Pain Perception in Immersive Virtual Reality and Mixed Reality with the Cold Pressor Task

Abstract

Immersive virtual reality (VR) has shown promise as an effective non-pharmacological analgesic, theorized to primarily work through presence-mediated distraction. Recent developments have enabled consumer access to immersive mixed reality (MR), which grounds virtual elements in the user’s real surroundings. As MR becomes increasingly available on consumer headsets, and as AR glasses capable of similar digital overlays approach mainstream adoption, understanding the therapeutic efficacy of these blended-reality experiences relative to VR is essential for informing their use in therapeutic contexts such as pain management. This study conducted an exploratory comparison of MR and VR during the cold pressor task (CPT), employing a randomized crossover design with a counterbalanced condition order and a washout period. Using a Meta Quest 3, 25 participants completed the CPT while interacting with an identical game in either VR or MR mode. Pain tolerance, measured as time to hand withdrawal, was analyzed using survival analysis and a linear mixed model, supplemented by electrodermal activity and validated questionnaires. Results suggest that VR elicited significantly greater presence than MR, while pain tolerance did not differ significantly between conditions, though VR showed a small but consistent trend towards higher pain tolerance. These findings support the validity of the experimental design and are consistent with a presence-mediated distraction hypothesis, though the non-significant pain outcome limits causal interpretation. Exploratory analyses suggested a possible temporal pattern, with VR’s relative advantage increasing after the initial shock of the ice bath before leveling off. Lastly, this work establishes a methodological foundation for comparing analgesic efficacy between VR and MR, though the study was underpowered to detect the observed effect size and adequately powered replications are needed to confirm these findings.