Analgesic effects and neural oscillatory mechanisms of music-synchronized virtual reality intervention

Chronic pain affects over 30% of the global population, yet non-pharmacological interventions with clear neurophysiological mechanisms remain limited. While virtual reality (VR) and music therapy independently show promise in pain management, the neural oscillatory underpinnings of rhythm-synchronized audiomotor integration in VR therapy remain poorly understood. This study aimed to investigate whether music-synchronized virtual reality (MSVR) enhances analgesia through distinct neural mechanisms compared to conventional distraction-based VR or non-immersive interventions. 90 healthy adults (45 female, 22 ± 2 years) were randomized to a single session of: (1) MSVR (rhythm-synchronized visuomotor tasks with music), (2) conventional VR (identical tasks with white noise), or (3) non-immersive 2D control. Pressure pain thresholds (PPT) were measured at five movement-generating muscle sites. Conditioned pain modulation (CPM) efficiency was assessed using PPT and cold-water stimulation. 64-channel EEG recorded theta, alpha, beta, and gamma oscillations. Outcomes included PPT changes, CPM efficiency, cold pain intensity/unpleasantness, and neural spectral power. MSVR significantly increased PPTs across all sites (15-25% vs. control, P < 0.001; superior to VR in upper limbs, P < 0.05) and enhanced CPM efficiency by 18% (vs. control, P = 0.010; vs. VR, P = 0.046). Cold pain intensity decreased by 22% with MSVR (P < 0.05 vs. both groups). MSVR uniquely enhanced parietal alpha oscillations during and post-intervention (P = 0.001). MSVR also induced greater immersion and realism than VR (P < 0.001). MSVR significantly enhances endogenous pain inhibition and elevates pain thresholds more effectively than conventional VR or 2D interventions, primarily through rhythmic audiomotor integration modulating parietal alpha-oscillation modulation. These findings suggest MSVR as a scalable digital therapeutic strategy for pain management.