Pain modulation by illusory body rotation: A new way to disclose the interaction between the vestibular system and pain processing.

BACKGROUND: Clinical and experimental evidence advocates a structural and functional link between the vestibular and other sensory systems. For instance, visuo-vestibular and vestibular-somatosensory interactions have been widely reported. However, whether visual inputs carrying vestibular information can modulate pain is not yet clear. Recent evidence using natural vestibular stimulation or moving visual stimuli, points at an unspecific effect of distraction. METHODS: By using immersive virtual reality (VR), we created a new way to prompt the vestibular system through the vision of static visual cues, studying the possible interaction with pain. Twenty-four healthy participants were visually immersed in a virtual room which could appear with five different degrees of rotation in the sagittal axis, either towards the right, left or with no rotation. Participants' heat pain thresholds and subjective reports of perceived body rotation, sense of presence and attention were measured. RESULTS: 'Being' in a tilted room induced the sensation of body rotation in our participants, even though they were always in an upright position. We also found that rotating the visual scenario can modulate the participants' pain thresholds, determining a significant increase when a left tilt is displayed. In addition, a positive correlation between the perceived body midline rotation and pain threshold was found when the virtual room was titled 15 degrees toward the left. Importantly, all VR conditions were found to be equally distractive. CONCLUSIONS: Vestibular information present in static visual cues can modulate experimentally-induced acute pain according to a side-dependent manner and bypassing supramodal attentional mechanisms. These findings may help refining pain management approaches based on multimodal stimulation. SIGNIFICANCE: This study explored how the visualization of static environments in immersive virtual reality can lead to pain threshold modulation through the activation of the vestibular system. Immersion into rotated virtual environments led to the illusory sensation of body rotation, and this sensation was found to be related with a modulation of pain perception. Possible analgesic effects due to distraction could be ruled out. These results expand our current knowledge about how the visual, vestibular and somatosensory (pain) systems interact. These findings may influence future pain treatment strategies based on multisensory stimulation.