Decreasing Pain Ratings in Chronic Arm Pain Through Changing a Virtual Body: Different Strategies for Different Pain Types |
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| Institution: | 2. Event-Lab, Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain;3. Hospital Clínic de Barcelona, 08036 Barcelona, Spain;4. ICREA, Barcelona, Spain;5. Departamento de Psicología Básica, Universitat de Barcelona, Barcelona, Spain;2. The George Institute for Global Health, University of Sydney, Australia;3. Pain Management Research Institute, Sydney Medical School, University of Sydney, Australia;4. School of Public Health, University of Sydney, Australia;5. Recover Injury Research Center, Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, Queensland, Australia;2. Department of Anesthesiology and Pain Medicine, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA.;3. Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA.;4. Indiana Poly Clinic, Indianapolis, IN.;2. Department of Neurology, University of Greifswald, Germany;3. Division of Hand Surgery and Functional Microsurgery, Department of Trauma and Reconstructive Surgery, and;4. Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany |
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| 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. |
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