Unlocking personalised relief for chronic pain with VR

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Scientists found that tiny changes in pupil size and blinking patterns can reveal how hard the brain is working during virtual reality tasks.

Combining artificial intelligence (AI) with eye tracking in virtual reality could one day help personalise treatment for millions living with chronic pain, according to world-first research from the University of East Anglia. 

Scientists found that tiny changes in pupil size and blinking patterns can reveal how hard the brain is working during virtual reality tasks. The team hope their work could open the door to wearable systems that automatically adapt therapy in real time. For the millions living with chronic pain, that could represent a significant step towards more personalised, drug-free care. 

The researchers published their findings in the journal Scientific Reports. 

Until now, most VR has been one-size-fits-all. Our findings could help make treatments more personalised and responsive. This could enhance future VR treatments, not just for pain but potentially for conditions like anxiety or depression

Jordan Tsigarides

Lead researcher Dr Jordan Tsigarides, from UEA’s School of Health Sciences, said: “Chronic pain affects an estimated 1.5 billion people worldwide and is one of the leading causes of disability. Virtual reality has enormous therapeutic potential – whether that’s guiding patients through a peaceful woodland, supporting relaxation exercises or engaging them with games and puzzles that help manage pain. It can help reduce chronic pain by immersing users in engaging, interactive environments that capture the brain’s attention and draw it away from pain, reduce pain-related stress and anxiety, and may even help retrain how the brain processes pain over time. But most virtual reality programmes offer the same experience to everyone, even though people’s pain and mental effort can fluctuate from moment to moment. Our work suggests future systems could read mental effort through the eyes and adapt therapy in real time to each individual. If a headset can detect when someone is becoming mentally overloaded, it could potentially adapt the experience automatically to keep them engaged and maximise therapeutic benefit.” 

The study was led by Dr Jordan Tsigarides as part of his PhD at UEA. “My PhD is exploring how AI and sensor technology could make virtual reality treatments more responsive to the individual. We want to strike the right balance between challenge and comfort,” he said. 

The study involved 84 volunteers, including 42 people with chronic musculoskeletal pain conditions such as arthritis and fibromyalgia. Participants completed a series of increasingly demanding memory challenges while wearing a VR headset equipped with eye-tracking technology. 

The team discovered that as tasks became more mentally challenging, participants’ pupils widened and their blink rates increased. State-of-the-art AI models that analysed patterns in these signals over time were then able to distinguish between low and high levels of mental workload with up to 88% accuracy in healthy volunteers. The VR tasks were also well tolerated with participants reporting very low levels of motion sickness and discomfort. 

Dr Tsigarides said: “These results suggest a future in which a headset could continuously monitor the brain’s workload through the eyes, automatically fine-tuning treatment to each individual user. Our earlier research showed promising pain reductions in people with fibromyalgia using therapeutic VR. Now we’re exploring how to make those experiences smarter, more responsive, and tailored to each person. Until now, most VR has been one-size-fits-all. Our findings could help make treatments more personalised and responsive. This could enhance future VR treatments, not just for pain but potentially for conditions like anxiety or depression. In future, the same principles could be explored in education and professional training, where virtual learning experiences might adapt to the learner’s mental workload.” 

However, the study also highlighted a challenge. While AI models performed strongly in healthy volunteers, accuracy was significantly lower among people living with chronic pain, suggesting that standardised approaches may not work equally well for all patients. The researchers believe future systems may need to be individually calibrated, learning how each person’s eyes respond to mental effort before making treatment decisions. And they say that larger studies are needed to determine whether adaptive VR therapies can improve real-world outcomes for patients.