Managing Neuropathic Pain After Spinal Cord Injury: The VR Approach

Neuropathic pain is especially cruel. Your legs are paralyzed; they cannot move, and they cannot even be touched. Yet, at the same time, you get a sensation of burning, stabbing, or shock-like pain in your very legs! This doesn't make any sense to anyone who feels it. For many years, it didn't even make sense to medicine.

Based on a new meta-analysis conducted and published in the Journal of Clinical Neuroscience 2025, the combined results of 25 articles revealed that 58% of people suffering from spinal cord injury suffer from neuropathic pain. That is more than half of all SCI survivors carrying a pain burden that standard medication often struggles to touch.

The search for better options is not new. But one approach gaining serious clinical ground is virtual reality for neuropathic pain, and the science behind it is more layered than most people realize.

Why Medications Keep Falling Short

Gabapentin, pregabalin, and tricyclic antidepressants are typically the first medications prescribed. They work for some people. For many others, the relief is partial at best, and the side effects, drowsiness, cognitive fog, and dependency risks, become their own daily problem.

A review published in Spinal Cord noted that neuropathic pain treatment options for pain presenting at or below the injury level remain largely refractory to both pharmacological and physical treatments. The underlying biology is part of why. It is not produced because of an injury or harm to the tissue. Rather, it occurs due to disturbances within the central nervous system’s own communication pathways, making this pain difficult to treat using any peripheral means.

That is exactly why researchers started looking inward, toward the brain.

What VR Actually Does to the Nervous System

To understand the mechanism, it helps to know a little about the gate control theory of pain. The inhibitory nerve circuits that form the spinal “pain gate” in the spinal cord are often disrupted after spinal cord injury. When those cells are compromised, pain signals travel to the brain with very little filtering.

Virtual reality for neuropathic pain targets this problem from two mechanisms.

First, it creates what researchers call inattentional blindness. As noted in reviews of VR-induced analgesia, virtual reality activates the visual cortex while engaging other sensory systems, which helps direct the brain’s attentional resources toward the virtual environment. Essentially, the brain gets fully absorbed in what it is seeing and loses focus on the pain signal.

Furthermore, continued exposure to VR may also trigger some form of neuroplasticity. Based on the study results found in PAIN Reports in 2024, researchers at the Icahn School of Medicine at Mount Sinai propose that virtual environments have the possibility to bring about neuroplastic changes and cortical reorganization. Through VR, individuals with paraplegia may experience the visual illusion of walking, which would promote changes to the body schema in the somatosensory cortex by suppressing unnecessary neuronal activity, leading to pain perception.

What the Studies Are Actually Finding

The 2024 Mount Sinai pilot randomized controlled trial, published in PAIN Reports, found a statistically significant interaction between VR environment and time on Neuropathic Pain Symptom Inventory scores. Scenic VR participants showed reduced scores both immediately after the sessions and at follow-up. A separate pilot study recorded mean pain scores dropping from 5.1 to around 3.0 on a numeric rating scale after just short exposure to VR environments among SCI patients.

The main approaches under investigation include: 

What a Session Actually Looks Like

VR rehabilitation therapy does not require a hospital setup. It is becoming increasingly common for the treatment to be administered in outpatient facilities or even at home through the use of head-mounted display devices. The person simply puts on the headset and is transported into another reality with their mind.

Based on neuroplasticity research, delivering these kinds of neuromodulation interventions consistently over 4 to 6 weeks is key. Results depend more on consistent practice than on single sessions. Most VR sessions last 20–40 minutes, with patients often reporting less pain, better sleep, improved mood, and greater motivation for rehabilitation.

This aspect is clinically significant. Chronic nerve pain management in SCI is not a short process. Anything that helps a patient stay active in their own recovery compounds its benefits over time.

The Honest Limitations

A comprehensive 2025 scoping review covering VR research from 2005 to February 2025 confirmed that while evidence is building, standardized clinical guidelines for VR in spinal cord injury pain management are still lacking. Most trials are small. Pain relief achieved during sessions does not always carry forward for days afterward. The subject matter is busy addressing such issues as well as identifying the most suitable VR setups and their effectiveness on specific types of injuries, as well as frequency levels.

This does not negate the obvious facts that there is a strong biological basis behind VR therapy, its promising initial results, and a high level of tolerability among patients.

A Final Word

Living with this kind of pain is profoundly exhausting. The signals are real even when the injury site says otherwise. Virtual reality for neuropathic pain does not replace everything that came before it, but it offers something genuinely different: a method that works with the brain's own capacity to change, rather than just trying to suppress a signal that keeps coming back.

What Is Next for You?

CogniHab develops evidence-based digital neurorehabilitation tools that make neurological recovery support more accessible to the people who need it most. Our team works with:

• Personalized rehab programs designed for your specific injury and pain needs

• Simple guidance and support for both patients and caregivers throughout recovery

• Easy progress tracking to monitor improvement over time

• Expanding access to novel digital therapies for underserved patient populations

Ready to explore what is possible? Connect with CogniHab today

FAQs

1. Can VR fully eliminate neuropathic pain after SCI?
   VR usually reduces pain rather than eliminating it. Even a 30–40% reduction can improve sleep, rehab participation, and daily life.

2. Does it work for complete and incomplete SCI?
   Yes. Both groups may benefit. Incomplete SCI patients may gain additional functional improvements, while complete SCI patients can still experience pain relief through brain-based pain modulation.

3. How long before results appear?
   Most programs last 4–8 weeks. Some people feel early relief, but lasting improvements develop gradually with repeated sessions.

4. Is VR therapy available outside clinical trials?
   Yes, access is growing. More rehab centers now offer VR pain therapy, and home-based options are also being developed.