Your first VR session for pain: a Veteran's guide

About this guide

VA's immersive technology guides describe how teams choose equipment, prepare staff, and organize care. The details vary by program. This guide translates those documents into questions you can bring to an appointment; it does not describe a guaranteed experience at every VA facility.

Ask what you will actually be doing

Virtual reality places you in a simulated environment, usually through a headset with sound and sometimes handheld controllers. Augmented reality adds digital elements to a view of the real world. Extended reality, or XR, is a broader term that includes both. VA introductory guide, page 3.

For pain care, an experience might involve relaxation, practicing coping skills, or movement guided by a clinician. Ask which activity you will be trying and why it was chosen for you. A relaxing scene and a rehabilitation exercise can have different goals, even if they use similar equipment.

You can say: “Please show me what the session involves before I put on the headset. What will you ask me to do?”

Discuss comfort and accessibility before starting

Tell the clinician about anything that could make a headset or virtual environment difficult to use. That might include current dizziness or nausea, neck discomfort, trouble with balance, vision or hearing needs, difficulty holding a controller, or concern about particular sounds or scenes. Mention seizure history, recent injuries, and other medical issues so the team can apply the precautions for the specific device and program.

The 2024 VA playbook calls for staff training in patient assessment, safety procedures, and contraindications. It does not provide one public checklist that clears every person for every device. Suitability belongs with the treating team and the product's instructions. VA playbook, pages 9 and 17–20.

Practical questions include:

• Can this experience be done seated, and is that appropriate for me?
• Will my glasses or hearing equipment fit comfortably?
• Can I use it without gripping a controller?
• Can we choose a different scene if one feels upsetting or distracting?

The introductory guide describes gaze-based interaction and screen mirroring as possible features. They are not available on every system. Ask whether the actual equipment has an option that meets your needs. VA introductory guide, page 6.

Learn the controls and the stopping plan

Ask staff to demonstrate headset adjustment and any controls before beginning the treatment activity. Agree on how you will signal that you want a pause. Clarify whether the clinician will remain with you, watch a mirrored view, or check in another way.

You should not feel that you must finish a game, beat a score, or tolerate symptoms to make the session count. In the VA facility study, some Veterans found the controls or activities frustrating. Others reported nausea or tired eyes. Those experiences are useful feedback for the team, not a failure by the person using the device. Rawlins et al., pages 6–8.

FDA identifies possible risks including cybersickness, head or neck strain, dizziness, fatigue, and effects on vision. If you develop discomfort or feel unsafe, pause and tell the clinician. Follow the device's instructions and the stopping plan rather than pushing through. FDA overview of AR and VR medical devices.

Ask how shared equipment is cleaned

For a headset used by several people, it is reasonable to ask how the face-contact surfaces, controllers, and accessories are cleaned between users. The VA playbook says infection control procedures should apply across devices and settings. Staff should follow their local procedures and the manufacturer's compatible cleaning instructions. VA playbook, page 18.

The older introductory guide lists products and vendors. A listing is background information, not a reason to assume a particular cleaning product is suitable for your device today.

Describe what changed after the session

Your team may ask for pain or other symptom ratings before and after use. Be specific about the experience. Did pain change while the headset was on? Was the change still present afterward? Did the activity feel easier, or did you mainly feel calmer?

Also report headaches, eye strain, nausea, balance problems, or frustration. The VA playbook discusses both outcome measures and feedback about the experience. Reporting discomfort is as useful as reporting improvement. VA playbook, page 20.

Before leaving, ask what happens next. A single enjoyable session does not establish that a longer program will improve chronic pain. Your team can explain whether the next step is another supervised trial, a different approach, or a review of the care plan.

A short note to bring with you

• My main goal for this session is: ______.
• Things that may affect comfort or use: ______.
• The signal or action I will use to pause: ______.
• The person I should contact afterward: ______.

For background on expected benefits, read what the VA resources show about VR and chronic pain. You can also browse the original VA guides and research.

Educational information only. Your clinician and the specific device instructions determine whether and how a program should be used.