Functional immersive rehabilitation for a severely burned patient with refractory pain: A case report

BACKGROUND: Severe burn injuries often lead to prolonged hospitalization, functional impairments, and painful necessary interventions such as physical and occupational therapy. Pharmacological pain management is often insufficient and associated with adverse effects, highlighting the need for integrative strategies that combine pain modulation with functional rehabilitation. OBJECTIVE: To evaluate the feasibility and impact of immersive virtual reality (VR) rehabilitation for pain modulation, functional recovery, and health economics in a severely burned patient. CASE DESCRIPTION: A 24-year-old firefighter sustained burns over 60% of total body surface area resulting in refractory pain and requiring prolonged intensive care unit stay. A rehabilitation protocol combining immersive motor training with conventional therapy was implemented, consisting of 12 sessions using a VR system designed to modulate pain and enhance motor engagement. Outcomes included Numerical Rating Scale (NRS) for pain, VR experience, Functional Independence Measure (FIM), User Satisfaction Evaluation Questionnaire (USEQ), and medication costs. OUTCOMES: Procedural pain decreased from severe (median NRS: 8/10) to moderate (4/10), with greater immersion correlating with lower pain intensity. Functionally, the patient progressed from full dependence (FIM: 13/91) to assisted ambulation (45/91), reaching improved independence by 8 months (59/91). The intervention was well tolerated (USEQ: 93.33%) with a reduced need for analgesic medication, resulting in a substantial cost savings (overall 59% reduction in total analgesic costs). CONCLUSION: Immersive rehabilitation was a feasible, non-pharmacologic strategy that enhanced recovery, reduced pain, and decreased pharmacologic costs for a complex patient recovering from severe burns.