• Jingwei Li, Haoyu Yang, Yian Xiao, Xu Liu, Bingjie Ma, Ke Ma, Li Hu, and Xuejing Lu.
• CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
• Br J Anaesth. 2023 Dec 1; 131 (6): 108210921082-1092.

BackgroundVirtual reality (VR) has been widely used as a non-pharmacological adjunct to pain management. However, there is no consensus on what type of VR content is the best for pain alleviation and by what means VR modulates pain perception. We used three experiments to explore the analgesic effect of VR scenes in healthy adult volunteers.MethodsWe first compared the effect of immersive VR on pain perception with active (i.e. non-immersive, two-dimensional video) and passive (i.e. no VR or audiovisual input) controls at both subjective perceptual (Experiment 1) and electrophysiological (electroencephalography) levels (Experiment 2), and then explored possible analgesic mechanisms responsible for VR scenes conveying different strategies (e.g. exploration or mindfulness; Experiment 3).ResultsThe multisensory experience of the VR environment lowered pain intensity and unpleasantness induced by contact heat stimuli when compared with two control conditions (P=0.001 and P<0.001, respectively). The reduced pain intensity rating correlated with decreased P2 amplitude (r=0.433, P<0.001) and increased pre-stimulus spontaneous gamma oscillations (r=-0.339, P=0.004) by 32-channel electroencephalography. A VR exploration scene induced a strong sense of immersion that was associated with increased pre-stimulus gamma oscillations (r=0.529, P<0.001), whereas a VR mindfulness meditation scene had a minor effect on immersive feelings but induced strong pre-stimulus alpha oscillations (r=-0.550, P<0.001), which led to a comparable analgesic effect.ConclusionsDistinct neural mechanisms are responsible for VR-induced analgesia, deepening our understanding of the analgesic benefits of VR and its neural electrophysiological correlates. These findings support further development of digital healthcare.Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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