Decreasing Pain Ratings in Chronic Arm Pain Through Changing a Virtual Body: Different Strategies for Different Pain Types
Abstract
Modifying the visual aspect of a virtual arm that is felt as one’s own using immersive virtual reality (VR) modifies pain threshold in healthy subjects, but does it modify pain ratings in chronic pain patients? Our aim was to investigate whether varying properties of a virtual arm co-located with the real arm modulated pain ratings in patients with chronic arm/hand pain because of complex regional pain syndrome (CRPS) type I (without nerve injury) or peripheral nerve injury (PNI). CRPS (n = 9) and PNI (n = 10) patients were immersed in VR and the virtual arm was shown at 4 transparency levels (transparency test) and 3 sizes (size test). We evaluated pain ratings throughout the conditions and assessed the virtual experience, finding that patients with chronic pain can achieve levels of ownership and agency over a virtual arm similar to healthy participants. All 7 conditions globally decreased pain ratings by half. Increasing transparency decreased pain in CRPS but did the opposite in PNI, whereas increasing size slightly increased pain ratings only in CRPS. We conclude that embodiment in VR can decrease pain ratings in chronic arm pain, although the type of pain determines which strategy to decrease pain is most useful. We discuss this through the interactions between body image and pain perception.
Perspective
“Embodiment” in VR is useful to decrease pain ratings in chronic pain patients, but the best strategy needs to be tuned to the pain etiology. This approach could potentially help patients with chronic pain and clinicians who seek alternatives to pain management for patients.
Section snippets
Participants
Nineteen patients between 40 and 55 years old with neuropathic chronic pain in the upper limb were enrolled in this study. They were patients of the Pain Unit at Hospital Clínic de Barcelona. Patients with CRPS type I had been previously diagnosed based on the Budapest criteria for CRPS20 by neurologists at the hospital (Hospital Clínic de Barcelona). Patients were recruited and grouped into those with CRPS type I, without nerve injury (9 patients), and those with PNI, with nerve injury …
Results
Nineteen patients were included in the study and grouped into those without nerve injury (9 patients with CRPS type I) and those with peripheral nerve injury (10 patients with PNI). The groups did not differ at baseline in terms of age, cognitive function (MMSE and FAB scores), degree of neuropathic pain (painDETECT), and pain ratings (Table 1). However, we included MMSE and age in the model (Equation 1) because preliminary investigation showed that variation in these may influence the results.
Discussion
Congruent multisensory correlations between the real and a virtual arm in immersive VR has been shown to induce an illusion of ownership over the virtual arm.51, 53 The appearance of such a virtual arm modulates the pain threshold in healthy controls,34, 35, 36,42 but can we extrapolate the observations regarding pain threshold in healthy subjects to chronic pain patients? To answer this, we investigated whether varying the transparency and size of a virtual arm that is co-located with the real…
Acknowledgments
Partially funded by AGAUR (2017-SGR1296) and by CERCA Programme/Generalitat de Catalunya. We thank Ramón Oliva from the Event-Lab for the virtual reality scenarios, and for technical support; Cristina Gonzalez-Liencres and Tony Donegan for editing assistance; the medical staff of the pain management clinic section of Hospital Clínic de Barcelona, headed by Carme Busquets Julià, for facilitating patients to conduct the study; and Isabel Sañudo, head of the department of rehabilitation of…
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