Clinical bottom line
Virtual reality (VR)-based interventions represent a promising, non-pharmacologic approach for managing phantom limb pain (PLP) in amputees. Emerging evidence suggests that immersive VR therapies, including virtual mirror therapy, may reduce pain intensity by modulating sensorimotor cortical representations and improving body schema integration. However, current data are limited by small sample sizes and heterogeneity in VR protocols. VR interventions warrant consideration as adjuncts to conventional PLP treatments, with individualized tailoring based on patient tolerance and response.
What the evidence shows
Phantom limb pain is a complex neuropathic pain syndrome experienced by many amputees, often refractory to standard analgesics (Nikolajsen et al., 2010). Traditional mirror therapy, which uses visual feedback to simulate the presence of the missing limb, has demonstrated efficacy in some patients by engaging sensorimotor networks and reducing cortical mismatch (Rothgangel et al., 2019). Building on this concept, immersive VR offers enhanced multisensory feedback and greater embodiment, potentially amplifying therapeutic effects.
Murray et al. (2009) provided early evidence that immersive VR environments could simulate limb presence and movement, resulting in PLP reduction. More recently, Adaikkammai et al. (2019) reported improvements in pain scores and functional outcomes in amputees undergoing VR rehabilitation, highlighting VR’s potential to engage neuroplastic mechanisms. Nielsen et al. (2017) compared different body positions during VR mirror therapy in lower limb amputees, finding that certain postures may optimize pain relief, suggesting the importance of individualized VR session design.
Rothgangel et al. (2019) reviewed VR and augmented reality applications for PLP, emphasizing that VR can be tailored to patient-specific pain mechanisms and preferences, potentially improving adherence and outcomes. Although Ravikumar et al. (2026) discuss VR’s transformative role in PLP rehabilitation, their findings remain preliminary and require validation in larger clinical trials.
Caveats and uncertainty
Despite encouraging findings, the evidence base for VR in PLP management remains limited. Most studies involve small cohorts, lack control groups, or use heterogeneous VR systems and protocols, limiting generalizability. The optimal VR dosage, session frequency, and duration are not well established. Additionally, patient factors such as amputation level, time since amputation, and comorbidities may influence VR responsiveness but are understudied.
Potential adverse effects, including cybersickness and discomfort, require monitoring. The cost and accessibility of immersive VR technology may limit widespread implementation in some clinical settings. Furthermore, long-term durability of VR-induced pain relief is unclear, necessitating longitudinal studies.
How this may change practice
VR-based interventions for PLP offer a novel adjunct to conventional therapies, particularly for patients with refractory pain or contraindications to pharmacologic treatments. Clinicians may consider integrating VR mirror therapy or immersive VR sessions into multidisciplinary rehabilitation programs, tailoring interventions to patient preferences and tolerability.
Physical medicine and rehabilitation specialists should remain informed about evolving VR technologies and emerging evidence to guide patient selection and optimize protocols. Collaboration with VR developers and therapists experienced in neurorehabilitation may enhance treatment efficacy. Future incorporation of VR may shift PLP management toward more personalized, mechanism-based approaches.