VR for pain management
Distraction versus skills-based retraining, and what the evidence supports.
Virtual embodiment and pain.
Virtual reality used to mean games. Over the past decade it has become a serious subject of pain research, and the most interesting strand is not distraction. It is embodiment: the finding that when people see a virtual body from their own point of view and it moves as they move, they come to feel it is theirs, and that this feeling can change what they feel in their real body.
Can virtual embodiment change how much pain you feel?
In the lab, yes. When Martini and colleagues gave volunteers a virtual arm and synchronized its movements with their own, the sense of owning that arm raised the temperature at which heat became painful, compared with control conditions. Reviews since then describe virtual embodiment as a promising way to remap how the brain represents a painful body part, but the clinical evidence remains early and small.
The idea connects directly to mirror therapy and graded motor imagery. A virtual body is a far more flexible mirror: it can show a limb moving freely, change its apparent size, or let someone practise movement in a setting that feels safe.
At a glance
- Article analysed
- Martini, Perez-Marcos and Sanchez-Vives, European Journal of Pain, 2014: a laboratory experiment on virtual body ownership and heat pain threshold
- Finding
- Ownership of a virtual arm, induced by synchronizing real and virtual finger movements, significantly increased thermal pain thresholds compared with control conditions
- What embodiment is
- The sense of owning and inhabiting a body. In VR, synchronized vision and movement make many people feel a virtual body is their own
- Reviews
- Matamala-Gomez et al., 2019 (embodiment for pain relief); Maggio et al., 2025 (remapping body representation in neuropathic pain, including spinal cord injury, CRPS and phantom limb pain)
- Early clinical work
- A case series in chronic low back pain (Trujillo et al., 2020) and a study in fibromyalgia (Swidrak et al., 2023)
- Broader VR reviews
- VR-assisted active training in chronic musculoskeletal pain (Lo et al., 2024) and chronic low back pain (Li et al., 2024); VR for fear of movement (Wang et al., 2023). They pool very different interventions
- Status
- Most embodiment research is still early, small and experimental. Motion sickness and discomfort are possible, and VR does not suit everyone
Key takeaways
- Distraction VR works only while it lasts. Embodiment aims at something more durable: changing how the brain represents the painful body.
- The laboratory evidence is clear that body ownership can shift pain thresholds. The clinical evidence that this translates into lasting relief is early and small.
- Embodiment extends the logic of mirror therapy and graded motor imagery with far more control over what the brain sees.
- The broader VR literature pools distraction, exercise games and skills programs together, so its pooled conclusions should be read with care.
- Karuna's program is built on embodiment training, and this page describes the research it draws on. The evidence for the program itself is covered, with its limits, on how it works.
How is embodiment different from distraction?
Early VR pain research used immersive environments to draw attention away from pain during painful procedures, and it works: distraction reduces pain while it lasts. For chronic pain, though, relief that ends when the headset comes off is not the goal. Researchers have looked for ways to use VR to change something that persists, whether a skill the person carries into daily life or the way the brain represents the body itself.
Embodiment is the second of those. In VR, people can be given a virtual body seen from a first-person perspective, and when what they see and what they feel are synchronized, many come to experience the virtual body as their own. That is not a trick of attention. It is the brain updating its model of the body on the basis of new evidence, which is exactly the process body-map retraining tries to harness.
What did the pain-threshold experiment show?
In a laboratory study, Martini and colleagues induced ownership of a virtual arm by synchronizing real and virtual finger movements, then measured how hot a stimulus had to be before volunteers reported it as painful (Martini et al., 2014). Owning the virtual arm significantly increased thermal pain thresholds compared with control conditions in which the illusion was not induced.
This is a small experiment in healthy volunteers, and it measures a threshold rather than chronic pain. Its importance is in what it demonstrates: the brain's sense of which body it is in changes the pain it produces. That is the premise on which clinical embodiment work rests.
A mirror can only show a limb that looks like the real one, moving as the other limb moves. A virtual body can show a limb moving freely, change its apparent size, or place it in a scene that feels safe. Embodiment is best understood as a more flexible mirror.
What does the clinical evidence look like so far?
Reviews have explored how virtual embodiment might be used for pain relief (Matamala-Gomez et al., 2019), and a 2025 systematic review examined VR approaches for remapping body representation in chronic neuropathic pain conditions such as spinal cord injury, complex regional pain syndrome and phantom limb pain (Maggio et al., 2025). Early clinical explorations include a case series in chronic low back pain (Trujillo et al., 2020) and a study in fibromyalgia (Swidrak et al., 2023).
These are the right conditions to study. Each involves a documented change in how the brain represents the painful body part, which is the thing embodiment is designed to address. They are also, so far, small studies, and none is a large randomized trial with a credible comparison group. That is the honest state of the clinical evidence for embodiment specifically.
What do the broader VR reviews add?
Systematic reviews have looked at VR across chronic musculoskeletal pain and chronic low back pain more generally, including VR-assisted active training (Lo et al., 2024; Li et al., 2024), and at VR for fear of movement (Wang et al., 2023). They report benefits for pain and function, with the usual caveats about small trials and the impossibility of blinding someone to whether they are wearing a headset.
These reviews pool very different interventions, from distraction to exercise games to structured skills programs, so their conclusions should be read with care. A pooled effect across such different things tells you that VR as a delivery medium can help; it tells you less about which approach is doing the work. Our guide to VR for pain management separates the categories.
What does this mean in practice?
For clinicians, embodiment-based VR is a promising, largely experimental extension of mirror therapy and graded motor imagery, most relevant where body representation is known to be altered. Skills-based VR programs are one option within multimodal care for chronic pain, with realistic expectations about effect sizes compared with active controls.
For people with pain, VR is not a replacement for other care, and it does not suit everyone. Motion sickness and discomfort are possible. For some, a headset makes graded movement, relaxation and pain education more engaging and easier to practise at home, and embodiment adds a way to experience the painful body moving comfortably before asking it to. Karuna's program is built on this research; its own outcome data, and the limits of that data, are set out on how it works.
Frequently asked questions
What is virtual embodiment?
The experience of owning and inhabiting a virtual body. In VR, when a person sees a body from their own viewpoint and it moves in time with their real movements, the brain accepts it as their own. Researchers measure this with questionnaires and with physiological responses, such as reacting when the virtual body is threatened.
Does virtual reality reduce chronic pain?
Reviews of VR-assisted training in chronic musculoskeletal and low back pain report benefits for pain and function, though the trials are small, cannot be blinded, and pool very different kinds of VR. Embodiment-specific clinical studies are earlier still. The fair summary is promising, with modest and uncertain effect sizes.
How is VR embodiment related to mirror therapy?
Both give the brain safe visual evidence of the painful body part moving comfortably. Mirror therapy does it with a reflection of the healthy limb. VR does it with a virtual body, which can be made to move freely, change size, or appear in a calming scene, and which can be used for parts of the body a mirror cannot reach, such as the back.
Which conditions has embodiment been studied in?
Chronic neuropathic pain conditions where body representation is altered, including spinal cord injury, complex regional pain syndrome and phantom limb pain, along with early work in chronic low back pain and fibromyalgia. These are small studies and case series rather than large trials.
Is VR safe for people with chronic pain?
Generally, with two cautions. Motion sickness and discomfort are possible, and they are reasons to adjust the level rather than push through. And VR is not appropriate for everyone; some conditions, such as PTSD or severe vision or hearing impairment, make an immersive environment the wrong setting. A clinician should confirm fit first.
Sources & research.
- Martini M, Perez-Marcos D, Sanchez-Vives MV. Modulation of pain threshold by virtual body ownership. Eur J Pain. 2014;18(7):1040-1048. PMID 24449513
- Matamala-Gomez M, Donegan T, Bottiroli S, et al. Immersive virtual reality and virtual embodiment for pain relief. Front Hum Neurosci. 2019;13:279. PMID 31551731
- Maggio MG, et al. Remapping body representation using virtual reality in chronic neuropathic pain: a systematic review. J Med Internet Res. 2025. PMID 40341015
- Trujillo MS, Alvarez AF, Nguyen L, Petros J. Embodiment in virtual reality for the treatment of chronic low back pain: a case series. J Pain Res. 2020;13:3131-3137. PMID 33269003
- Swidrak J, et al. Virtual embodiment in fibromyalgia. Sci Rep. 2023. PMID 37400503
- Lo HHM, et al. Virtual reality-assisted active training in chronic musculoskeletal pain: systematic review and meta-analysis. J Med Internet Res. 2024. PMID 39159449
- Li R, et al. Virtual reality-based training in chronic low back pain: systematic review and meta-analysis. J Med Internet Res. 2024. PMID 38407948
- Wang S, et al. Virtual reality for kinesiophobia: a meta-analysis. J Clin Nurs. 2023. PMID 35692077
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