Real-time VR system enhances effect of chronic pain therapy

A compelling new study, published in the journal Pain, has found integrating an immersive virtual reality system into a chronic pain treatment can significantly enhance a patient’s pain-relief outcome. The research suggests “digiceutical” therapies may be effective for patients suffering chronic pain.

The study focused on VR as an adjunct to spinal cord stimulation (SCS), a therapy for chronic pain involving a surgical implant designed to deploy electrical pulses that interrupt pain signaling to the brain. Fifteen subjects with SCS implants for chronic leg pain were recruited for the study.

The experimental method uses VR to show patients a virtual image of their own body. The idea is patients will be able to see the effect of SCS in real-time, watching parts of their leg light up when electrical current is switched on.

Prior research has suggested this kind of embodied VR experience can deliver analgesic effects, so the new study hypothesized this method could amplify the efficacy of SCS. Generally SCS is only helpful in 60 to 70 percent of patients, and even then it only reduces pain sensations by around 50 percent.

The study tested three different interventions: congruent SCS-VR (where the VR visualizations were in sync with the tingling areas in a patient’s leg), incongruent SCS-VR (where distinctly different parts of a patient’s leg lit up in VR compared to the SCS target), and VR alone (just VR visualizations with no SCS current).

Subjective pain scores from the patients decreased by 23 percent when SCS was delivered in combination with incongruous VR visualization, but that pain reduction nearly doubled to 44 percent when the VR visualizations were in sync with the electrical stimulation. Virtually no change was seen in pain scores when VR visualizations were deployed with no SCS.

“We also show that analgesia persists after congruent SCS-VR had stopped, indicating carry over effects and underlining its therapeutic potential,” the research team writes in the study. “[T]he strength of the effect, its selectivity, its ease of application, and consistent increase across sessions and long-term analgesia will facilitate the application of prolonged and more frequent therapy doses in future SCS-VR studies, likely further boosting the described effects.”

Further work is needed to understand exactly how this kind of congruent embodied VR experience amplifies the efficacy of SCS. However, the difference in effect size between the congruent and incongruent VR visualizations suggests the results are more than a case of simple distraction. Instead, the researchers hypothesize the synchronized visual and tactile sensations may enhance the way SCS masks our feeling of pain.

The study uses the term “digiceutical” to refer to the addition of a digital tool into a clinically validated medical treatment. Digiceuticals, also known as digital therapeutics, are currently regulated in the United States by the FDA under its recently launched Digital Health Center of Excellence.

“Linking latest VR technology with recent insights from the neuroscience of body perception and SCS-neuromodulation, our personalized new SCS-VR platform highlights the impact of immersive digiceutical therapies for chronic pain,” the researchers conclude in the newly published study.

The new study was published in the journal Pain.

Source: Wolters Kluwer Health

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