Key Takeaways & Executive Findings
- •• Virtual reality (VR) serves as a novel non-pharmacological intervention for neuropathic pain after spinal cord injury (SCI), applicable alone or in combination with other therapies. • Virtual walking visual illusion is the most widely used single-modal VR strategy for SCI-related neuropathic pain, with preliminary efficacy validated. • Combining VR with transcranial direct current stimulation, tactile feedback, proprioceptive input, and motor therapy expands clinical applications, offering multimodal treatment strategies. • VR intervention targets both spinal central sensitization and brain plasticity abnormalities, addressing the multidimensional pathogenesis of neuropathic pain post-SCI.
Abstract
BACKGROUND: Virtual reality has demonstrated unique advantages as a novel non-pharmacological intervention in the treatment of neuropathic pain following spinal cord injury. OBJECTIVE: To systematically review the pathogenesis of neuropathic pain following spinal cord injury, summarize the specific application modes and mechanisms of virtual reality therapy for this condition, and explore key factors influencing treatment efficacy, thereby providing novel therapeutic options for patients with neuropathic pain following spinal cord injury. METHODS: A literature search was conducted in the CNKI, PubMed, Web of Science, and Cochrane Library databases up to June 2025. The Chinese and English search terms included “spinal cord injury, central sensitization, cerebral cortex, noninvasive therapy, neuropathic pain, virtual reality.” A total of 1 352 articles were retrieved, and 73 articles that met the inclusion criteria were ultimately included in the analysis. RESULTS AND CONCLUSION: The development of neuropathic pain following spinal cord injury involves complex mechanisms in both the spinal cord and brain, closely associated with central sensitization at the spinal level and abnormal plasticity changes in the brain. Virtual reality, as a novel intervention approach, can be used alone or in combination with other intervention methods, showing unique therapeutic value for the multidimensional pathogenesis of neuropathic pain after spinal cord injury. Standalone virtual reality applications primarily involve virtual walking interventions aimed at restoring abnormal brain plasticity changes, while combined virtual reality applications have shown certain effects in both inhibiting central sensitization and modulating brain plasticity. Although virtual reality intervention shows great potential in the treatment of neuropathic pain following spinal cord injury, current research and applications still have certain limitations. Future efforts should focus on addressing these issues to fully realize the therapeutic value of virtual reality in neuropathic pain following spinal cord injury.
1. Introduction
Spinal cord injury (SCI) is a severe neurological disorder that not only affects sensory, motor, reflex, and autonomic functions [1], but also leads to a series of complications that severely impact patients' quality of life. Neuropathic pain occurs in up to 53% of SCI patients and often progresses to chronic pain [2-3]. Characterized by spontaneous pain, hyperalgesia, and allodynia [4], neuropathic pain manifests as burning, stabbing, or electric shock-like sensations [5]. The occurrence of neuropathic pain after SCI significantly affects patients' emotional state and daily activities, causing fatigue, anxiety, depression, and sleep disturbances, with an impact on physical and mental health that often exceeds the sensory and motor dysfunction caused by the SCI itself [6].
The pathogenesis of neuropathic pain following SCI involves complex mechanisms in both the spinal cord and brain, closely associated with central sensitization at the spinal level and abnormal plasticity changes in the brain [7-8]. Pharmacological intervention is the most common treatment, primarily by modulating neurotransmitter release, blocking pain factor-receptor binding, and limiting pain signal transmission [9]. However, long-term drug use can lead to drug resistance and dependence, adversely affecting treatment outcomes. Given the limitations of pharmacological therapy, non-pharmacological approaches such as visual feedback therapy [10], transcranial direct current stimulation [11], exercise therapy [12], and cognitive behavioral training have gained increasing attention [3]. Nevertheless, these interventions are also constrained by patient symptoms, compliance, and other factors in practical application.
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DU Xinyu, ZHAO Donglin, ZHANG Shuyang, LI Shihao, XING Zheng, CHU Xiaolei, LI Qi (2026). Virtual reality therapy on neuropathic pain following spinal cord injury. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21243
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Frequently Asked Questions
What is virtual reality therapy for neuropathic pain after spinal cord injury?
Virtual reality (VR) therapy uses computer-generated 3D environments to provide immersive sensory experiences. For neuropathic pain after spinal cord injury, VR interventions, such as virtual walking, aim to modulate brain plasticity and reduce pain by engaging the user in virtual scenarios, either alone or combined with other treatments.
How does virtual reality alleviate neuropathic pain in spinal cord injury patients?
VR therapy may alleviate neuropathic pain by targeting central sensitization and abnormal brain plasticity. It provides visual and sensory feedback that can distract from pain, promote cortical reorganization, and potentially inhibit pain signaling pathways, though the exact mechanisms are still under investigation.
What are the common VR interventions used for spinal cord injury neuropathic pain?
Common VR interventions include virtual walking visual illusions, which are the most widely used standalone approach, and combined approaches that integrate VR with transcranial direct current stimulation, tactile feedback, proprioceptive input, or motor therapy to enhance therapeutic effects.
Is virtual reality effective for all spinal cord injury patients with neuropathic pain?
VR therapy shows promise, but its effectiveness may vary. Factors such as the completeness of the injury, patient engagement, and the specific VR protocol can influence outcomes. More research is needed to optimize VR interventions for different patient subgroups.
What are the limitations of current VR therapy for neuropathic pain after spinal cord injury?
Current limitations include small sample sizes, heterogeneity in VR protocols, lack of long-term follow-up, and uncertainty about optimal parameters. Additionally, the mechanisms by which VR modulates pain are not fully understood, and accessibility to VR equipment may be a barrier.
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