Virtual Reality Approaches to Pain: Toward a State of the Science

Zina Trost; Christopher France; Monima Anam; Corey Shum


Pain. 2021;162(2):325-331. 

In This Article

The Evolving Definition of Virtual Reality

The definition of VR has evolved alongside advancements in technical capabilities from an early stage of large projection rooms to current consumer products that use high-resolution head-mounted displays (HMDs). At its core, VR refers to simulated experiences intentionally presented to the individual's senses.[62] Virtual reality paradigms that have been used to date can be distinguished along 3 central and highly interrelated dimensions that have been dubbed the "pillars of VR": presence, immersion, and interactivity.[74]Presence refers to the "subjective experience of being in one place or environment, even when one is physically situated in another."[101]Immersion can refer both to the subjective user assessment (ie, a sense of being "caught up and absorbed" in the virtual world) and to the VR system configuration (eg, a 3-dimensional 360-degree virtual environment presented through HMD vs a 2-dimensional presentation on a computer screen).[52,70] Finally, interactivity refers to the degree to which users can influence the virtual environment,[14,52] as facilitated by the technical configuration. The objective vs subjective nature and hierarchical organization of these mutually informative constructs continue to be discussed within VR technology research[74] and provide initial guidance in interpreting findings in the context of pain. Indeed, the definition of VR is likely to evolve as technical progress continues to offer additional perceptual experiences (eg, see "Embodiment" as User Experiential Factor below). Studies/VR interventions cited in Table S1 (available as supplemental digital content at are categorized with respect to inclusion of the above factors, further discussed below.