Pain management is a category in itself. In this regard, the field of VR is extremely useful, and this is seen on a daily basis in Janské Lázně. Therapeutic approaches based on VR have the potential to influence pain at the level of the central nervous system. The principle of action at this level is very different from that of common chemical substances aimed at pain management, such as opiates. What is important is that side effects are rare and quite negligible. For this reason, VR Medical systematically supports the development of these approaches to pain management. The comparability of the effect of opiates and therapeutic methods using VR has already been evaluated in some types of patients. For example, in burn patients, VR-based approaches achieved comparable levels of analgesia, assessed both subjectively by patients and with the help of functional magnetic resonance imaging.
The general principles underlying VR pain management are distraction, attention shifting, and skill building. These are core domains of pain management that are supported by the literature. Distraction analgesia is the least known mechanism of pain management using VR, it does not require complex applications and it can be imagined as a visual "escape" from the patient's current environment to a new one. The patient's mere presence, his "immersion" in the environment of, for example, magnificent mountains, a beautiful lake or the underwater world, in many cases causes a real reduction in the perception of physical pain. The distraction effect is explained using Melzack's neuromatrix theory of pain, which places importance on cognition, all (even non-nociceptive) senses and also on attention. All of these factors have their role in the complex process that leads to the final individual experience of pain. It is simply believed that cognition and attention can only have a finite number of inputs, which with VR intensively occupy visual inputs and therefore do not have as much space for direct processing of nociceptive sensations. This is therefore the use of fundamentally different principles than those used (and sometimes abused) in the case of pharmacotherapy. Simple distraction is useful for both acute and chronic pain. In children, adults and seniors. Experience with pain reduction using VR does not show that this effect is always based on pure distraction alone. Other mechanisms for pain treatment using VR have been described, which are based on inducing neurophysiological changes.

While the distraction mechanism is essentially a passive matter from the patient's perspective (it is enough to be "immersed" in an unusual environment), another interesting mechanism is active shift of attention. This principle is also applicable to both acute and chronic pain. The patient solves a cognitive task in an immersive VR environment, while his attention is diverted even more than in simple distraction. Jeffs et al (2014) in the study “Effect of virtual reality on adolescent pain during burn wound care” were among the first to publish a clinical randomized trial that evaluated this effect. Their work showed that playing games in a VR environment significantly reduced the level of pain in 30 burn adolescents whose wounds were treated using VR while being distracted. The third principle applicable to VR is skills training for pain management and for preventing its causes. By this we can imagine direct training in pain management, for example using meditative principles, prevention of hyperventilation during painful procedures, or in the long term training in working with breath, straightening the spine and activity of the body's root joints, which is the basis of the VR Medical application called Imaginary Support.

In conclusion, if the principles of VR pain management are sufficiently utilized, they will become a hope in the effort to reduce the use of pharmacotherapeutic drugs with their unpleasant side effects.