{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T12:46:14Z","timestamp":1782477974194,"version":"3.54.5"},"reference-count":133,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MTI"],"abstract":"<jats:p>Pain is the most common reason for medical consultation and use of health care resources. The high socio-economic burden of pain justifies seeking an appropriate therapeutic strategy. Immersive virtual reality (VR) has emerged as a first-line non-pharmacological option for pain management. However, the growing literature has not been accompanied by substantial progress in understanding how VR could reduce the pain experience, with some user experience factors being associated with the hypoalgesic effects of immersive VR. The aim of this review is (i) to summarize the state of the art on the effects of VR on adults and children suffering from pain conditions; (ii) to identify and summarize how mechanisms across immersive VR user experience influence hypoalgesic effects in patients with acute and chronic pain among adults and children. A critical narrative review based on PICOT criteria (P = Patient or Population and Problem; I = Intervention or Indicator; C = O = Outcome; T = Type) was conducted that includes experimental studies or systematic reviews involving studies in experimentally induced pain, acute pain, or chronic pain in adults and children. The results suggest an association between immersive VR-induced hypoalgesia and user experience such as distraction, presence, interactivity, gamification, and virtual embodiment. These findings suggest that hierarchical relationships might exist between user experience-related factors and greater hypoalgesic effects following an immersive VR intervention. This relationship needs to be considered in the design and development of VR-based strategies for pain management.<\/jats:p>","DOI":"10.3390\/mti8080066","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T11:34:20Z","timestamp":1722512060000},"page":"66","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["User Experience in Immersive Virtual Reality-Induced Hypoalgesia in Adults and Children Suffering from Pain Conditions"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3898-1356","authenticated-orcid":false,"given":"Javier","family":"Guerra-Armas","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, University of Malaga, 29071 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar","family":"Flores-Cortes","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Malaga, 29071 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3012-666X","authenticated-orcid":false,"given":"Guillermo","family":"Ceniza-Bordallo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain"},{"name":"Doctoral School of Health Care, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Matamala-Gomez","sequence":"additional","affiliation":[{"name":"Department of Cognition, Development and Educational Psychology, University of Barcelona, 08035 Barcelona, Spain"},{"name":"Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"University School of Health and Sport (EUSES), Department of Medicine-Campus Bellvitge, University of Girona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1097\/j.pain.0000000000001939","article-title":"The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises","volume":"161","author":"Raja","year":"2020","journal-title":"Pain"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2420","DOI":"10.1097\/j.pain.0000000000000613","article-title":"Updating the definition of pain","volume":"157","author":"Williams","year":"2016","journal-title":"Pain"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.jpain.2007.09.006","article-title":"Pain and stress in a systems perspective: Reciprocal neural, endocrine, and immune interactions","volume":"9","author":"Chapman","year":"2008","journal-title":"J. Pain"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2737","DOI":"10.1097\/j.pain.0000000000002264","article-title":"Association of chronic pain with comorbidities and health care utilization: A retrospective cohort study using health administrative data","volume":"162","author":"Foley","year":"2021","journal-title":"Pain"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2105\/AJPH.2018.304747","article-title":"The global burden of musculoskeletal pain\u2014Where to from here?","volume":"109","author":"Blyth","year":"2019","journal-title":"Am. J. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1016\/S0140-6736(21)00393-7","article-title":"Chronic pain: An update on burden, best practices, and new advances","volume":"397","author":"Cohen","year":"2021","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.ejpain.2011.07.006","article-title":"Socio-economic burden of patients with a diagnosis related to chronic pain\u2013Register data of 840,000 S wedish patients","volume":"16","author":"Gustavsson","year":"2012","journal-title":"Eur. J. Pain"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.jpain.2012.03.009","article-title":"The economic costs of pain in the United States","volume":"13","author":"Gaskin","year":"2012","journal-title":"J. Pain"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Harvie, D.S., Smith, R.T., Martin, D., Hirsh, A.T., and Trost, Z. (2022). Novel applications of virtual and mixed reality in pain research and treatment. Front. Virtual Real., 3.","DOI":"10.3389\/frvir.2022.1018804"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1038\/s41380-020-0661-4","article-title":"The changing opioid crisis: Development, challenges and opportunities","volume":"26","author":"Volkow","year":"2021","journal-title":"Mol. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1097\/j.pain.0000000000002060","article-title":"Virtual reality approaches to pain: Toward a state of the science","volume":"162","author":"Trost","year":"2021","journal-title":"Pain"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Skarbez, R., Smith, M., and Whitton, M.C. (2021). Revisiting Milgram and Kishino\u2019s reality-virtuality continuum. Front. Virtual Real., 2.","DOI":"10.3389\/frvir.2021.647997"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Zhao, J., Riecke, B.E., Kelly, J.W., Stefanucci, J., and Klippel, A. (2023). Human spatial perception, cognition, and behaviour in extended reality. Front. Virtual Real., 4.","DOI":"10.3389\/frvir.2023.1257230"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.ecns.2019.02.006","article-title":"A call to unify definitions of virtual reality","volume":"31","author":"Farra","year":"2019","journal-title":"Clin. Simul. Nurs."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"108","DOI":"10.17011\/ht\/urn.201611174652","article-title":"Immersion revisited: A review of existing definitions of immersion and their relation to different theories of presence","volume":"12","author":"Nilsson","year":"2016","journal-title":"Hum. Technol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1080\/10833196.2021.1903209","article-title":"Exploring the effectiveness of immersive Virtual Reality interventions in the management of musculoskeletal pain: A state-of-the-art review","volume":"26","author":"Brady","year":"2021","journal-title":"Phys. Ther. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.2147\/JPR.S200498","article-title":"Virtual reality as an analgesic for acute and chronic pain in adults: A systematic review and meta-analysis","volume":"12","author":"Mallari","year":"2019","journal-title":"J. Pain Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1111\/pan.14546","article-title":"Virtual reality in pediatrics, effects on pain and anxiety: A systematic review and meta-analysis update","volume":"32","author":"Tas","year":"2022","journal-title":"Pediatric Anesthesia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1213\/ANE.0000000000004165","article-title":"Systematic review and meta-analysis of virtual reality in pediatrics: Effects on pain and anxiety","volume":"129","author":"Eijlers","year":"2019","journal-title":"Anesthesia Analg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Hadjiat, Y., and Marchand, S. (2022). Virtual reality and the mediation of acute and chronic pain in adult and pediatric populations: Research developments. Front. Pain Res., 3.","DOI":"10.3389\/fpain.2022.840921"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Viderman, D., Tapinova, K., Dossov, M., Seitenov, S., and Abdildin, Y.G. (2023). Virtual reality for pain management: An umbrella review. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1203670"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e50089","DOI":"10.2196\/50089","article-title":"Virtual Reality Therapy for the Management of Chronic Spinal Pain: Systematic Review and Meta-Analysis","volume":"12","author":"Zhang","year":"2024","journal-title":"JMIR Serious Games"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/AJP.0000000000001029","article-title":"The state of science in the use of virtual reality in the treatment of acute and chronic pain: A systematic scoping review","volume":"38","author":"Baker","year":"2022","journal-title":"Clin. J. Pain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e10839","DOI":"10.2196\/10839","article-title":"Virtual reality clinical research: Promises and challenges","volume":"6","author":"Garrett","year":"2018","journal-title":"JMIR Serious Games"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1016\/j.pmrj.2018.07.004","article-title":"Barriers, facilitators and interventions to support virtual reality implementation in rehabilitation: A scoping review","volume":"10","author":"Glegg","year":"2018","journal-title":"PM&R"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s10055-022-00654-2","article-title":"Virtual reality applied to physiotherapy: A review of current knowledge","volume":"27","author":"Brepohl","year":"2023","journal-title":"Virtual Real."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Donegan, T., Ryan, B.E., Swidrak, J., and Sanchez-Vives, M.V. (2020). Immersive virtual reality for clinical pain: Considerations for effective therapy. Front. Virtual Real., 1.","DOI":"10.3389\/frvir.2020.00009"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1097\/j.pain.0000000000002883","article-title":"Effect modifiers of virtual reality in pain management: A systematic review and meta-regression analysis","volume":"164","author":"Lier","year":"2023","journal-title":"Pain"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1007\/s11916-009-0019-8","article-title":"The use of virtual reality for pain control: A review","volume":"13","author":"Mahrer","year":"2009","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1089\/cpb.2007.9993","article-title":"The neurobiology of virtual reality pain attenuation","volume":"10","author":"Gold","year":"2007","journal-title":"CyberPsychology Behav."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Guerra-Armas, J., Flores-Cortes, M., Pineda-Galan, C., Luque-Suarez, A., and La Touche, R. (2023). Role of Immersive Virtual Reality in Motor Behaviour Decision-Making in Chronic Pain Patients. Brain Sci., 13.","DOI":"10.3390\/brainsci13040617"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"eabj7360","DOI":"10.1126\/scitranslmed.abj7360","article-title":"Brain circuits for pain and its treatment","volume":"13","author":"Lindsay","year":"2021","journal-title":"Sci. Transl. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.neubiorev.2021.08.013","article-title":"The anatomy of pain and suffering in the brain and its clinical implications","volume":"130","author":"Adhia","year":"2021","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Moreau, S., Th\u00e9rond, A., Cerda, I.H., Studer, K., Pan, A., Tharpe, J., Crowther, J.E., Abd-Elsayed, A., Gilligan, C., and Tolba, R. (2024). Virtual reality in acute and chronic pain medicine: An updated review. Curr. Pain Headache Rep., 1\u201336.","DOI":"10.1007\/s11916-024-01246-2"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s12984-020-00753-8","article-title":"Virtual reality in pain therapy: A requirements analysis for older adults with chronic back pain","volume":"17","author":"Stamm","year":"2020","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Matamala-Gomez, M., Donegan, T., Bottiroli, S., Sandrini, G., Sanchez-Vives, M.V., and Tassorelli, C. (2019). Immersive virtual reality and virtual embodiment for pain relief. Front. Hum. Neurosci., 13.","DOI":"10.3389\/fnhum.2019.00279"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1097\/AJP.0000000000000599","article-title":"Virtual reality as a distraction intervention to relieve pain and distress during medical procedures: A comprehensive literature review","volume":"34","author":"Indovina","year":"2018","journal-title":"Clin. J. Pain"},{"key":"ref_38","first-page":"193","article-title":"How we experience immersive virtual environments: The concept of presence and its measurement","volume":"40","author":"Slater","year":"2009","journal-title":"Anu. Psicol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Burdea, G.C., and Coiffet, P. (2003). Virtual Reality Technology, John Wiley & Sons.","DOI":"10.1162\/105474603322955950"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1177\/0141076813480996","article-title":"\u2018Gamification\u2019: Influencing health behaviours with games","volume":"106","author":"King","year":"2013","journal-title":"J. R. Soc. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/j.pmn.2022.05.004","article-title":"A systematic review of virtual reality therapeutics for acute pain management","volume":"23","author":"Dreesmann","year":"2022","journal-title":"Pain Manag. Nurs."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e34402","DOI":"10.2196\/34402","article-title":"Virtual reality applications in chronic pain management: Systematic review and meta-analysis","volume":"10","author":"Goudman","year":"2022","journal-title":"JMIR Serious Games"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Hoffman, H.G. (2021). Interacting with virtual objects via embodied avatar hands reduces pain intensity and diverts attention. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-89526-4"},{"key":"ref_44","first-page":"69","article-title":"Interactive and passive virtual reality distraction: Effects on presence and pain intensity","volume":"2011","year":"2011","journal-title":"Annu. Rev. Cybertherapy Telemed."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1097\/j.pain.0000000000003083","article-title":"Effects of virtual reality on psychophysical measures of pain: Superiority to imagination and nonimmersive conditions","volume":"165","author":"Tesarz","year":"2024","journal-title":"Pain"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1097\/j.pain.0000000000001900","article-title":"Virtual reality: Physiological and behavioral mechanisms to increase individual pain tolerance limits","volume":"161","author":"Colloca","year":"2020","journal-title":"Pain"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Won, A.S., Bailey, J., Bailenson, J., Tataru, C., Yoon, I.A., and Golianu, B. (2017). Immersive virtual reality for pediatric pain. Children, 4.","DOI":"10.3390\/children4070052"},{"key":"ref_48","first-page":"751","article-title":"Virtual Reality Distraction for Reducing Acute Postoperative Pain After Hip Arthroplasty: A Randomized Trial","volume":"138","author":"Kopac","year":"2024","journal-title":"Anesth. Analg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1017\/S1478951518000639","article-title":"Virtual reality as a distraction technique for pain and anxiety among patients with breast cancer: A randomized control trial","volume":"17","author":"Mohammad","year":"2019","journal-title":"Palliat. Support. Care"},{"key":"ref_50","first-page":"278","article-title":"Randomized, crossover study of immersive virtual reality to decrease opioid use during painful wound care procedures in adults","volume":"39","author":"McSherry","year":"2018","journal-title":"J. Burn. Care Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.burns.2022.02.002","article-title":"A comparison of interactive immersive virtual reality and still nature pictures as distraction-based analgesia in burn wound care","volume":"49","author":"Patterson","year":"2023","journal-title":"Burns"},{"key":"ref_52","first-page":"27","article-title":"Interactivity influences the magnitude of virtual reality analgesia","volume":"2","author":"Wender","year":"2009","journal-title":"J. Cyber Ther. Rehabil."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Lier, E.J., Oosterman, J.M., Assmann, R., de Vries, M., and Van Goor, H. (2020). The effect of Virtual Reality on evoked potentials following painful electrical stimuli and subjective pain. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-66035-4"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.jpain.2023.03.013","article-title":"Get your head in the game: A replicated single-case experimental design evaluating the effect of a novel virtual reality intervention in people with chronic low back pain","volume":"24","author":"MacIntyre","year":"2023","journal-title":"J. Pain"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1089\/g4h.2022.0130","article-title":"The effect of a virtual reality-mediated gamified rehabilitation program on pain, disability, function, and balance in knee osteoarthritis: A prospective randomized controlled study","volume":"12","author":"Tuna","year":"2023","journal-title":"Games Health J."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Hoffman, H.G., Fontenot, M.R., Garcia-Palacios, A., Greenleaf, W.J., Alhalabi, W., Curatolo, M., and Flor, H. (2023). Adding tactile feedback increases avatar ownership and makes virtual reality more effective at reducing pain in a randomized crossover study. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-31038-4"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1097\/j.pain.0000000000002617","article-title":"A prospective, double-blind, pilot, randomized, controlled trial of an \u2018embodied\u2019 virtual reality intervention for adults with low back pain","volume":"163","author":"Eccleston","year":"2022","journal-title":"Pain"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Matamala-Gomez, M., Nierula, B., Donegan, T., Slater, M., and Sanchez-Vives, M.V. (2020). Manipulating the perceived shape and color of a virtual limb can modulate pain responses. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020291"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.jpain.2018.12.001","article-title":"Decreasing pain ratings in chronic arm pain through changing a virtual body: Different strategies for different pain types","volume":"20","author":"Gonzalez","year":"2019","journal-title":"J. Pain"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1080\/17483107.2022.2129846","article-title":"A randomized controlled pilot study examining immediate effects of embodying a virtual reality superhero in people with chronic low back pain","volume":"19","author":"Harvie","year":"2024","journal-title":"Disabil. Rehabil. Assist. Technol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1186\/s13018-023-04158-w","article-title":"Virtual embodiment for improving range of motion in patients with movement-related shoulder pain: An experimental study","volume":"18","author":"Donegan","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.pmn.2015.03.001","article-title":"The effect of virtual reality distraction on pain relief during dressing changes in children with chronic wounds on lower limbs","volume":"16","author":"Hua","year":"2015","journal-title":"Pain Manag. Nurs."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Ryu, J.H., Park, J.W., Nahm, F.S., Jeon, Y.T., Oh, A.Y., Lee, H.J., Kim, J.H., and Han, S.H. (2018). The effect of gamification through a virtual reality on preoperative anxiety in pediatric pa-tients undergoing general anesthesia: A prospective, randomized, and controlled trial. J. Clin. Med., 7.","DOI":"10.3390\/jcm7090284"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1089\/g4h.2018.0111","article-title":"A randomized controlled trial on the use of virtual reality for needle-related procedures in children and adolescents in the emergency department","volume":"8","author":"Dumoulin","year":"2019","journal-title":"Games Health J."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e22620","DOI":"10.2196\/22620","article-title":"Virtual reality in pain rehabilitation for youth with chronic pain: Pilot feasibility study","volume":"7","author":"Griffin","year":"2020","journal-title":"JMIR Rehabil. Assist. Technol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1111\/papr.12799","article-title":"Pain and distraction according to sensory modalities: Current findings and future directions","volume":"19","author":"Michael","year":"2019","journal-title":"Pain Pract."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s11916-005-0044-1","article-title":"How does distraction work in the management of pain?","volume":"9","author":"Johnson","year":"2005","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/jan.15473","article-title":"Effectiveness of virtual reality intervention on reducing the pain, anxiety and fear of needle-related procedures in paediatric patients: A systematic review and meta-analysis","volume":"79","author":"Gao","year":"2023","journal-title":"J. Adv. Nurs."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"104115","DOI":"10.1016\/j.ijnurstu.2021.104115","article-title":"Effectiveness of virtual reality in the management of paediatric anxiety during the peri-operative period: A systematic review and meta-analysis","volume":"125","author":"Simonetti","year":"2022","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e35008","DOI":"10.2196\/35008","article-title":"Effect of virtual reality on pediatric pain and fear during procedures involving needles: Systematic review and meta-analysis","volume":"10","author":"Peyro","year":"2022","journal-title":"JMIR Serious Games"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"3032","DOI":"10.1111\/jocn.16217","article-title":"Use of virtual reality in managing paediatric procedural pain and anxiety: An integrative literature review","volume":"31","author":"Addab","year":"2022","journal-title":"J. Clin. Nurs."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Do, A.L., Enax-Krumova, E.K., \u00d6zg\u00fcl, \u00d6., Eitner, L.B., Heba, S., Tegenthoff, M., Maier, C., and H\u00f6ffken, O. (2020). Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation. BMC Neurosci., 21.","DOI":"10.1186\/s12868-020-00604-1"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Smith, K.L., Wang, Y., and Colloca, L. (2022). Impact of virtual reality technology on pain and anxiety in pediatric burn patients: A systematic review and meta-analysis. Front. Virtual Real., 2.","DOI":"10.3389\/frvir.2021.751735"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Valverde, N., Muriel Fernandez, J., L\u00f3pez-Valverde, A., Valero Juan, L.F., Ram\u00edrez, J.M., Flores Fraile, J., Herrero Payo, J., Blanco Antona, L.A., Macedo de Sousa, B., and Bravo, M. (2020). Use of virtual reality for the management of anxiety and pain in dental treatments: Systematic review and meta-analysis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9041025"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1162\/pres.1997.6.6.603","article-title":"A framework for immersive virtual environments (FIVE): Speculations on the role of presence in virtual environments","volume":"6","author":"Slater","year":"1997","journal-title":"Presence Teleoperators Virtual Environ."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1166\/jnsne.2013.1063","article-title":"Virtual reality in the neuroscience of multisensory integration and consciousness of bodily self","volume":"2","author":"Tseng","year":"2013","journal-title":"J. Neurosci. Neuroeng."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1038\/nrn3122","article-title":"Virtual reality in neuroscience research and therapy","volume":"12","author":"Bohil","year":"2011","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1089\/cyber.2020.0823","article-title":"Virtual reality as a pain distraction modality for experimentally induced pain in a chronic pain population: An exploratory study","volume":"25","author":"Brown","year":"2022","journal-title":"Cyberpsychol. Behav. Soc. Netw."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.pain.2004.06.013","article-title":"Manipulating presence influences the magnitude of virtual reality analgesia","volume":"111","author":"Hoffman","year":"2004","journal-title":"Pain"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Flores-Cortes, M., Guerra-Armas, J., Pineda-Galan, C., La Touche, R., and Luque-Suarez, A. (2023). Sensorimotor Uncertainty of Immersive Virtual Reality Environments for People in Pain: Scoping Review. Brain Sci., 13.","DOI":"10.3390\/brainsci13101461"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1007\/s00426-021-01613-3","article-title":"Visual\u2013haptic integration, action and embodiment in virtual reality","volume":"86","author":"McAnally","year":"2022","journal-title":"Psychol. Res."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1016\/j.concog.2006.11.001","article-title":"Adolescent development of motor imagery in a visually guided pointing task","volume":"16","author":"Choudhury","year":"2007","journal-title":"Conscious. Cogn."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1093\/pm\/pnx109","article-title":"Innovative technology using virtual reality in the treatment of pain: Does it reduce pain via distraction, or is there more to it?","volume":"19","author":"Gupta","year":"2018","journal-title":"Pain Med."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"3722","DOI":"10.1080\/09638288.2019.1610803","article-title":"The effect of interactive virtual reality on pain perception: A systematic review of clinical studies","volume":"42","author":"Wittkopf","year":"2020","journal-title":"Disabil. Rehabil."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1080\/10447318.2017.1412144","article-title":"Body movement reduces pain intensity in virtual reality-based analgesia","volume":"34","author":"Czub","year":"2018","journal-title":"Int. J. Hum. Comput. Interact."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"S182","DOI":"10.1111\/j.1526-4637.2007.00381.x","article-title":"Virtual reality and interactive simulation for pain distraction","volume":"8","author":"Wiederhold","year":"2007","journal-title":"Pain Med."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Lier, E.J., Harder, J., Oosterman, J.M., de Vries, M., and van Goor, H. (2018). Modulation of tactile perception by Virtual Reality distraction: The role of individual and VR-related factors. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0208405"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Deng, X., Jian, C., Yang, Q., Jiang, N., Huang, Z., and Zhao, S. (2022). The analgesic effect of different interactive modes of virtual reality: A prospective functional near-infrared spectroscopy (fNIRS) study. Front. Neurosci., 16.","DOI":"10.3389\/fnins.2022.1033155"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1007\/s10055-022-00722-7","article-title":"Immersive virtual reality for upper limb rehabilitation: Comparing hand and controller interaction","volume":"27","author":"Juan","year":"2023","journal-title":"Virtual Real."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.bjpt.2020.11.003","article-title":"Effectiveness of virtual reality in children and young adults with cerebral palsy: A systematic review of randomized controlled trial","volume":"25","author":"Fandim","year":"2021","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1111\/pan.13842","article-title":"Virtual reality in pediatric anesthesia: A toy or a tool","volume":"30","author":"Evans","year":"2020","journal-title":"Pediatr. Anesthesia"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1007\/s12178-022-09797-w","article-title":"Gamification in musculoskeletal rehabilitation","volume":"15","author":"Alfieri","year":"2022","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.amepre.2012.02.023","article-title":"Role of video games in improving health-related outcomes: A systematic review","volume":"42","author":"Primack","year":"2012","journal-title":"Am. J. Prev. Med."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Mouatt, B., Smith, A.E., Mellow, M.L., Parfitt, G., Smith, R.T., and Stanton, T.R. (2020). The use of virtual reality to influence motivation, affect, enjoyment, and engagement during exercise: A scoping review. Front. Virtual Real., 1.","DOI":"10.3389\/frvir.2020.564664"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12984-020-00801-3","article-title":"Immersive virtual reality health games: A narrative review of game design","volume":"18","author":"Tao","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1177\/1460458214537511","article-title":"A game plan: Gamification design principles in mHealth applications for chronic disease management","volume":"22","author":"Miller","year":"2016","journal-title":"Health Inform. J."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/PEP.0000000000000326","article-title":"Gamification in physical therapy: More than using games","volume":"29","author":"Janssen","year":"2017","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"3350","DOI":"10.1111\/jocn.16227","article-title":"Effect of a game-based intervention on preoperative pain and anxiety in children: A systematic review and meta-analysis","volume":"31","year":"2022","journal-title":"J. Clin. Nurs."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"e163","DOI":"10.1016\/j.apmr.2024.02.575","article-title":"Impact of Gamification on Pain, Range of Motion, Muscle Strength, and Functional Independence Post Distal Radius Fracture","volume":"105","author":"Naqvi","year":"2024","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1089\/g4h.2021.0232","article-title":"Effects of gaming on pain-related fear, pain catastrophizing, anxiety, and depression in patients with chronic musculoskeletal pain: A systematic review and meta-analysis","volume":"11","author":"Gava","year":"2022","journal-title":"Games Health J."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.cobeha.2018.12.007","article-title":"From fear of movement-related pain and avoidance to chronic pain disability: A state-of-the-art review","volume":"26","author":"Meulders","year":"2019","journal-title":"Curr. Opin. Behav. Sci."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Vitters\u00f8, A.D., Halicka, M., Buckingham, G., Proulx, M.J., and Bultitude, J.H. (2022). The sensorimotor theory of pathological pain revisited. Neurosci. Biobehav. Rev., 139.","DOI":"10.1016\/j.neubiorev.2022.104735"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"pzab289","DOI":"10.1093\/ptj\/pzab289","article-title":"Linking pain and motor control: Conceptualization of movement deficits in patients with painful conditions","volume":"102","author":"Kantak","year":"2022","journal-title":"Phys. Ther."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.neubiorev.2016.08.009","article-title":"Chronic pain and distorted body image: Implications for multisensory feedback interventions","volume":"69","author":"Senkowski","year":"2016","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1007\/s11926-007-0079-x","article-title":"Role of distorted body image in pain","volume":"9","author":"Lotze","year":"2007","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.concog.2016.06.005","article-title":"Real, rubber or virtual: The vision of \u2018one\u2019s own\u2019 body as a means for pain modulation. A narrative review","volume":"43","author":"Martini","year":"2016","journal-title":"Conscious. Cogn."},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Boesch, E., Bellan, V., Moseley, G.L., and Stanton, T.R. (2016). The effect of bodily illusions on clinical pain: A systematic review and meta-analysis. Pain, 157.","DOI":"10.1097\/j.pain.0000000000000423"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1068\/p7545","article-title":"Measuring the effects through time of the influence of visuomotor and visuotactile synchronous stimulation on a virtual body ownership illusion","volume":"43","author":"Kokkinara","year":"2014","journal-title":"Perception"},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Buetler, K.A., Penalver-Andres, J., \u00d6zen, \u00d6., Ferriroli, L., M\u00fcri, R.M., Cazzoli, D., and Marchal-Crespo, L. (2022). \u2018Tricking the Brain\u2019 Using Immersive Virtual Reality: Modifying the Self-Perception Over Embodied Avatar Influences Motor Cortical Excitability and Action Initiation. Front. Hum. Neurosci., 15.","DOI":"10.3389\/fnhum.2021.787487"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1097\/j.pain.0000000000002099","article-title":"Altered interoception and its role for the co-occurrence of chronic primary pain and mental health problems in children","volume":"162","author":"Hechler","year":"2021","journal-title":"Pain"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"8074","DOI":"10.1523\/JNEUROSCI.0745-06.2006","article-title":"Neural Basis of Embodiment: Distinct Contributions of Temporoparietal Junction and Extrastriate Body Area","volume":"26","author":"Arzy","year":"2006","journal-title":"J. Neurosci."},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"Matamala-Gomez, M., Maselli, A., Malighetti, C., Realdon, O., Mantovani, F., and Riva, G. (2021). Virtual Body Ownership Illusions for Mental Health: A Narrative Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10010139"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s10055-021-00511-8","article-title":"Trick the body trick the mind: Avatar representation affects the perception of available action possibilities in virtual reality","volume":"26","author":"Joy","year":"2022","journal-title":"Virtual Real."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.concog.2005.09.004","article-title":"Having a body versus moving your body: How agency structures body-ownership","volume":"15","author":"Tsakiris","year":"2006","journal-title":"Conscious. Cogn."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10055-021-00530-5","article-title":"Evaluation of the impact of different levels of self-representation and body tracking on the sense of presence and embodiment in immersive VR","volume":"26","author":"Melo","year":"2022","journal-title":"Virtual Real."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.1080\/09593985.2022.2095313","article-title":"\u2018It made you feel like you\u2019ve still got it\u2019: Experiences of people with chronic low back pain undertaking a single session of body image training in virtual reality","volume":"39","author":"Kelly","year":"2023","journal-title":"Physiother. Theory Pract."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1093\/pm\/pnab217","article-title":"The Analgesic Effects of Virtual Reality for People with Chronic Pain: A Scoping Review","volume":"23","author":"Austin","year":"2022","journal-title":"Pain Med."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.pain.2010.04.009","article-title":"\u2018Pain inhibits pain\u2019 mechanisms: Is pain modulation simply due to distraction?","volume":"150","author":"Moont","year":"2010","journal-title":"Pain"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.burns.2015.06.022","article-title":"Interactive gaming consoles reduced pain during acute minor burn rehabilitation: A randomized, pilot trial","volume":"42","author":"Parker","year":"2016","journal-title":"Burns"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jpain.2021.10.009","article-title":"Real Bodies Not Required? Placebo Analgesia and Pain Perception in Immersive Virtual and Augmented Reality","volume":"23","author":"Ho","year":"2022","journal-title":"J. Pain"},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"McNaughton, D., Beath, A., Hush, J., and Jones, M. (2022). Perceptual sensory attenuation in chronic pain subjects and healthy controls. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-13175-4"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1097\/j.pain.0000000000003063","article-title":"The role of evolving concepts and new technologies and approaches in advancing pain research, management, and education since the establishment of the International Association for the Study of Pain","volume":"164","author":"Flor","year":"2023","journal-title":"Pain"},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Sim\u00f3n-Vicente, L., Rodr\u00edguez-Cano, S., Delgado-Benito, V., Aus\u00edn-Villaverde, V., and Delgado, E.C. (2022). Cybersickness. A systematic literature review of adverse effects related to virtual reality. Neurolog\u00eda.","DOI":"10.1016\/j.nrl.2022.04.009"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1007\/s10055-021-00513-6","article-title":"Cybersickness in current-generation virtual reality head-mounted displays: Systematic review and outlook","volume":"25","author":"Caserman","year":"2021","journal-title":"Virtual Real."},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Weech, S., Kenny, S., and Barnett-Cowan, M. (2019). Presence and cybersickness in virtual reality are negatively related: A review. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.00158"},{"key":"ref_126","doi-asserted-by":"crossref","unstructured":"Saredakis, D., Szpak, A., Birckhead, B., Keage, H.A.D., Rizzo, A., and Loetscher, T. (2020). Factors associated with virtual reality sickness in head-mounted displays: A systematic review and meta-analysis. Front. Hum. Neurosci., 14.","DOI":"10.3389\/fnhum.2020.00096"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"e41091","DOI":"10.2196\/41091","article-title":"Research status and emerging trends in virtual reality rehabilitation: Bibliometric and knowledge graph study","volume":"11","author":"Fan","year":"2023","journal-title":"JMIR Serious Games"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"e11973","DOI":"10.2196\/11973","article-title":"Recommendations for Methodology of Virtual Reality Clinical Trials in Health Care by an International Working Group: Iterative Study","volume":"6","author":"Birckhead","year":"2019","journal-title":"JMIR Ment. Health"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"e26344","DOI":"10.2196\/26344","article-title":"Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review","volume":"23","author":"Brassel","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"ref_130","doi-asserted-by":"crossref","unstructured":"Badia, S.B.I., Fluet, G.G., Llorens, R., and Deutsch, J.E. (2016). Virtual Reality for Sensorimotor Rehabilitation Post Stroke: Design Principles and Evidence. Neurorehabilitation Technology, Springer International Publishing.","DOI":"10.1007\/978-3-319-28603-7_28"},{"key":"ref_131","first-page":"30","article-title":"Development of a Multimodal, Personalized Intervention of Virtual Reality Integrated within Physiotherapy for Patients with Complex Chronic Low-Back Pain","volume":"1","author":"Slatman","year":"2024","journal-title":"J. Med. Ext. Real."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.joca.2023.03.004","article-title":"Osteoarthritis consumers as co-researchers: Identifying consumer insights to improve osteoarthritis management by co-designing translational research solutions","volume":"31","author":"Braithwaite","year":"2023","journal-title":"Osteoarthr. Cartil."},{"key":"ref_133","first-page":"373","article-title":"In-home virtual reality program for chronic low back pain: Durability of a randomized, placebo-controlled clinical trial to 18 months post-treatment","volume":"49","author":"Maddox","year":"2024","journal-title":"Reg. Anesthesia Pain Med."}],"container-title":["Multimodal Technologies and Interaction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-4088\/8\/8\/66\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:28:17Z","timestamp":1760110097000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-4088\/8\/8\/66"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":133,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["mti8080066"],"URL":"https:\/\/doi.org\/10.3390\/mti8080066","relation":{},"ISSN":["2414-4088"],"issn-type":[{"value":"2414-4088","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}