• Samuel T Rodriguez, Nathan Makarewicz, Ellen Y Wang, Michelle Zuniga-Hernandez, Janet Titzler, Christian Jackson, Man Yee Suen, Oswaldo Rosales, and Thomas J Caruso.
• 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.
• J Clin Anesth. 2023 Dec 1; 91: 111257111257.

Study ObjectiveBoth 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.DesignWithin-subject cross-over clinical trial.SettingThe Stanford Chariot Program conducted this study at Lucile Packard Children's Hospital Stanford (LCPHS).PatientsHealthy participants meeting inclusion criteria were recruited by volunteer solicitation from LCPHS.InterventionsParticipants 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.MeasurementsPain 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 ResultsForty-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.ConclusionsThe 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.Copyright © 2023 Elsevier Inc. All rights reserved.

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