PTRCTJournal of neuroengineering and rehabilitation2025

Modifying lumbar flexion pain thresholds in patients with chronic low back pain through visual-proprioceptive manipulation with virtual reality: a cross-sectional study.

Jaime Jordán-López, María D Arguisuelas, Julio Doménech and 6 others

PMID 40537791

WHAT IT FOUND

Virtual reality made chronic back pain patients bend 5% further before pain when their arms looked shorter.

That was 7% more than when the arms looked longer, and when the avatar made the movement look larger, pain-free bending did not differ from no VR.

Key findings

01Under VR that made the arms look 20% shorter, pain-free lumbar flexion averaged 105% of the no-VR control, versus 100% with no VR and 98% when the arms looked 20% longer.

02The understated VR condition gave a statistically significant 5% increase over control and a 7% increase over overstated feedback; overstated feedback did not differ from control.

03Participants with higher pain intensity and more daily-life interference responded more to the understated condition; differences by kinesiophobia and catastrophizing were not significant.

STILL TO COME

How it was doneWhat they foundWhat it means for PTs

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What it does not show

The study tested a single laboratory session, so it does not show that repeated VR treatment changes pain or function. Participants were recruited from hospital orthopaedic and rehabilitation clinics, and the authors note possible selection bias and limited generalisability to more acute or highly disabling chronic low back pain. The sample was 50 adults, and the kinesiophobia and catastrophizing subgroup analyses had small numbers, so those subgroup findings were not significant. Chronic low back pain was non-specific, and the authors say underlying pain mechanisms may have varied. The required pain history was based partly on recall of the previous 6 months, which the authors note may introduce recall bias. The study was registered retrospectively.

The easy way to misread this

Do not conclude that VR treatment improves chronic low back pain. This was a single laboratory test of visual feedback, and the reported effect was a 5% to 7% change in pain-free flexion, not a lasting clinical improvement.

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