How does Karuna work?

What is VR embodiment training?

When pain becomes chronic, the brain's map of the painful body part changes: the area gets tagged as dangerous, movement feels threatening, and the alarm fires with less and less provocation. This is the core of neuroplastic pain — and it's the target of embodiment training.

In a VR headset, you see and control a virtual body. Carefully designed exercises let your brain experience the painful area moving comfortably and safely — sometimes further, smoother, or more easily than feels possible outside the headset. Repeated over weeks, these experiences give the brain fresh evidence that the body is not in danger, which is exactly what an oversensitized pain system needs in order to turn the alarm down.

This isn't distraction. It's the same logic behind pain reprocessing therapy and graded exposure — approaches with growing support in the pain-science literature — delivered through a medium built for retraining the brain's body map. Our guide to virtual reality for pain management covers the evidence base in depth.

What happens over the 12 weeks?

Every patient's program is tailored to their condition, goals, and starting point, but the arc generally follows five stages:

1. Assessment and physician review. A free consultation, a detailed intake about your pain history, and a physician's review to confirm the program is appropriate for you.
2. Onboarding. Your VR headset arrives pre-configured. Your pain coach walks you through setup and your first sessions — no technical experience needed.
3. Daily practice plus weekly coaching. Short VR embodiment exercises most days, paired with a one-on-one session with your dedicated pain coach each week to review progress and adjust the plan.
4. Graded expansion. As your nervous system recalibrates, exercises progressively expand what feels safe — in the headset first, then in real-world movement and activity.
5. Consolidation and independence. The final weeks focus on locking in gains, building your own flare plan, and making sure progress continues after the program ends.

What outcomes has Karuna measured?

Karuna collects outcome data on an ongoing basis from patients in the 12-week KarunaHOME program. The figures below come from a real-world evidence analysis of 50 patients — all of them injured at work, covered under workers' compensation insurance, and living with chronic pain lasting longer than six months. Measures were taken before and after the programme.

Two patterns are worth drawing out. First, the gains in function and confidence are larger than the gain in pain — activity improved by a median of 49% and confidence by 71%, against 28% for pain itself. That is the expected shape of recovery in a sensitized system: people get their life back before they get the last of the pain gone.

Second, the largest single movement is in fear-avoidance and confidence — the beliefs that determine whether someone will move at all. This is the mechanism the programme is built to target, and it is measured with the FABQ, the standard instrument for it.

How to read these numbers

This is real-world evidence, not a clinical trial, and the distinction matters:

• There was no control group. Everyone received the programme, so these results cannot be compared against no treatment, usual care, or placebo.
• The sample is small and specific — 50 patients, all workers' compensation cases with work-related injuries. Results may not generalise to other populations.
• The measures are self-reported, as most pain, sleep, and confidence measures necessarily are.
• Not everyone improved. Between 21% and 33% of patients did not improve on any given measure, and the table shows that honestly.
• Median improvement is reported among those who improved, so it does not describe the average patient's experience across the whole group.

Karuna has also run institutional review board–approved studies on the technology itself: validating that range-of-motion measurement in VR matches real-world measurement, testing how mirror visual feedback affects pain-free range of motion, and a feasibility study using the Oswestry Disability Index and the Pain Catastrophizing Scale as outcome measures.

Who guides you through the program?

Your pain coach

You're matched with a dedicated pain coach for the full 12 weeks. In weekly one-on-one sessions, your coach teaches the pain neuroscience behind each exercise, helps you interpret flares and setbacks, adjusts your VR plan, and translates in-headset progress into everyday life — sleep, movement, work, and the moments pain has been running the show. Having one consistent person who knows your story is a deliberate part of the design.

Your physician

A physician reviews your case before you start and provides oversight throughout the program. That means your treatment is medically supervised from day one: the physician confirms the program suits your condition, monitors your course, and ensures VR retraining complements — never replaces — the medical care you already receive. Karuna is founded on the biopsychosocial model, which takes the biology of your pain as seriously as the psychology and life context around it.

Who is Karuna for — and who isn't it for?

Karuna is designed for adults with chronic pain — pain persisting beyond three months — that has already been medically evaluated. It's a particularly strong fit when tests are reassuring but pain continues, which is the classic profile of a sensitized pain system. That includes conditions like chronic low back pain, fibromyalgia, neck and shoulder pain, CRPS, and phantom limb pain.

It is not the right first step for everyone:

• Acute injury. Fresh injuries need standard medical care and time to heal — not pain-system retraining.
• Unexamined pain or red-flag symptoms. Unexplained weight loss, fever, new weakness or numbness, loss of bowel or bladder control, or pain after major trauma need prompt medical evaluation first.
• Pain that hasn't been medically assessed. A prior evaluation is required — the physician review exists to make sure retraining is appropriate, not to replace a diagnosis.

Not sure where you fall? The free consultation exists precisely to answer that question honestly — including telling you if Karuna isn't the right fit. You can also browse the conditions we work with.

What do you need to get started?

Very little. Karuna provides the VR headset, and the program is built for people who have never touched one before. You need:

• A small clear space — enough room to stand or sit and move your arms freely.
• A few minutes most days — sessions are short by design, because consistency matters more than duration.
• A phone or computer for your weekly video sessions with your coach.
• No tech expertise. The headset arrives ready to use, and your coach handles setup with you.

The program is drug-free, non-invasive, and HSA/FSA eligible, and results are backed by a money-back guarantee. Common questions — motion sickness, insurance, doing the program alongside PT — are covered in our FAQs.