Abstract
Study design
Within-subject, randomised cross-over trial.
Objectives
To determine whether a commercially available 3D head-mounted (HMD) virtual reality (VR) device results in significant reductions in neuropathic pain compared to using a 2D screen device in people with spinal cord injury (SCI).
Setting
Greenwich Hospital, Sydney, Australia.
Methods
Sixteen men with established SCI and chronic neuropathic pain participated in a single-session randomised cross-over trial. We compared the effects of 3D HMD VR and a 2D screen application on SCI neuropathic pain intensity and levels of perceived presence.
Results
Participants reported significantly lower pain intensity after 3D HMD VR compared to 2D screen application (1.9 ± SD 1.8 versus 3.4 ± SD 1.6, mean 95% CI: 1.5, P < 0.0001). Participants reported significantly higher perceived levels of presence with the 3D HMD VR compared to 2D screen of (49.6 ± SD 8.9 versus 32.8 ± SD 11.1, mean 95% CI: 16.6, P < 0.0001). Increased perceived presence was associated with significantly lower pain intensity regardless of randomised sequencing of the two conditions (mean 95% CI: 0.06, P = 0.005). Effect size for pain reduction using 3D HMD VR was 0.80.
Conclusions
We suggest that 3D HMD VR may provide neuropathic pain relief for people with SCI. Given the lack of cybersickness and ease of access, we propose that immersive VR could be a helpful adjunct to current pharmacotherapy. Further research is required to show that VR can be effective for more long-term reductions in SCI pain.
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Data availability
The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Burke D, Fullen BM, Stokes D, Lennon O. Neuropathic pain prevalence following spinal cord injury: a systematic review and meta-analysis. Eur J Pain. 2017;21:29–44.
Hadjipavlou G, Cortese AM, Ramaswamy B. Spinal cord injury and chronic pain. BJA Educ. 2016;16:264–8.
Gerke MB, Duggan AW, Xu L, Siddall PJ. Thalamic neuronal activity in rats with mechanical allodynia following contusive spinal cord injury. Neuroscience. 2003;117:715–22.
Weech S, Kenny S, Barnett-Cowan M. Presence and cybersickness in virtual reality are negatively related: a review. Front Psychol. 2019;10:1–19.
Kenny MP, Milling LS. The effectiveness of virtual reality distraction for reducing pain: a meta-analysis. Psychol Conscious Theory Res Pract. 2016;3:199–210.
Villiger M, Bohli D, Kiper D, Pyk P, Spillmann J, Meilick B, et al. Virtual reality-augmented neurorehabilitation improves motor function and reduces neuropathic pain in patients with incomplete spinal cord injury. Neurorehabil Neural Repair. 2013;27:675–83.
Rooney B, Hennessy E. Actually in the cinema: a field study comparing real 3D and 2D movie patrons’ attention, emotion, and film satisfaction. Media Psychol. 2013;16:441–60.
Norrbrink Budh C, Lund I, Hultling C, Levi R, Werhagen L, Ertzgaard P, et al. Gender related differences in pain in spinal cord injured individuals. Spinal Cord. 2003;41:122–8.
The International Spinal Cord Society. International standards for neurological classification of spinal cord injury. Aylesbury, UK: International Spinal Cord Society; 2019. https://www.iscos.org.uk/international-standards-for-neurological-classification-of-spinal-cord-injury-isncsci.
Bantick SJ, Wise RG, Ploghaus A, Clare S, Smith SM, Tracey I. Imaging how attention modulates pain in humans using functional MRI. Brain. 2002;125:310–9.
Evans SR. Clinical trial structures. J Exp Stroke Transl Med. 2010;3:8–18.
Jin W, Choo A, Gromala D, Shaw C, Squire P. A virtual reality game for chronic pain management: a randomized, controlled clinical study. Stud Health Technol Inform. 2016;220:154–60.
Fowler CA, Ballistrea LM, Mazzone KE, Martin AM, Kaplan H, Kip KE, et al. A virtual reality intervention for fear of movement for Veterans with chronic pain: protocol for a feasibility study. Pilot Feasibility Stud. 2019;5:146.
LaViola JJ. A discussion of cybersickness in virtual environments. SIGCHI Bull. 2000;32:47–56.
Farrar JT, Young JP Jr., LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–58.
Mitchell MC, Burns NR, Dorstyn DS. Screening for depression and anxiety in spinal cord injury with DASS-21. Spinal Cord. 2008;46:547–51.
Schwind V, Knierim P, Haas N, Henze N. Using presence questionnaires in virtual reality. Proceedings of the 2019 CHI conference on human factors in computing systems; Glasgow, Scotland Uk: Association for Computing Machinery; 2019. pp. 360.
IBM C. IBM SPSS statistics for Windows, version 25.0. Armonk, NY: IBM Corp; 2018.
Kenward MG, Roger JH. The use of baseline covariates in crossover studies. Biostatistics. 2010;11:1–17.
Mallari B, Spaeth EK, Goh H, Boyd BS. Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. J Pain Res. 2019;12:2053–85.
Rosner B. Hypothesis testing: two-sample inference. fundamentals of biostatistics. 7th ed. CENGAGE Learning Inc; Boston USA, 1995. p. 271.
Jutzeler CR, Warner FM, Cragg JJ, Haefeli J, Richards JS, Andresen SR, et al. Placebo response in neuropathic pain after spinal cord injury: a meta-analysis of individual participant data. J Pain Res. 2018;11:901–12.
Eippert F, Finsterbusch J, Bingel U, Büchel C. Direct evidence for spinal cord involvement in placebo analgesia. Science. 2009;326:404.
Pozeg P, Palluel E, Ronchi R, Solcà M, Al-Khodairy AW, Jordan X, et al. Virtual reality improves embodiment and neuropathic pain caused by spinal cord injury. Neurology. 2017;89:1894–903.
Jordan M, Richardson EJ. Effects of virtual walking treatment on spinal cord injury-related neuropathic pain: pilot results and trends related to location of pain and at-level neuronal hypersensitivity. Am J Phys Med Rehabil. 2016;95:390–6.
Jones T, Moore T, Choo J. The impact of virtual reality on chronic pain. PloS ONE. 2016;11:e0167523.
Wake N, Sano Y, Oya R, Sumitani M, Kumagaya S, Kuniyoshi Y. Multimodal virtual reality platform for the rehabilitation of phantom limb pain. In: 7th International IEEE/EMBS Conference on Neural Engineering (NER), Montpellier, 2015, pp. 787–90.
Flores A, Linehan MM, Todd SR, Hoffman HG. The use of virtual reality to facilitate mindfulness skills training in dialectical behavioral therapy for spinal cord injury: a case study. Front Psychol. 2018;9:531.
Valet M, Sprenger T, Boecker H, Willoch F, Rummeny E, Conrad B, et al. Distraction modulates connectivity of the cingulo-frontal cortex and the midbrain during pain-an fMRI analysis. Pain. 2004;109:399–408.
Donati ARC, Shokur S, Morya E, Campos DSF, Moioli RC, Gitti CM, et al. Long-term training with a brain-machine interface-based gait protocol induces partial neurological recovery in paraplegic patients. Sci Rep. 2016;6:30383.
Funding
The postdoctoral researcher (PA) was funded by Australian and New Zealand College of Anaesthetists project grant (19/002) for this study.
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Authors and Affiliations
Contributions
PA—principle investigator. Contributed to the design of study protocols, screening and recruitment of subjects, administering questionnaires, organising clinic visits, performance of VR, collection and analysis of data and drafting presentations, reports and the current article. AC—contributed to the design of study protocols, recruitment of subjects. He also contributed to the writing while also provided feedback on the article. JM—contributed to the design of study protocols, location and recruitment of subjects. He also contributed to the writing while also provided feedback on the article. YT—contributed to the design of study protocols, development of the study. She also contributed to the writing while also provided feedback on the article. DC—designed and conducted statistical analysis. He also contributed to the writing of the current study article. PW—contributed to the design of study protocols, screening and recruitment of subjects. He also contributed to the writing of the current study article. PS—chief investigator. Initiated and contributed to the design of study protocols, screening and recruitment of subjects. He also contributed to the writing while also provided feedback on the article.
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Austin, P.D., Craig, A., Middleton, J.W. et al. The short-term effects of head-mounted virtual-reality on neuropathic pain intensity in people with spinal cord injury pain: a randomised cross-over pilot study. Spinal Cord 59, 738–746 (2021). https://doi.org/10.1038/s41393-020-00569-2
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DOI: https://doi.org/10.1038/s41393-020-00569-2
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