Effects of virtual walking on neuropathic pain following spinal cord injury: a systematic review.

BACKGROUND: Neuropathic pain following spinal cord injury (SCI) is associated with significant functional and psychological impairments. Virtual walking is a form of virtual reality–based intervention that simulates lower-limb movement through visual feedback, using either immersive or non-immersive environments. It has been proposed as a potential strategy to reduce neuropathic pain. This review aims to evaluate and synthesize the existing literature on virtual walking interventions in individuals with SCI, focusing on their effects on pain intensity, pain quality, pain interference, and pain-related disability. METHODS: The search was conducted using the following databases: PubMed, Scopus, CINAHL, EMBASE, PEDro, and Web of Science, up to November 2025. Experimental studies conducted in subjects with SCI, using virtual walking, and measuring any dimension of neuropathic pain, were considered in the present systematic review. The quality of the studies was determined using the Physiotherapy Evidence Database scale (PEDro). RESULTS: A total of 10 studies met the inclusion criteria. The total number of participants with SCI who participated in the studies was 345 (mean age 31.5; 68% were male). The range of total scores on the PEDro Scale among the studies was between 3 and 7, with a median of 6. The results revealed that virtual walking has some beneficial effects on the quality, intensity, interference, and severity of pain. CONCLUSIONS: Virtual walking appears to be a safe and tolerable procedure. The evidence on the effects of virtual walking on neuropathic pain in individuals with SCI remains limited. Further high-quality studies with larger sample sizes are strongly needed.