Department of Communication, Cornell University, Ithaca, NY, United States.
Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, United States.
J Med Internet Res. 2021 May 26;23(5):e16536. doi: 10.2196/16536.
Complex regional pain syndrome (CRPS) is a rare and severe chronic pain condition, with effective treatment options not established for many patients. The underlying pathophysiology remains unclear, but there is a growing appreciation for the role of central mechanisms which have formed the basis for brain-based therapies such as transcranial magnetic stimulation and mirror visual feedback (MVF). MVF has been deployed in the treatment of CRPS using both conventional mirrors and virtual reality (VR).
The aim of this study was to further investigate the use of VR in the treatment of patients with unilateral upper limb CRPS. VR has the potential advantage of more flexible and more motivating tasks, as well as the option of tracking patient improvement through the use of movement data.
We describe the development, acceptability, feasibility, and usability of an open-source VR program MVF module designed to be used with consumer VR systems for the treatment of CRPS. The development team was an interdisciplinary group of physical therapists, pain researchers, and VR researchers. Patients recruited from a pain clinic completed 3-5 visits each to trial the system and assessed their experiences in pre- and post-treatment questionnaires.
All 9 (100%) participants were able to use the system for 3, 4, or 5 trials each. None of the participants quit any trial due to cybersickness. All 9 (100%) participants reported interest in using the module in the future. Participants' reported average pain scores in the affected limb were not significantly different from baseline during treatment or after treatment (P=.16). We did not find a statistically significant effect on participants' self-reported average pain scores.
We propose that this module could be a useful starting point for modification and testing for other researchers. We share modifications to make this module usable with standalone headsets and finger tracking. Next steps include adapting this module for at-home use, or for use with participants with lower limb pain.
复杂性区域疼痛综合征（CRPS）是一种罕见且严重的慢性疼痛疾病，许多患者缺乏有效治疗方法。其潜在病理生理学仍不清楚，但人们越来越认识到中枢机制的作用，这为基于大脑的治疗方法（如经颅磁刺激和镜像视觉反馈（MVF））奠定了基础。MVF 已被用于治疗单侧上肢 CRPS，包括常规镜子和虚拟现实（VR）。
本研究旨在进一步探讨 VR 在治疗单侧上肢 CRPS 患者中的应用。VR 具有更灵活、更具激励性的任务的潜在优势，并且可以通过跟踪患者的运动数据来评估治疗效果。
我们描述了一个开源 VR 程序 MVF 模块的开发、可接受性、可行性和可用性，该模块旨在与消费类 VR 系统一起用于治疗 CRPS。开发团队由物理治疗师、疼痛研究人员和 VR 研究人员组成的跨学科团队。从疼痛诊所招募的患者完成了 3-5 次就诊，以试用该系统，并在治疗前后的问卷调查中评估他们的体验。
所有 9 名（100%）参与者都能够使用该系统进行 3、4 或 5 次试验。没有参与者因网络晕动症而退出任何试验。所有 9 名（100%）参与者均表示有兴趣在未来使用该模块。参与者报告的患病侧肢体平均疼痛评分在治疗期间和治疗后与基线相比没有显著差异（P=.16）。我们没有发现对参与者自我报告的平均疼痛评分有统计学意义的影响。
我们提出，该模块可以为其他研究人员提供有用的修改和测试起点。我们共享了一些修改方法，以使该模块能够与独立耳机和手指跟踪器一起使用。下一步包括将该模块改编为家庭使用或用于下肢疼痛患者。
