The effect of interactive virtual reality on pain perception: a systematic review of clinical studies

Purpose: The aim of this systematic review was to evaluate the effect of immersive and non-immersive interactive virtual reality on pain perception in patients with a clinical pain condition. Methods: The following databases were searched from inception: Medline (Ovid), PsychInfo, CINAHL, Cochrane library and Web of Science. Two reviewers screened reports and extracted the data. A third reviewer acted as an arbiter. Studies were eligible if they were randomized controlled trials, quasirandomized trials, and uncontrolled trials. Crossover and parallel-group designs were included. Risk of bias was assessed for all included studies. Results: Thirteen clinical studies were included. The majority of studies investigated a sample o participants with chronic pain. Six were controlled trials and seven uncontrolled studies. Findings from controlled research suggest that interactive virtual reality may reduce pain associated with ankylosing spondylitis and post-mastectomy, but results are inconsistent for patients with neck pain. Findings from uncontrolled studies suggest that interactive virtual reality may reduce neuropathic limb pain, and phantom limb pain, but had no effect on nonspecific chronic back pain. Conclusions: There is a need for more rigorous randomized control trials in order to conclude on the effectiveness of the use of virtual reality for the management of pain

Development and Validation of a Wearable Device to Provide Rich Somatosensory Stimulation for Rehabilitation After Sensorimotor Impairment

: Training sensory discrimination of the skin has the potential to reduce chronic pain due to sensorimotor impairments and increase sensorimotor function. Currently, there is no such device that can systematically provide rich skin stimulation suitable for a training protocol for individuals with amputation or major sensory impairment. This study describes the development and validation of a non-invasive wearable device meant to repeatedly and safely deliver somatosensory stimulations. The development was guided by a structured design control process to ensure the verifiability and validity of the design outcomes. Two sub-systems were designed: 1) a tactile display for touch and vibration sensations, and 2) a set of bands for sliding, pressure, and strain sensations. The device was designed with a versatile structure that allows for its application on different body parts. We designed a device-paired interactive computer program to enable structured sensory training sessions. Validation was performed with 11 individuals with intact limbs whose upper arm tactile sensitivity was measured over 5 training sessions. Tactile discrimination and perception threshold were measured using the standard 2-point discrimination and Semmes-Weinstein monofilament tests, respectively. The results of the monofilament test showed a significant improvement (p = 0.011), but the improvement was not significant for the 2-point discrimination test(p = 0.141). These promising results confirm the potential of the proposed training to increase the sensory acuity in the upper arms of individuals with intact limbs. Further studies will be conducted to determine how to transfer the findings of this work to improve the pain and/or functional rehabilitation in individuals with sensorimotor impairments

Bodily resonance: Exploring the effects of virtual embodiment on pain modulation and the fostering of empathy toward pain sufferers

Globally, around 20% of people suffer from chronic pain, an illness that cannot be cured and has been linked to numerous physical and mental conditions. According to the BioPsychoSocial model of pain, chronic pain presents patients with biological, psychological, and social challenges and difficulties. Immersive virtual reality (VR) has shown great promise in helping people manage acute and chronic pain, and facilitating empathy of vulnerable populations. Therefore, the first research trajectory of this dissertation targets chronic pain patients’ biological and psychological sufferings to provide VR analgesia, and the second research trajectory targets healthy people to build empathy and reduce patients’ social stigma. Researchers have taken the attention distraction approach to study how acute pain patients can manage their condition in VR, while the virtual embodiment approach has mostly been studied with healthy people exposed to pain stimulus. My first research trajectory aimed to understand how embodied characteristics affect users’ sense of embodiment and pain. Three studies have been carried out with healthy people under heat pain, complex regional pain syndrome patients, and phantom limb pain patients. My findings indicate that for all three studies, when users see a healthy or intact virtual body or body parts, they experience significant reductions in their self-reported pain ratings. Additionally, I found that the appearance of a virtual body has a significant impact on pain, whereas the virtual body’s motions do not. Despite the prevalence of chronic pain, public awareness of it is remarkably low, and pain patients commonly experience social stigma. Thus, having an embodied perspective of chronic pain patients is critical to understand their social stigma. Although there is a growing interest in using embodied VR to foster empathy towards gender or racial bias, few studies have focused on people with chronic pain. My second trajectory explored how researchers can foster empathy towards pain patients in embodied VR. To conclude, this dissertation uncovers the role of VR embodiment and dissects embodied characteristics in pain modulation and empathy generation. Finally, I summarized a novel conceptual design framework for embodied VR applications with design recommendations and future research directions

Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient

A variety of treatments have been historically used to alleviate phantom limb pain (PLP) with varying efficacy. Recently, virtual reality (VR) has been employed as a more sophisticated mirror therapy. Despite the advantages of VR over a conventional mirror, this approach has retained the use of the contralateral limb and is therefore restricted to unilateral amputees. Moreover, this strategy disregards the actual effort made by the patient to produce phantom motions. In this work, we investigate a treatment in which the virtual limb responds directly to myoelectric activity at the stump, while the illusion of a restored limb is enhanced through augmented reality (AR). Further, phantom motions are facilitated and encouraged through gaming. The proposed set of technologies was administered to a chronic PLP patient who has shown resistance to a variety of treatments (including mirror therapy) for 48 years. Individual and simultaneous phantom movements were predicted using myoelectric pattern recognition and were then used as input for VR and AR environments, as well as for a racing game. The sustained level of pain reported by the patient was gradually reduced to complete pain-free periods. The phantom posture initially reported as a strongly closed fist was gradually relaxed, interestingly resembling the neutral posture displayed by the virtual limb. The patient acquired the ability to freely move his phantom limb, and a telescopic effect was observed where the position of the phantom hand was restored to the anatomically correct distance. More importantly, the effect of the interventions was positively and noticeably perceived by the patient and his relatives. Despite the limitation of a single case study, the successful results of the proposed system in a patient for whom other medical and non-medical treatments have been ineffective justifies and motivates further investigation in a wider study

Go virtual to get real: virtual reality as a resource for spinal cord treatment

Abstract: Increasingly, refined virtual reality (VR) techniques allow for the simultaneous and coherent stimulation of multiple sensory and motor domains. In some clinical interventions, such as those related to spinal cord injuries (SCIs), the impact of VR on people′s multisensory perception, movements, attitudes, and even modulations of socio‐cognitive aspects of their behavior may influence every phase of their rehabilitation treatment, from the acute to chronic stages. This work describes the potential advantages of using first‐person‐perspective VR to treat SCIs and its implications for manipulating sensory‐motor feedback to alter body signals. By situating a patient with SCI in a virtual environment, sensorial perceptions and motor intention can be enriched into a more coherent bodily experience that also promotes processes of neural regeneration and plasticity. In addition to the great potential of research, the most significant areas of interest concern is managing neuropathic pain, motor rehabilitation, and psychological well‐being

Virtual Reality combined with Robotic facilitated movements for pain management and sensory stimulation of the upper limb following a Brachial Plexus injury: A case study

Brachial Plexus injuries are complex in nature caused in large by high impact traffic accidents which can lead to additional complications such as Complex Regional Pain Syndrome and even lead to amputation or the need for further surgical intervention. Treatment options to help repair the brachial plexus initially involve surgical intervention and post-surgery rehabilitation with medication to help with ongoing pain. Pain treatments used for these types of injuries are limited and differ in effectiveness. Paradigms utilising multimodal systems such as the one described in this paper based on virtual reality and robotics could yield results that are non-invasive and provide better rehabilitation outcomes for the sufferers. In this paper we present a single case study exploring whether Virtual Reality plus Haptic feedback have any practical potential for reducing upper limb pain and improving function in patients with brachial plexus injuries. The case study is presented with long standing complex combination of phantom limb and neuropathic pain. A decrease in perceived levels of pain was reported which amounts to a 50% reduction in pain from baseline and an improved range of motion. An examination of the sensory phantom map on the stump seems to indicate an early establishment of the thumb representation on the stump close to the area being stimulated with potential implications for prosthesis use

Proceedings of the 6th international conference on disability, virtual reality and associated technologies (ICDVRAT 2006)

The proceedings of the conferenc

Augmenting the Reality of Phantom Limbs: Three Case Studies Using an Augmented Mirror Box Procedure

Phantom sensation and phantom pain are common after limb amputation. Previous research documents increased motor control of phantom limbs and alleviation of phantom limb pain through exposure to the “mirror box illusion.” This approach centers on the potential for vision and sensorimotor interactions to alter phantom limb perception. The applicability and flexibility of this intervention is limited by methodological constraints inherent in the use of conventional mirrors. This article reports the application of an "augmented reality" intervention that seeks to overcome these constraints. Three case studies are presented, and it is argued that augmented reality technology offers a promising new approach to the investigation of phantom experience and potentially to the treatment of phantom pain