Research Article| Volume 22, ISSUE 6, P707-714, June 2021

Exposure to an Immersive Virtual Reality Environment can Modulate Perceptual Correlates of Endogenous Analgesia and Central Sensitization in Healthy Volunteers

  • Author Footnotes
    # These authors contributed equally to this manuscript.
    Erzsebet Mehesz
    # These authors contributed equally to this manuscript.
    The Nick Davey Laboratory, Department of Surgery and Cancer, Imperial College London, London, UK
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  • Author Footnotes
    # These authors contributed equally to this manuscript.
    Hajer Karoui
    # These authors contributed equally to this manuscript.
    The Nick Davey Laboratory, Department of Surgery and Cancer, Imperial College London, London, UK
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  • Paul H. Strutton
    The Nick Davey Laboratory, Department of Surgery and Cancer, Imperial College London, London, UK
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  • Sam W. Hughes
    Address reprint requests to Sam W. Hughes, PhD, The Pain Neuroplasticity and Modulation Laboratory, Brain Research and Imaging Centre (BRIC), School of Psychology, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK.
    The Pain Neuroplasticity and Modulation Laboratory, Brain Research and Imaging Centre (BRIC), School of Psychology, Faculty of Health, University of Plymouth, Plymouth, UK
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  • Author Footnotes
    # These authors contributed equally to this manuscript.
Published:January 16, 2021DOI:


      • Virtual reality (VR) enhanced conditioned pain modulation (CPM) efficiency.
      • Sham VR exposure reduced CPM efficiency.
      • There was no effect of real or sham VR on acute pain thresholds.
      • Real and sham VR had no effect on pain ratings during the CPM conditioning period.
      • VR attenuated mechanical pain sensitivity in a human surrogate model of central sensitization.


      Virtual reality (VR) has been shown to produce analgesic effects during different experimental and clinical pain states. Despite this, the top-down mechanisms are still poorly understood. In this study, we examined the influence of both a real and sham (ie, the same images in 2D) immersive arctic VR environment on conditioned pain modulation (CPM) and in a human surrogate model of central sensitization in 38 healthy volunteers. CPM and acute heat pain thresholds were assessed before and during VR/sham exposure in the absence of any sensitization. In a follow-on study, we used the cutaneous high frequency stimulation model of central sensitization and measured changes in mechanical pain sensitivity in an area of heterotopic sensitization before and during VR/sham exposure. There was an increase in CPM efficiency during the VR condition compared to baseline (P < .01). In the sham condition, there was a decrease in CPM efficiency compared to baseline (P < .01) and the real VR condition (P < .001). Neither real nor sham VR had any effect on pain ratings reported during the conditioning period or on heat pain threshold. There was also an attenuation of mechanical pain sensitivity during the VR condition indicating a lower sensitivity compared to sham (P < .05). We conclude that exposure to an immersive VR environment has no effect over acute pain thresholds but can modulate dynamic CPM responses and mechanical hypersensitivity in healthy volunteers.


      This study has demonstrated that exposure to an immersive virtual reality environment can modulate perceptual correlates of endogenous pain modulation and secondary hyperalgesia in a human surrogate pain model. These results suggest that virtual reality could provide a novel mechanism-driven analgesic strategy in patients with altered central pain processing.

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