The short-term effects of head-mounted virtual-reality on neuropathic pain intensity in people with spinal cord injury pain: a randomised cross-over pilot study


Study design

Within-subject, randomised cross-over trial.


To determine whether a commercially available 3D head-mounted (HMD) virtual reality (VR) device results in significant reductions in neuropathic pain compared to using a 2D screen device in people with spinal cord injury (SCI).


Greenwich Hospital, Sydney, Australia.


Sixteen men with established SCI and chronic neuropathic pain participated in a single-session randomised cross-over trial. We compared the effects of 3D HMD VR and a 2D screen application on SCI neuropathic pain intensity and levels of perceived presence.


Participants reported significantly lower pain intensity after 3D HMD VR compared to 2D screen application (1.9 ± SD 1.8 versus 3.4 ± SD 1.6, mean 95% CI: 1.5, P < 0.0001). Participants reported significantly higher perceived levels of presence with the 3D HMD VR compared to 2D screen of (49.6 ± SD 8.9 versus 32.8 ± SD 11.1, mean 95% CI: 16.6, P < 0.0001). Increased perceived presence was associated with significantly lower pain intensity regardless of randomised sequencing of the two conditions (mean 95% CI: 0.06, P = 0.005). Effect size for pain reduction using 3D HMD VR was 0.80.


We suggest that 3D HMD VR may provide neuropathic pain relief for people with SCI. Given the lack of cybersickness and ease of access, we propose that immersive VR could be a helpful adjunct to current pharmacotherapy. Further research is required to show that VR can be effective for more long-term reductions in SCI pain.

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Fig. 1: Cross-over study protocols for 3D HMD and 2D screen VR interventions.
Fig. 2: A box plot showing participants rating of neuropathic pain at baseline, during and post 3D VR and 2D screen interventions.
Fig. 3: A box plot showing participants rating of presence post 3D VR and 2D screen interventions.

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.


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The postdoctoral researcher (PA) was funded by Australian and New Zealand College of Anaesthetists project grant (19/002) for this study.

Author information




PA—principle investigator. Contributed to the design of study protocols, screening and recruitment of subjects, administering questionnaires, organising clinic visits, performance of VR, collection and analysis of data and drafting presentations, reports and the current article. AC—contributed to the design of study protocols, recruitment of subjects. He also contributed to the writing while also provided feedback on the article. JM—contributed to the design of study protocols, location and recruitment of subjects. He also contributed to the writing while also provided feedback on the article. YT—contributed to the design of study protocols, development of the study. She also contributed to the writing while also provided feedback on the article. DC—designed and conducted statistical analysis. He also contributed to the writing of the current study article. PW—contributed to the design of study protocols, screening and recruitment of subjects. He also contributed to the writing of the current study article. PS—chief investigator. Initiated and contributed to the design of study protocols, screening and recruitment of subjects. He also contributed to the writing while also provided feedback on the article.

Corresponding author

Correspondence to Philip D. Austin.

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Austin, P.D., Craig, A., Middleton, J.W. et al. The short-term effects of head-mounted virtual-reality on neuropathic pain intensity in people with spinal cord injury pain: a randomised cross-over pilot study. Spinal Cord (2020).

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