Immersive virtual reality for neuropathic pain management in spinal cord injury: A randomized controlled trial

PRIMARY: To evaluate the efficacy of immersive virtual reality (VR) in reducing neuropathic pain (NP) in individuals with spinal cord injury (SCI). SECONDARY: To assess the impact of immersive VR on depersonalization symptoms in the SCI population. DESIGN: Double-blind, randomized controlled trial. SETTING: Rehabilitation unit of a tertiary care teaching hospital in South India. PARTICIPANTS: Fifty-two individuals with SCI (ASIA A, B, and C) who had a LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) score ≥12 and were on stable pharmacological treatment. Participants were randomized using computer-generated block randomization. INTERVENTIONS: The intervention group received immersive VR exposure via a head-mounted display, involving virtual tasks such as wheelchair propulsion, cycling, and walking, for 15 min per session, twice daily, five days a week, over two weeks. The control group viewed 2D animated films of equivalent duration using the same device. OUTCOME MEASURES: Visual Analog Scale (VAS) for neuropathic pain and Cambridge Depersonalization Scale (CDS) for depersonalization. RESULTS: = 20). The intervention group demonstrated a significant reduction in VAS scores from 59.35 to 37.61 (a 36.63% reduction), while the control group showed a reduction from 59.00 to 48.00 (an 18.64% reduction). The between-group difference in VAS score change was statistically significant. CDS scores also improved significantly in the intervention group compared to the control group. CONCLUSION: Immersive VR is a promising nonpharmacological, non-invasive intervention for managing neuropathic pain in individuals with SCI. It is associated with improved embodiment and reduced depersonalization symptoms, offering a potential pathway to enhance quality of life. Its portability, minimal adverse effects, and ease of customization make it a viable adjunct to conventional rehabilitation strategies.