Enhancing analgesic spinal cord stimulation for chronic pain with personalized immersive virtual reality

止痛药 虚拟现实 医学 慢性疼痛 脊髓刺激 神经病理性疼痛 脊髓 物理医学与康复 神经刺激 麻醉 物理疗法 刺激 神经调节 内科学 计算机科学 人机交互 精神科
作者
Marco Solcà,Vibhor Krishna,Nicole A. Young,Milind Deogaonkar,Bruno Herbelin,Pavo Orepić,Robin Mange,Giulio Rognini,Andrea Serino,Ali R. Rezai,Olaf Blanke
出处
期刊:Pain [Lippincott Williams & Wilkins]
卷期号:162 (6): 1641-1649 被引量:24
标识
DOI:10.1097/j.pain.0000000000002160
摘要

Abstract Spinal cord stimulation (SCS) is an approved treatment for truncal and limb neuropathic pain. However, pain relief is often suboptimal and SCS efficacy may reduce over time, requiring sometimes the addition of other pain therapies, stimulator revision, or even explantation. We designed and tested a new procedure by combining SCS with immersive virtual reality (VR) to enable analgesia in patients with chronic leg pain. We coupled SCS and VR by linking SCS-induced paresthesia with personalized visual bodily feedback that was provided by VR and matched to the spatiotemporal patterns of SCS-induced paresthesia. In this cross-sectional prospective interventional study, 15 patients with severe chronic pain and an SCS implant underwent congruent SCS-VR (personalized visual feedback of the perceived SCS-induced paresthesia displayed on the patient's virtual body) and 2 control conditions (incongruent SCS-VR and VR alone). We demonstrate the efficacy of neuromodulation-enhanced VR for the treatment of chronic pain by showing that congruent SCS-VR reduced pain ratings on average by 44%. Spinal cord stimulation–VR analgesia was stronger than that in both control conditions (enabling stronger analgesic effects than incongruent SCS-VR analgesia or VR alone) and kept increasing over successive stimulations, revealing the selectivity and consistency of the observed effects. We also show that analgesia persists after congruent SCS-VR had stopped, indicating carry over effects and underlining its therapeutic potential. 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. Registration: clinicaltrials.gov, Identifier: NCT02970006.

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