Immersive Virtual Reality-Based Exercise for Pain Management in Fibromyalgia: An Exploratory Study with Risk of Poor Outcomes Stratification

Fibromyalgia (FM) is characterized by persistent widespread pain that severely impacts quality of life. Immersive virtual reality-based exercise (iVRE) is emerging as a therapeutic modality for chronic pain management. However, research on iVRE in FM patients has primarily focused on perceived pain...

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Main Authors: Claudio Carvajal-Parodi, Gonzalo Arias-Álvarez, David Ulloa-Díaz, Luis Romero-Vera, Oscar Andrades-Ramírez, Francisco Guede-Rojas, Jesús G. Ponce-González
Format: Article
Language:English
Published: MDPI AG 2025-05-01
Series:Applied Sciences
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Online Access:https://www.mdpi.com/2076-3417/15/11/5956
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author Claudio Carvajal-Parodi
Gonzalo Arias-Álvarez
David Ulloa-Díaz
Luis Romero-Vera
Oscar Andrades-Ramírez
Francisco Guede-Rojas
Jesús G. Ponce-González
author_facet Claudio Carvajal-Parodi
Gonzalo Arias-Álvarez
David Ulloa-Díaz
Luis Romero-Vera
Oscar Andrades-Ramírez
Francisco Guede-Rojas
Jesús G. Ponce-González
author_sort Claudio Carvajal-Parodi
collection DOAJ
description Fibromyalgia (FM) is characterized by persistent widespread pain that severely impacts quality of life. Immersive virtual reality-based exercise (iVRE) is emerging as a therapeutic modality for chronic pain management. However, research on iVRE in FM patients has primarily focused on perceived pain intensity (PI), with limited exploration of underlying analgesic mechanisms. This study aims to explore the effects of iVRE on PI, considering risk of poor outcomes (RPO) stratification, and on mechanical pain sensitivity (MPS) in FM. A single-arm, uncontrolled, pre-post-test exploratory study was conducted in subjects with FM. The intervention included 2 weekly 15-min iVRE sessions for 6 weeks. PI (numeric rating scale [NRS]) and MPS (pressure pain thresholds [PPTs] at the upper trapezius, lumbar spine, and knee) were assessed at baseline, after the first session (to assess exercise-induced hypoalgesia), and postintervention. RPO was assessed using the Keele STarT MSK Tool. Eleven participants completed the study. No adverse effects were reported. Clinically important reductions were observed in PI (mean difference [MD]: −2.36, 95% CI: [−4.15, −0.58], d = 0.89; <i>p</i> < 0.05) with this effect being associated with baseline RPO. No observable changes were found in PPTs (all 95% CIs included 0, <i>p</i> > 0.05). In this sample, iVRE appears to reduce PI but not PPTs, suggesting the persistence of MPS and limitations in activating endogenous pain inhibitory mechanisms. Further randomized controlled trials with larger samples are needed to corroborate these results.
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spelling doaj-art-ac26152ded454968a9f0f6a9c3e33a2e2025-08-20T02:32:34ZengMDPI AGApplied Sciences2076-34172025-05-011511595610.3390/app15115956Immersive Virtual Reality-Based Exercise for Pain Management in Fibromyalgia: An Exploratory Study with Risk of Poor Outcomes StratificationClaudio Carvajal-Parodi0Gonzalo Arias-Álvarez1David Ulloa-Díaz2Luis Romero-Vera3Oscar Andrades-Ramírez4Francisco Guede-Rojas5Jesús G. Ponce-González6Facultad de Odontología y Ciencias de la Rehabilitación, Escuela de Kinesiología, Universidad San Sebastián, Lientur #1457, Concepcion 4030000, ChileFacultad de Odontología y Ciencias de la Rehabilitación, Escuela de Kinesiología, Universidad San Sebastián, Lientur #1457, Concepcion 4030000, ChileDepartment of Sports Sciences and Physical Conditioning, Universidad Católica de la Santísima Concepción, Concepcion 4030000, ChileFacultad de Medicina y Ciencias de la Salud, Escuela de Kinesiología, Magíster en Fisiología Clínica del Ejercicio, Universidad Mayor, Santiago 8580745, ChileFacultad de Salud y Ciencias Sociales, Escuela de Ciencias de la Actividad Física, Universidad de las Américas, Concepcion 4030000, ChileExercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, ChileExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, 11002 Cadiz, SpainFibromyalgia (FM) is characterized by persistent widespread pain that severely impacts quality of life. Immersive virtual reality-based exercise (iVRE) is emerging as a therapeutic modality for chronic pain management. However, research on iVRE in FM patients has primarily focused on perceived pain intensity (PI), with limited exploration of underlying analgesic mechanisms. This study aims to explore the effects of iVRE on PI, considering risk of poor outcomes (RPO) stratification, and on mechanical pain sensitivity (MPS) in FM. A single-arm, uncontrolled, pre-post-test exploratory study was conducted in subjects with FM. The intervention included 2 weekly 15-min iVRE sessions for 6 weeks. PI (numeric rating scale [NRS]) and MPS (pressure pain thresholds [PPTs] at the upper trapezius, lumbar spine, and knee) were assessed at baseline, after the first session (to assess exercise-induced hypoalgesia), and postintervention. RPO was assessed using the Keele STarT MSK Tool. Eleven participants completed the study. No adverse effects were reported. Clinically important reductions were observed in PI (mean difference [MD]: −2.36, 95% CI: [−4.15, −0.58], d = 0.89; <i>p</i> < 0.05) with this effect being associated with baseline RPO. No observable changes were found in PPTs (all 95% CIs included 0, <i>p</i> > 0.05). In this sample, iVRE appears to reduce PI but not PPTs, suggesting the persistence of MPS and limitations in activating endogenous pain inhibitory mechanisms. Further randomized controlled trials with larger samples are needed to corroborate these results.https://www.mdpi.com/2076-3417/15/11/5956fibromyalgiavirtual realityexercisenumeric rating scalepressure pain thresholdrisk of poor outcomes
spellingShingle Claudio Carvajal-Parodi
Gonzalo Arias-Álvarez
David Ulloa-Díaz
Luis Romero-Vera
Oscar Andrades-Ramírez
Francisco Guede-Rojas
Jesús G. Ponce-González
Immersive Virtual Reality-Based Exercise for Pain Management in Fibromyalgia: An Exploratory Study with Risk of Poor Outcomes Stratification
Applied Sciences
fibromyalgia
virtual reality
exercise
numeric rating scale
pressure pain threshold
risk of poor outcomes
title Immersive Virtual Reality-Based Exercise for Pain Management in Fibromyalgia: An Exploratory Study with Risk of Poor Outcomes Stratification
title_full Immersive Virtual Reality-Based Exercise for Pain Management in Fibromyalgia: An Exploratory Study with Risk of Poor Outcomes Stratification
title_fullStr Immersive Virtual Reality-Based Exercise for Pain Management in Fibromyalgia: An Exploratory Study with Risk of Poor Outcomes Stratification
title_full_unstemmed Immersive Virtual Reality-Based Exercise for Pain Management in Fibromyalgia: An Exploratory Study with Risk of Poor Outcomes Stratification
title_short Immersive Virtual Reality-Based Exercise for Pain Management in Fibromyalgia: An Exploratory Study with Risk of Poor Outcomes Stratification
title_sort immersive virtual reality based exercise for pain management in fibromyalgia an exploratory study with risk of poor outcomes stratification
topic fibromyalgia
virtual reality
exercise
numeric rating scale
pressure pain threshold
risk of poor outcomes
url https://www.mdpi.com/2076-3417/15/11/5956
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