VR-Based Exercise Reduces Perceived Pain Intensity, Mechanical Pain Sensitivity Persists in Fibromyalgia

Immersive virtual reality-based exercise (iVRE) reduced perceived pain intensity (PI) but had a limited effect on mechanical pain sensitivity (MPS) in a new study evaluating the intervention in people with fibromyalgia (FM).1

“Considering the limited evidence on the effects of iVRE in FM and the need to understand its potential for managing chronic pain in this population, this exploratory study aims to assess the initial clinical impact of a 6-week iVRE program on PI and MPS. Additionally, it investigates the acute effects of a single iVRE session on PPTs as a marker of the exercise-induced hypoalgesia mechanism. Prognostic risk stratification is applied to analyze PI based on patients’ baseline risk of poor outcomes (RPO), and basic feasibility parameters are reported. These exploratory findings will not only address potential methodological issues but also lay the groundwork for future larger-scale studies to elucidate the mechanisms underlying the therapeutic benefits of iVRE on pain in FM,” lead investigator Claudio Carvajal-Parodi, Facultad de Odontología y Ciencias de la Rehabilitación, Escuela de Kinesiología, Universidad San Sebastián, Lientur, Chile, and Programa de Doctorado en Ciencias de la Actividad Física y del Deporte, Campus Puerto Real, Universidad de Cádiz, Avda. República Saharaui s/n, Puerto Real, Cadiz, Spain, and colleagues wrote.1

Carvajal-Parodi and colleagues conducted a single-arm, uncontrolled, pre-post-test exploratory study that involved participants completing 2 weekly 15-min iVRE sessions for 6 weeks. The investigators assessed PI (numeric rating scale [NRS]) and MPS (pressure pain thresholds [PPTs] at the upper trapezius, lumbar spine, and knee) assessed at baseline, after the first session (to assess exercise-induced hypoalgesia), and postintervention. They also used the Keele STarT MSK Tool to assess RPO.

The study was small, with 11 participants completing the study. No participants reported adverse effects. Carvajal-Parodi and colleagues observed clinically important reductions in PI (mean difference [MD], −2.36 [95% CI, −4.15 to −0.58]; d, 0.89; P <.05) which were associated with baseline RPO. However, investigators did not observe any changes in PPTs (all 95% CIs included 0, P >.05).1

Based off a 30% reduction threshold in the NRS2, 63.63% (n = 7) of participants were classified as responders to iVRE. Among high-risk patients, 50% (n = 4) showed a positive response, while all medium-risk patients (n = 3) responded positively. Although high-risk individuals had higher PI both pre- and post-intervention, medium-risk patients saw greater absolute and proportional NRS reductions.1

At baseline, 27.3% (n = 3) were medium-risk and 72.7% (n = 8) were high-risk per KSMT; no low-risk cases were identified. Post-intervention, 81.8% (n = 9) improved to a lower-risk category, while those remaining unchanged were all in the high-risk group.1

“These findings highlight that, while iVRE effectively reduced perceived pain in our sample of FM patients, it did not induce changes in their PPTs. Given the exploratory nature of these results, they should be interpreted with caution due to the inherent methodological limitations of a small sample size and an uncontrolled design,” Carvajal-Parodi and colleagues concluded.1 “Although our study provides initial insights, it underscores the need for further validation through randomized controlled trials with larger samples to comprehensively evaluate the effects of iVRE on pain-related outcomes and to explore other factors that may influence these responses in this population. Such future research is crucial to confirm our preliminary observations and determine the potential of iVRE as a therapeutic approach for FM.”

REFERENCES

1. Carvajal-Parodi C, Arias-Álvarez G, Ulloa-Díaz D, Romero-Vera L, Andrades-Ramírez O, Guede-Rojas F, Ponce-González JG. Immersive Virtual Reality-Based Exercise for Pain Management in Fibromyalgia: An Exploratory Study with Risk of Poor Outcomes Stratification. Applied Sciences. 2025; 15(11):5956. doi: 10.3390/app15115956

2. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole MR. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149-158. doi:10.1016/S0304-3959(01)00349-9