# Pain Rehabilitation Virtual Reality (PRVR): Innovations to enhance mobility in the presence of pain

> **NIH NIH R21** · STANFORD UNIVERSITY · 2022 · $171,409

## Abstract

Project Summary / Abstract
Chronic musculoskeletal (MSK) pain affects the lives of over a quarter of adolescents in the US each year with
impacts into adulthood evidenced by lower educational attainment, poor vocational function, social impairments
and higher risk for opioid misuse. Progressively increasing activity in the presence of pain is critical for effective
functional restoration in chronic MSK pain with physiotherapy (PT) a foundational treatment. Despite the
widespread use of PT, daring to increase movement while in pain can often feel physically and emotionally
unattainable with fear of pain a particularly salient influence on pain outcomes, hindering clinical improvement.
Virtual reality (VR) provides access to a multisensory, three-dimensional (3D) immersive experience that has the
potential to break the vicious cycle of fear of movement and avoidance during PT. VR has been suggested as
an alternative to opioids with the therapeutic mechanisms centered on distraction, neuromodulation of body
perception, and graded exposure to feared/avoided movements. Moreover, VR can potentially enhance
motivation and engagement, facilitate repetitive motions, and incorporate real-time and longitudinal feedback for
the patient and clinician. From our preliminary data, user-centered iteratively developed Pain Rehabilitation
Virtual Reality (PRVR) was deemed highly engaging and increased in-session movement when compared to
Standard Physiotherapy Rehabilitation (SPR). Building on this pilot work, the proposed research is a randomized
controlled trial of PRVR aimed at measuring changes in physical function and pain-related fear for adolescents
with chronic MSK pain when compared to SPR. Aim 1 evaluates physical function (primary outcome) and pain
related fear (secondary outcome) between PRVR and SPR. Aim 2 characterizes feasibility of a future hybrid
effectiveness-dissemination trial of PRVR in routine PT practice. Significant breakthroughs in the treatment of
MSK pain require mechanistically-informed innovative approaches. PRVR harnesses immersive technology to
overcome the key barrier of fear of movement in the presence of pain, provides real-time feedback in a gamified
context to sustain motivation and adherence, and purposefully captures both objective (kinematics, actigraphy)
and subjective (self-report) daily functioning to define clinical endpoints and assess treatment progress in the
clinic and at home. These findings will directly inform the decision of whether to proceed with a hybrid
effectiveness-dissemination trial of PRVR, serving as the basis for potential large-scale implementation of PRVR.

## Key facts

- **NIH application ID:** 10397145
- **Project number:** 5R21AR079140-02
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** LAURA E SIMONS
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $171,409
- **Award type:** 5
- **Project period:** 2021-05-01 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10397145

## Citation

> US National Institutes of Health, RePORTER application 10397145, Pain Rehabilitation Virtual Reality (PRVR): Innovations to enhance mobility in the presence of pain (5R21AR079140-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10397145. Licensed CC0.

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