Virtual reality facilitated exercise improves pain perception: A crossover study

Samuel T Rodriguez; Nathan Makarewicz; Ellen Y Wang; Michelle Zuniga-Hernandez; Janet Titzler; Christian Jackson; Man Yee Suen; Oswaldo Rosales; Thomas J Caruso

doi:10.1016/j.jclinane.2023.111257

Virtual reality facilitated exercise improves pain perception: A crossover study

J Clin Anesth. 2023 Dec:91:111257. doi: 10.1016/j.jclinane.2023.111257. Epub 2023 Sep 13.

Authors

Samuel T Rodriguez¹, Nathan Makarewicz², Ellen Y Wang¹, Michelle Zuniga-Hernandez³, Janet Titzler³, Christian Jackson³, Man Yee Suen³, Oswaldo Rosales⁴, Thomas J Caruso⁵

Affiliations

¹ Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA.
² Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA; Stanford University School of Medicine, Stanford, CA, USA.
³ Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA.
⁴ Stanford University Graduate School of Education, Stanford, CA, USA.
⁵ Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA. Electronic address: tjcaruso@stanford.edu.

PMID: 37708601
DOI: 10.1016/j.jclinane.2023.111257

Abstract

Study objective: Both virtual reality (VR) and exercise are recognized for their analgesic and anxiolytic properties. The purpose of this study is to evaluate the ability of VR-facilitated exercise to modulate pain.

Design: Within-subject cross-over clinical trial.

Setting: The Stanford Chariot Program conducted this study at Lucile Packard Children's Hospital Stanford (LCPHS).

Patients: Healthy participants meeting inclusion criteria were recruited by volunteer solicitation from LCPHS.

Interventions: Participants were randomized by hand dominance and subjected to a standardized cold pressor test with no VR or exercise. After a 5-min wash-out period, participants repeated the test on their other hand while experiencing a VR-facilitated exercise condition. Pain sensitivity, pain tolerance, and sympathetic activation data were collected during both conditions.

Measurements: Pain sensitivity was scored 0-10 and collected every 30 s. Pain tolerance was recorded as the duration a participant could endure the painful stimuli. Sympathetic activation was measured by skin conductance response density (SCRD) and recorded in 30 s epochs by a biosensor. In all analyses, data were nested by participant.

Main results: Forty-one participants completed both interventions. Pain sensitivity was reduced in the VR-facilitated exercise condition (p < 0.0001). There was no difference in pain tolerance between conditions. While both conditions resulted in an increase in sympathetic activity, SCRD was higher at all time points in the VR-facilitated exercise condition.

Conclusions: The reduction in pain sensitivity indicates VR-facilitated exercise results in improved pain perception. VR-facilitated exercise may be especially useful for patients with chronic pain or other conditions requiring physical therapy, where pain may be exacerbated by exercise.

Keywords: Anesthesia; Exercise; Pain; Pain perception; Physical therapy; Virtual reality.