Orakpo Nnamdi, Yuan Chujun, Olukitibi Olanrewaju, Burdette Jeff, Arrington Kim
Department of Psychiatry, Garnet Health Medical Center, Middletown, NY, United States.
Department of Psychiatry at Lehigh Valley Health Network, Allentown, PA, United States.
Front Hum Neurosci. 2022 May 18;16:915376. doi: 10.3389/fnhum.2022.915376. eCollection 2022.
This case report concerns a patient with clinically diagnosed moderate-severe insomnia secondary to chronic lower back pain and sciatica, previously treated with hydrocodone, naproxen, cyclobenzaprine and nightly diazepam. He underwent a trial of 20 sessions of virtual reality neurofeedback therapy (VR-NFB) at infra-low frequency, and by the end of 20 sessions achieved sustained analgesia and consequently, a complete resolution of his pain-related insomnia. Follow-up at 1 year confirmed his improvements were sustained, and he maintained his abstinence from sedatives, as observed on the Prescription Monitoring Program for controlled substances. This case highlights the importance of understanding chronic pain and its connection with restorative sleep: incorporating endogenous neuromodulation in behavioral sleep medicine helped to diminish the risk of benzodiazepine use disorder. This may be the first case of complete resolution of chronic pain with comorbid insomnia after treatment with VR-NFB at the infra-low frequency.
本病例报告涉及一名临床诊断为中度至重度失眠的患者，该失眠继发于慢性下背痛和坐骨神经痛，此前曾接受氢可酮、萘普生、环苯扎林和每晚服用地西泮的治疗。他接受了20次超低频虚拟现实神经反馈疗法（VR-NFB）的试验，在20次治疗结束时实现了持续镇痛，从而完全解决了与疼痛相关的失眠问题。1年的随访证实他的改善得以持续，并且如在管制物质处方监测计划中所观察到的，他保持了不使用镇静剂的状态。本病例突出了理解慢性疼痛及其与恢复性睡眠之间联系的重要性：在行为睡眠医学中纳入内源性神经调节有助于降低苯二氮䓬类药物使用障碍的风险。这可能是首例经超低频VR-NFB治疗后慢性疼痛合并失眠完全缓解的病例。
