A critical role of affective content in the analgesic effect of virtual reality: a cross-sectional within-subject study

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2026-03-01 Epub Date: 2026-02-16 DOI:10.1016/j.lana.2026.101385

Nandini Raghuraman , Roni Shafir , GianCarlo Colloca , Craig Kier , Barbara Brawn , Amitabh Varshney , Sarah Murthi , Yang Wang , Luana Colloca

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Abstract

Background

The dual challenges of the opioid crisis and the global burden of chronic pain underscore the need for safe, non-pharmacological alternatives. Virtual reality (VR) is a promising digital therapeutic for pain, yet its mechanisms remain unclear. This study aimed to disentangle the roles of immersion and emotional engagement in VR-induced analgesia in individuals with temporomandibular disorders (TMD).

Methods

In a counterbalanced within-subject design, 62 adults with TMD (21 males, 41 females; mean age 34.7 years [19–55]; 57 (91.9%) non-Hispanic or Latino, 30 (48.4%) White) were exposed to seven conditions: three immersive VR environments (ocean, opera, pink noise), matched non-immersive (2D) versions, and a 2-back working memory task. Heat pain tolerance was assessed using thermal stimulation. Participants rated pain intensity, pain unpleasantness, mood, anxiety, and enjoyment. Skin conductance response (SCR) indexed autonomic arousal. Multilevel mediation models tested the underlying psychological mechanisms.

Findings

VR Ocean significantly increased heat pain tolerance (Cohen's d = 1.60), reduced pain intensity and unpleasantness, improved mood, and reduced situational anxiety relative to all other conditions (all p < 0.05). It was also rated as the most enjoyable experience (p < 0.01). Mediation analyses indicated mood (ab = −5.15) and enjoyment (ab = −6.12) significantly mediated VR Ocean's effect on pain intensity, whereas anxiety did not. No mediators explained changes in pain tolerance. SCR did not differ between VR and 2D conditions.

Interpretation

VR-based analgesia relies not only on immersion but also on affectively rewarding contents. Digital therapeutics that enhance positive mood and enjoyment may be especially effective for chronic pain management.

Funding

This study was supported by the National Institutes of Health and the University of Maryland.

查看原文本刊更多论文

情感内容在虚拟现实镇痛效果中的关键作用：一项横断面的受试者研究。

背景：阿片类药物危机和全球慢性疼痛负担的双重挑战强调了对安全、非药物替代品的需求。虚拟现实（VR）是一种很有前途的疼痛数字治疗方法，但其机制尚不清楚。本研究旨在阐明沉浸和情绪参与在颞下颌障碍（TMD）患者vr诱导的镇痛中的作用。方法：在受试者内平衡设计中，62名成年TMD患者（21名男性，41名女性，平均年龄34.7岁[19-55]；57名（91.9%）非西班牙裔或拉丁裔，30名（48.4%）白人）暴露于7种条件下：三种沉浸式VR环境（海洋，歌剧，粉红噪音），匹配的非沉浸式（2D）版本，以及2-back工作记忆任务。热刺激法评估热痛耐受性。参与者对疼痛强度、疼痛不愉快程度、情绪、焦虑和享受程度进行评分。皮肤电导反应（SCR）与自主神经觉醒有关。多层次中介模型检验了潜在的心理机制。研究结果：与所有其他条件相比，VR Ocean显著提高了热痛耐受性（Cohen’s d = 1.60），减轻了疼痛强度和不愉快，改善了情绪，减少了情境焦虑（均p < 0.05）。它也被评为最愉快的体验（p < 0.01）。中介分析表明，情绪（ab = -5.15）和享受（ab = -6.12）显著调节了VR Ocean对疼痛强度的影响，而焦虑则没有。没有介质解释疼痛耐受力的变化。在VR和2D条件下，SCR没有差异。解释：基于vr的镇痛不仅依赖于沉浸，还依赖于有效奖励内容。提高积极情绪和享受的数字疗法可能对慢性疼痛管理特别有效。资助：本研究由美国国立卫生研究院和马里兰大学资助。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.