


      Looking at one's own body might induce visual analgesia. However, the cognitive and physiological mechanisms underlying such visual analgesia are unknown. Because body and pain representations in the brain are multisensory, and have been reported to partially overlap, we herein investigated whether experimentally-induced changes in bodily self-consciousness (BSC) modulate pain. We measured physiological responses to pain (skin conductance response [SCR]) and the subjective experience of pain, under conditions of manipulated BSC. First we investigated whether looking at a virtual body that was associated with BSC (embodiment) reduced responses to pain, which revealed the effect of BSC on pain processing. Second, we manipulated the visual size of the virtual body during painful stimulation, a procedure known to modulate pain processing when used with biological bodies, but never studied with embodied avatars. We found reduced SCR in conditions of illusory embodiment, and a negative correlation between virtual body size and SCR, whereas subjective pain ratings were not affected by these manipulations. These results suggest that pain processing is modulated during illusory states of BSC and that these changes are greater for larger virtual bodies, which sustains that pain and its physiological mechanisms are associated with the bodily self, opening promising avenues for future pain treatments.


      We show that BSC affects the processing of painful stimuli with induction of different levels of pain responses for embodied virtual bodies of different sizes. Our data reveal novel links between pain and self and suggest that embodied virtual bodies are a promising technique for future pain treatments.

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        • Andreassi J.L.
        Psychophysiology: Human Behavior & Physiological Response.
        Lawrence Erlbaum Associates, Hillsdale, NJ2000
        • Armel K.C.
        • Ramachandran V.S.
        Projecting sensations to external objects: Evidence from skin conductance response.
        Proc Biol Sci. 2003; 270: 1499-1506
        • Benedek M.
        • Kaernbach C.
        A continuous measure of phasic electrodermal activity.
        J Neurosci Methods. 2010; 190: 80-91
        • Bernardi N.F.
        • Marino B.F.
        • Maravita A.
        • Castelnuovo G.
        • Tebano R.
        • Bricolo E.
        Grasping in wonderland: Altering the visual size of the body recalibrates the body schema.
        Exp Brain Res. 2013; 226: 585-594
        • Blanke O.
        Multisensory brain mechanisms of bodily self-consciousness.
        Nat Rev Neurosci. 2012; 13: 556-571
        • Blanke O.
        • Metzinger T.
        Full-body illusions and minimal phenomenal selfhood.
        Trends Cogn Sci. 2009; 13: 7-13
        • Botvinick M.
        • Cohen J.
        Rubber hands “feel” touch that eyes see.
        Nature. 1998; 391: 756
        • Broughton R.
        • Wasel N.
        A text-stimuli presentation manager for the IBM PC with ipsatization correction for response sets and reaction times.
        Behav Res Methods Instrum Comput. 1990; 22: 421-423
        • Brown C.A.
        • Seymour B.
        • El-Deredy W.
        • Jones A.K.
        Confidence in beliefs about pain predicts expectancy effects on pain perception and anticipatory processing in right anterior insula.
        Pain. 2008; 139: 324-332
        • Cattell R.B.
        Psychological measurement: Ipsative, normative and interactive.
        Psychol Rev. 1944; 51: 292-303
        • Cole J.
        • Crowle S.
        • Austwick G.
        • Slater D.H.
        Exploratory findings with virtual reality for phantom limb pain; from stump motion to agency and analgesia.
        Disabil Rehabil. 2009; 31: 846-854
        • Colloca L.
        • Benedetti F.
        • Pollo A.
        Repeatability of autonomic responses to pain anticipation and pain stimulation.
        Eur J Pain. 2006; 10: 659-665
        • Damasio A.
        • Meyer K.
        Consciousness: An overview of the phenomenon and of its possible neural basis.
        in: Laureys S. Tononi G. The Neurology of Consciousness: Cognitive Neuroscience and Neuropathology. UK, Elsevier Academic Press, Oxford2009: 3-14
        • de Vignemont F.
        Embodiment, ownership and disownership.
        Conscious Cogn. 2011; 20: 82-93
        • de Vignemont F.
        • Ehrsson H.H.
        • Haggard P.
        Bodily illusions modulate tactile perception.
        Curr Biol. 2005; 15: 1286-1290
        • Ehrsson H.
        The concept of body ownership and its relation to multisensory integration.
        in: Stein B.E. New Handbook of Multisensory Process. MA, MIT Press, Cambridge2012: 775-792
        • Ehrsson H.H.
        The experimental induction of out-of-body experiences.
        Science. 2007; 317: 1048
        • Gallese V.
        • Sinigaglia C.
        The bodily self as power for action.
        Neuropsychologia. 2010; 48: 746-755
        • Gerstmann J.
        Problem of imperception of disease and of impaired body territories with organic lesions.
        Arch Neurol Psychiatry. 1942; 48: 890
        • Gläscher J.
        • Adolphs R.
        Processing of the arousal of subliminal and supraliminal emotional stimuli by the human amygdala.
        J Neurosci. 2003; 23: 10274-10282
        • Guterstam A.
        • Petkova V.I.
        • Ehrsson H.H.
        The illusion of owning a third arm.
        PLoS One. 2011; 6: e17208
        • Haggard P.
        • Iannetti G.D.
        • Longo M.R.
        Spatial sensory organization and body representation in pain perception.
        Curr Biol. 2013; 23: R164-R176
        • Hägni K.
        • Eng K.
        • Hepp-Reymond M.C.
        • Holper L.
        • Keisker B.
        • Siekierka E.
        • Kiper D.C.
        Observing virtual arms that you imagine are yours increases the galvanic skin response to an unexpected threat.
        PLoS One. 2008; 3: e3082
        • Hänsel A.
        • Lenggenhager B.
        • von Känel R.
        • Curatolo M.
        • Blanke O.
        Seeing and identifying with a virtual body decreases pain perception.
        Eur J Pain. 2011; 15: 874-879
        • Head H.
        • Holmes G.
        Sensory disturbances from cerebral lesions.
        Brain. 1911; 34: 102-254
        • Hegedüs G.
        • Darnai G.
        • Szolcsányi T.
        • Feldmann A.
        • Janszky J.
        • Kállai J.
        The rubber hand illusion increases heat pain threshold.
        Eur J Pain. 2014; 18: 1173-1181
        • Hoffman H.G.
        • Patterson D.R.
        • Carrougher G.J.
        • Sharar S.R.
        Effectiveness of virtual reality–based pain control with multiple treatments.
        Clin J Pain. 2001; 17: 229-235
        • Iannetti G.D.
        • Mouraux A.
        From the neuromatrix to the pain matrix (and back).
        Exp Brain Res. 2010; 205: 1-12
        • Kennett S.
        • Taylor-Clarke M.
        • Haggard P.
        Noninformative vision improves the spatial resolution of touch in humans.
        Curr Biol. 2001; 11: 1188-1191
        • Kilteni K.
        Over my fake body: Body ownership illusions for studying the multisensory basis of own-body perception.
        Front Hum Neurosci. 2015; 9: 141
        • Lenggenhager B.
        • Mouthon M.
        • Blanke O.
        Spatial aspects of bodily self-consciousness.
        Conscious Cogn. 2009; 18: 110-117
        • Lenggenhager B.
        • Tadi T.
        • Metzinger T.
        • Blanke O.
        Video ergo sum: Manipulating bodily self-consciousness.
        Science. 2007; 317: 1096-1099
        • Lenz F.A.
        • Casey K.L.
        • Jones E.G.
        • Willis W.D.
        Organization of the central pain pathways.
        in: The Human Pain System. Cambridge University Press, Cambridge2010: 64-195
        • Longo M.R.
        • Betti V.
        • Aglioti S.M.
        • Haggard P.
        Visually induced analgesia: Seeing the body reduces pain.
        J Neurosci. 2009; 29: 12125-12130
        • Longo M.R.
        • Iannetti G.D.
        • Mancini F.
        • Driver J.
        • Haggard P.
        Linking pain and the body: Neural correlates of visually induced analgesia.
        J Neurosci. 2012; 32: 2601-2607
        • Longo M.R.
        • Schüür F.
        • Kammers M.P.
        • Tsakiris M.
        • Haggard P.
        What is embodiment? A psychometric approach.
        Cognition. 2008; 107: 978-998
        • Mancini F.
        • Longo M.R.
        • Kammers M.P.
        • Haggard P.
        Visual distortion of body size modulates pain perception.
        Psychol Sci. 2011; 22: 325-330
        • Martini M.
        • Perez-Marcos D.
        • Sanchez-Vives M.V.
        Modulation of pain threshold by virtual body ownership.
        Eur J Pain. 2014; 18: 1040-1048
        • Maselli A.
        • Slater M.
        Sliding perspectives: Dissociating ownership from self-location during full body illusions in virtual reality.
        Front Hum Neurosci. 2014; 8: 1-19
        • Maselli A.
        • Slater M.
        The building blocks of the full body ownership illusion.
        Front Hum Neurosci. 2013; 7: 83
        • Mohan R.
        • Jensen K.B.
        • Petkova V.I.
        • Dey A.
        • Barnsley N.
        • Ingvar M.
        • McAuley J.H.
        • Moseley G.L.
        • Ehrsson H.H.
        No pain relief with the rubber hand illusion.
        PLoS One. 2012; 7: e52400
        • Moseley G.L.
        • Parsons T.J.
        • Spence C.
        Visual distortion of a limb modulates the pain and swelling evoked by movement.
        Curr Biol. 2008; 18: R1047-R1048
        • Moseley L.G.
        Using visual illusion to reduce at-level neuropathic pain in paraplegia.
        Pain. 2007; 130: 294-298
        • Osumi M.
        • Imai R.
        • Ueta K.
        • Nakano H.
        • Nobusako S.
        • Morioka S.
        Factors associated with the modulation of pain by visual distortion of body size.
        Front Hum Neurosci. 2014; 8: 137
        • Pavani F.
        • Zampini M.
        The role of hand size in the fake-hand illusion paradigm.
        Perception. 2007; 36: 1547-1554
        • Pfeiffer C.
        • Lopez C.
        • Schmutz V.
        • Duena J.A.
        • Martuzzi R.
        • Blanke O.
        Multisensory origin of the subjective first-person perspective: Visual, tactile, and vestibular mechanisms.
        PLoS One. 2013; 8: e61751
        • Pfeiffer C.
        • Schmutz V.
        • Blanke O.
        Visuospatial viewpoint manipulation during full-body illusion modulates subjective first-person perspective.
        Exp Brain Res. 2014; 232: 4021-4033
        • Ploghaus A.
        Dissociating pain from its anticipation in the human brain.
        Science. 1999; 284: 1979-1981
        • Ramachandran V.S.
        • Brang D.
        • McGeoch P.D.
        Size reduction using mirror visual feedback (MVF) reduces phantom pain.
        Neurocase. 2009; 15: 357-360
        • Rhudy J.L.
        • Bartley E.J.
        • Williams A.E.
        Habituation, sensitization, and emotional valence modulation of pain responses.
        Pain. 2010; 148: 320-327
        • Romano D.
        • Gandola M.
        • Bottini G.
        • Maravita A.
        Arousal responses to noxious stimuli in somatoparaphrenia and anosognosia: Clues to body awareness.
        Brain. 2014; 137: 1213-1223
        • Romano D.
        • Maravita A.
        The visual size of one’s own hand modulates pain anticipation and perception.
        Neuropsychologia. 2014; 57: 93-100
        • Romano D.
        • Pfeiffer C.
        • Maravita A.
        • Blanke O.
        Illusory self-identification with an avatar reduces arousal responses to painful stimuli.
        Behav Brain Res. 2014; 261: 275-281
        • Romano D.
        • Sedda A.
        • Brugger P.
        • Bottini G.
        Body ownership: When feeling and knowing diverge.
        Conscious Cogn. 2015; 34: 140-148
        • Rossetti A.
        • Romano D.
        • Bolognini N.
        • Maravita A.
        Dynamic expansion of alert responses to incoming painful stimuli following tool use.
        Neuropsychologia. 2014; 70: 486-494
        • Siedlecka M.
        • Klimza A.
        • Lukowska M.
        • Wierzchoń M.
        Rubber hand illusion reduces discomfort caused by cold stimulus.
        PLoS One. 2014; 9: e109909
        • Tidoni E.
        • Grisoni L.
        • Liuzza M.T.
        • Aglioti S.M.
        Rubber hand illusion highlights massive visual capture and sensorimotor face-hand remapping in a tetraplegic man.
        Restor Neurol Neurosci. 2014; 32: 611-622
        • Tronstad C.
        • Kalvøy H.
        • Grimnes S.
        • Martinsen O.G.
        Waveform difference between skin conductance and skin potential responses in relation to electrical and evaporative properties of skin.
        Psychophysiology. 2013; 50: 1070-1078
        • Tsakiris M.
        My body in the brain: A neurocognitive model of body-ownership.
        Neuropsychologia. 2010; 48: 703-712
        • World Medical Organization
        Declaration of Helsinki.
        Br Med J. 1996; 313: 1448-1449