JMIR Publications

ABSTRACT

Background:

This pilot study examined the feasibility, acceptability, and neural correlates of an 8-week home-based therapeutic VR intervention (RelieVRx) for sub-acute (<2 months post-injury) musculoskeletal pain, utilizing functional near-infrared spectroscopy (fNIRS) to assess changes in prefrontal cortex (PFC) activation and coactivation.

Objective:

This pilot study examined the feasibility, acceptability, and neural correlates of an 8-week home-based therapeutic VR intervention (RelieVRx) for sub-acute (<2 months post-injury) musculoskeletal pain, utilizing functional near-infrared spectroscopy (fNIRS) to assess changes in prefrontal cortex (PFC) activation and coactivation.

Methods:

Ten orthopedic patients (age: 46.8  11.86 years, 70% female) completed the RelieVRx intervention and underwent fNIRS and behavioral assessments pre- and post-treatment. Behavioral measures included pain intensity, pain interference, pain catastrophizing, pain anxiety, mindfulness, coping, and pain self-efficacy. fNIRS recorded PFC hemodynamic responses during movement-evoked pain and VR-based relaxation/distraction tasks. Feasibility and acceptability were assessed qualitatively and quantitatively (valid fNIRS recordings, participant feedback). Analyses evaluated pre-post changes in PFC activation, functional coactivation, and correlations with behavioral measures.

Results:

fNIRS procedures demonstrated high feasibility (92.5% valid recordings) and acceptability. Significant improvements were observed across all behavioral measures, including reduced pain intensity at rest (mean difference [MD] = -2.50, p < 0.001, d = 2.24), and with activity (MD = -3.40, p <.001, d = 1.98), decreased pain interference (MD range = -3.90 to -4.90, p <.001, d range =1.32 to 2.30), reduced pain anxiety (MD = -32.70, p =.001, d = 2.14) and pain catastrophizing (MD = -16.40, p = 0.003, d = 2.13), and improved mindfulness (MD = +3.29, p = .01, d = 0.94), coping (MD = +0.59, p = .01, d = 1.01), and self-efficacy (MD = 15.40, p = .008, d = 1.51). fNIRS showed significant post-treatment increases in medial PFC activation (right medial channel: distraction task t = -4.473, p = 0.004; relaxation task t = -3.036, p = 0.023) and enhanced coactivation between medial and lateral PFC regions (distraction task t = -2.784, p = 0.027). Increased functional coactivation between the right medial and left lateral PFC was negatively correlated with improved mindfulness (r = -0.716, p = 0.046) and coping scores (r = -0.709, p = 0.049).

Conclusions:

This study provides initial evidence of the feasibility and acceptability of integrating fNIRS neuroimaging into clinical VR interventions. Results demonstrate that VR therapy modulates neural activity in key PFC regions associated with pain regulation, correlating with significant improvements in pain and behavioral measures. The neural and behavioral changes highlight the potential of VR as a mechanistically informed, scalable non-pharmacological approach to managing sub-acute pain following orthopedic injuries. These findings justify larger mechanistic trials incorporating multimodal neuroimaging to refine and personalize VR-based pain therapies. Clinical Trial: ClinicalTrials.gov NCT055520