Personalized adaptive virtual reality experience driven by electroencephalography-based pain recognition

Background Non-pharmacological pain management represents an urgent clinical need. Emerging technologies such as virtual reality (VR) and electroencephalography (EEG)-based artificial intelligence (AI) offer promising avenues for objective pain assessment and adaptive therapeutic intervention. Purpose This study aims to develop and validate a real-time, closed-loop EEG-driven VR therapy system that classifies pain levels from brain signals and delivers personalized, avatar-guided therapeutic responses. Methods An open-source EEG dataset (51 participants; perception condition; laser-induced pain stimuli rated 0–100) was preprocessed using bandpass filtering, Independent Component Analysis (ICA), and AutoReject. Wavelet-based features (Daubechies-4, 5 levels) were extracted from 1-second epochs and used to train two gradient-boosting classifiers: XGBoost and LightGBM. Predicted pain levels were transmitted via HTTP POST requests to Unreal Engine 5.3.2, where a MetaHuman avatar delivered adaptive therapeutic responses. Results LightGBM achieved 97.89% classification accuracy (cross-validation: 95.78% ± 0.82%) and XGBoost achieved 97.25% (cross-validation: 96.09% ± 0.70%) across 11 pain classes (0–10), outperforming all comparable studies in the literature. Real-time avatar responses were demonstrated across three pain categories: Slight (1–3), Moderate (4–6), and Severe (7–10). Conclusion The study successfully demonstrates the technical feasibility of a closed-loop EEG-VR pain management system using lightweight machine learning models. The system achieves state-of-the-art pain classification accuracy with fine-grained 11-class granularity. Implications This system offers a scalable, drug-free alternative for pain management applicable in clinical and rehabilitation settings. The modular design facilitates future extensions, including emotional state tracking, haptic feedback, and reinforcement learning-based personalization.