Effect of Virtual Reality Hypnosis on Pain Threshold and Neurophysiological and Autonomic Biomarkers in Healthy Volunteers: Prospective Randomized Crossover Study

Abstract

Background Virtual reality hypnosis (VRH) is a promising tool to reduce pain. However, the benefits of VRH on pain perception and on the physiological expression of pain require further investigation. Objective In this study, we characterized the effects of VRH on the heat pain threshold among adult healthy volunteers while monitoring several physiological and autonomic functions. Methods Sixty healthy volunteers were prospectively included to receive nociceptive stimulations. The first set of thermal stimuli consisted of 20 stimulations at 60°C (duration 500 milliseconds) to trigger contact heat evoked potentials (CHEPs). The second set of thermal stimuli consisted of ramps (1°C/second) to determine the heat pain threshold of the participants. Electrocardiogram, skin conductance responses, respiration rate, as well as the analgesia nociception index were also recorded throughout the experiment. Results Data from 58 participants were analyzed. There was a small but significant increase in pain threshold in VRH (50.19°C, SD 1.98°C) compared to that in the control condition (mean 49.45°C, SD 1.87; P<.001, Wilcoxon matched-pairs signed-rank test; Cohen d=0.38). No significant effect of VRH on CHEPs and heart rate variability parameters was observed (all P>0.5; n=22 and n=52, respectively). During VRH, participants exhibited a clear reduction in their autonomic sympathetic tone, as shown by the lower number of nonspecific skin conductance peak responses (P<.001, two-way analysis of variance; n=39) and by an increase in the analgesia nociception index (P<.001, paired t-test; n=40). Conclusions The results obtained in this study support the idea that VRH administration is effective at increasing heat pain thresholds and impacts autonomic functions among healthy volunteers. As a nonpharmacological intervention, VRH has beneficial action on acute experimental heat pain. This beneficial action will need to be evaluated for the treatment of other types of pain, including chronic pain.

Hypnotic Modulation of Autonomic Nervous System (ANS) Activity

“…Lastly, this study ventures into the exciting and promising area of ANS modulation via virtual reality hypnosis [ 57 ]. This novel approach represents a cutting-edge development in the field, offering new possibilities for therapeutic interventions and further expanding our understanding of hypnotic ANS modulation.…”

“…Terzulli et al [ 57 ] analyzed the effects of virtual reality hypnosis (VRH) on the heat pain threshold among 60 adult healthy volunteers while monitoring several physiological and autonomic functions, During VRH, participants exhibited a clear reduction in their autonomic sympathetic tone, as shown by the lower number of nonspecific skin conductance peak responses and by an increase in the analgesia nociception index (ANI).…”

Pain Reduction With an Immersive Digital Therapeutic in Women Living With Endometriosis-Related Pelvic Pain: At-Home Self-Administered Randomized Controlled Trial

“…While acute pain is treated in hospital settings, chronic pain is experienced on a daily scale and dedicated solutions that can be autonomously used at home without medical supervision are expected by patients [52]. To date, most studies have been conducted in a medical context under the supervision of the health care team [24][25][26][27] and only few have been conducted at patients' homes with self-administered treatment [28].…”

“…However, most studies on VR for pain have been conducted in a medical context under the supervision of a health care team [24][25][26][27] and only few are conducted at patients' homes with treatment self-administered by the patients themselves [28]. In fact, most of the medical devices developed to treat pain, either acute or chronic, are designed to be used by medical staff in a medical setting [24,27,[29][30][31][32].…”

“…Studies have shown that virtual reality (VR) is an effective mode to reduce acute pain such as that experienced by burn victims, in cases of lumbar puncture, women during labor, or dental surgery [ 18 - 21 ], as well as for chronic pain such as musculoskeletal pain, neuropathic pain, and cancer [ 22 , 23 ]. However, most studies on VR for pain have been conducted in a medical context under the supervision of a health care team [ 24 - 27 ] and only few are conducted at patients’ homes with treatment self-administered by the patients themselves [ 28 ]. In fact, most of the medical devices developed to treat pain, either acute or chronic, are designed to be used by medical staff in a medical setting [ 24 , 27 , 29 - 32 ] .…”