Background: Neuropathic pain following spinal cord injury (SCI) affects approximately 60% of individuals with SCI. Effective pharmacological and non-pharmacological treatments remain elusive. We recently demonstrated that our immersive virtual reality walking intervention (VRWalk) may be effective for SCI NP. Additionally, we found that SCI NP may result from a decrease in thalamic γ-aminobutyric-acid (GABA), which disturbs central sensorimotor processing. Objective: While we identified GABAergic changes associated with SCI NP, a critical outstanding question is whether a decrease in SCI NP generated by our VRWalk intervention causes GABA content to rise. Method: A subset of participants (n = 7) of our VRWalk trial underwent magnetic resonance spectroscopy pre- and post-VRWalk intervention to determine if the decrease in SCI NP is associated with an increase in thalamic GABA. Results: The findings revealed a significant increase in thalamic GABA content from pre- to post-VRWalk treatment. Conclusion: While the current findings are preliminary and should be interpreted with caution, pre- to post-VRWalk reductions in SCI NP may be mediated by pre- to post-treatment increases in thalamic GABA by targeting and normalizing maladaptive sensorimotor cortex reorganization. Understanding the underlying mechanisms of pain recovery can serve to validate the efficacy of home-based VR walking treatment as a means of managing pain following SCI. Neuromodulatory interventions aimed at increasing thalamic inhibitory function may provide more effective pain relief than currently available treatments.

Commentary on: Habermann MB, Christian MB. Uncontrollability of experimental pain decreases pain intensity and relief pleasantness ratings in a between- group design. PAIN Rep 2026;11:e1448.

As emerging media technologies, virtual reality (VR) applications are used to elicit emotional engagement across various contexts—entertainment, education, therapy, training, marketing, and fitness, to name a few—often with the hope of effecting behavioral change. Within the healthcare domain, VR technologies have been successfully leveraged to manage acute pain, but understanding of their efficacy in managing chronic pain remains limited. Current models emphasize the necessity of examining discrete effects of VR across multiple dimensions of pain, particularly its emotional impact. An emotion receiving increased attention by media scholars over the past few years is awe, the complex response to perceived vastness. Awe is a highly relevant, yet largely unexplored, emotion in chronic pain research, as it involves cognitive processes—vastness appraisals, feelings of connectedness, accommodation of new ideas—which may influence psychological processes shaping pain perception. To date, no study has examined the feasibility of inducing awe through VR among individuals with chronic pain. Accordingly, this preliminary study deployed a descriptive mixed-methods approach to examine the feasibility of utilizing a head-mounted display for VR-induced awe. Participants (n = 10) with CLBP viewed 360-degree virtual nature scenes depicting a mountain ascension, combined with music previously validated to elicit awe. Participants completed self-report measures before and after the VR session documenting pain intensity and emotional experiences. Semi-structured qualitative interviews were conducted following the post-session surveys. Results from both methods support the feasibility of inducing awe among individuals with chronic pain via virtual immersion, showing overall positive affective changes and reduction in frequency of self- and pain-related thoughts.

Introduction: The number of clinical trials of extended reality (XR), including virtual and augmented reality, for pain has exponentially increased in the past 2 decades. To synthesize findings across studies and assess the effectiveness of XR interventions, a core outcome set (COS) is needed. Prior work identified 7 core outcome domains for XR trials in pain through a systematic review and consensus process. Objectives: The aim of this study was to establish a finalized COS of outcome measures (adult and pediatric) for XR trials for pain (acute, recurrent, and chronic). Methods: First, potential outcome measures were identified for each core domain through literature reviews. Second, a Delphi study was conducted with experts who rated suitability of each measure. Third, an expert consensus conference (including clinicians, researchers, and people with lived experience) was held to review the measurement properties of each candidate measure and to vote on a final COS of measures for XR. Results: A total of 52 experts participated in the Delphi survey and 15 attended the consensus conference. Among participants, 8 (52%) specialised in pediatric populations, 5 (33%) in adult populations, and 2 (15%) across the lifespan. Within each outcome domain, 2 to 4 measures with the highest rated suitability were selected as candidates. Consensus was achieved on a final COS consisting of 10 measures for pediatric trials and 8 for adult trials. Conclusion: This is a promising and necessary step to advance the field of XR pain research and better understand the effectiveness of XR for pain.