Fully Immersive Virtual Reality for Chronic Pain: New Scoping Article Highlights Promise and Ideas for Future Work
Virtual reality brings to mind immersive environments, interactive games, and training simulation experiences. But rehabilitation researchers are also exploring how virtual reality can help people with chronic pain through embodiment techniques, which aim to help people understand and alter experiences of body distortion to reduce pain.
To shed light on this new field, a team of researchers from Tufts University, the University of Pittsburgh, and the U.S. Department of Veterans Affairs published a scoping review in Virtual Worlds in January 2026.
For people experiencing chronic pain or body representation disorders, there can be a difference between people’s perception of their body and their sensory and motor functions, resulting in heightened perceptions of pain.
As a tool to affect chronic pain disorders and those related to body representation, such as phantom limb pain and complex regional pain syndrome, fibromyalgia, and chronic back pain, fully immersive virtual reality (FIVR) can encourage embodiment of a virtual avatar, virtual limb, or part of the body experiencing pain and then alter the sensory feedback related to movement, appearance, and synchronization.
According to the National Institutes of Health, chronic pain is one of the most common reasons adults seek medical care, is associated with decreased quality of life, opioid misuse, increased anxiety and depression, and unmet mental health needs.
In their publication, “Embodied Fully Immersive Virtual Reality as a Therapeutic Modality to Treat Chronic Pain: A Scoping Review,” the team, which included Joanne Baird, PhD, OTR/L, CHSE, FAOTA from the University of Pittsburgh’s Department of Occupational Therapy in the School of Health and Rehabilitation Sciences, described the field as in a “discovery phase,” with foundational studies focused on conceptualization and preliminary testing and ample opportunities for future work.
Co-author Baird said, “Chronic pain affects so many aspects of a person's daily life and their ability to participate in the activities that matter to them. Even though this is still early-stage research, it's meaningful that we're seeing consistent signals that embodiment-based approaches can reduce pain. This gives us real motivation to keep refining the science.”
Through this state-of-the-science scoping review, the authors aimed to describe which chronic pain disorders have been investigated to date using embodied FIVR, identify the impact on pain, describe the analgesic effects, and identify what terms are being used in published articles to describe embodied FIVR as a therapeutic modality.
To be included in the scoping review, articles had to use fully immersive virtual reality (FIVR), defined here as the use of a head-mounted display as an intervention. While studies on this topic are increasing, the authors stated that, to their knowledge, only one previous review focused on the use of FIVR has been completed.
Boundaries of the Review
In the scoping review, the team searched for papers that were published between 1990 and March 2024 to better understand how FIVR is being used in the rehabilitation of chronic pain disorders. Authors searched for papers in PubMed, Web of Science, Scopus, PsychInfo, and CINAHL, published in English in peer-reviewed journals with adult participants experiencing chronic pain.
In their search, the authors were looking for specific outcomes, which were pain intensity, pain quality, or pain function. Additionally, the article had to focus on assessing FIVR’s ability to manipulate sensory feedback to an embodied limb. After removing duplicate articles and screening titles and abstracts, 27 articles were included and reviewed.
Fully Immersive Virtual Reality and Chronic Pain: State of the Science
The team’s scoping review found that primarily neuropathic types of pain disorders have been investigated using virtual embodiment in the reviewed articles. The most commonly studied were phantom limb pain, which included both those with amputations and brachial plexus avulsion (42.9%), then spinal cord injuries with neuropathic pain (21.4%), followed by general chronic pain diagnoses such as chronic low back pain, fibromyalgia, and peripheral nerve injury (17.9%), and chronic regional pain syndrome (14.3%).
The most commonly used types of sensory feedback to affect pain sensation in the articles were movement (42.9%), added limb (22.4%), and sensory synchronization (18.4%). In these articles, FIVR interventions ranged from 5 to 45 minutes, and over 80% reported improved pain. The authors highlighted that 55.1% of interventions lasted less than 10 minutes and that in over half of the studies (62.9%) a combination of manipulations was used.
For pain outcomes, pain intensity was reported in all articles. A decrease in pain intensity was reported in most articles (82.5%), two experimental groups (5.0%) reported increased pain, and five experimental groups found no change (12.5%). The authors highlighted that only five studies followed up with patients after a week, so the longer-term impacts of FIVR for chronic pain require further investigation. While pain intensity was the most studied outcome in these articles, pain quality was assessed in six experimental groups.
In the authors' review of the terminology used to describe embodied FIVR, they identified 33 different terms, with “mirror therapy” being the most commonly used term followed by “embodiment”, revealing a lack of consensus on how to name this construct.
Opportunities for Continued Exploration
From the scoping review of these initial articles, the authors highlight that, although embodied FIVR, as an emerging practice, holds potential as a treatment for chronic pain, more systematic and rigorous studies are needed.
Regarding the state of the science outlined in the scoping review, there is a need for larger participant groups, more robust study design, and more female participants.
Additionally, future studies are needed to explore what pairing of manipulations and diagnoses is most effective, understand control conditions related to distraction effects from FIVR, additional investigations on pain quality in addition to pain intensity, exploration of longer-term impacts, and adverse effects, such as nausea, dizziness, and physical discomfort, which were evaluated in seven of the articles.
Regarding standardized terminology, especially in new fields of study, the authors highlight the importance of developing a shared nomenclature so researchers can work together to translate ideas into actionable understanding.
As a starting point for supporting future taxonomy development, the authors provided grouped terms based on a review of the 33 terms they identified in the articles. These groups were “embodiment,” “illusory interventions,” “body ownership,” “body perception,” “body swapping,” “mirror therapy,” and “other.”
This scoping review paves the way for future research questions and studies. The authors offer numerous ideas for researchers in the field seeking to build on these foundational articles.
The authors state that embodied FIVR for addressing chronic pain holds “great promise” but also highlight significant gaps in the science. The exploration of FIVR as a therapeutic modality is also promising to people whose daily life and activities are impacted by their experiences of chronic pain, which in 2023 in the United States impacted a quarter of adults according to data from the Centers for Disease Control and Prevention’s National Health Interview Survey.
The authors share a reminder to readers that their scoping review sought to provide an initial “proof of concept”. These gaps could be explored in future work, helping occupational therapists and rehabilitation scientists better understand how embodied FIVR works to support people who are experiencing chronic pain or altered body representations.