Arcos-Holzinger Mauricio, Biebl Johanna Theresia, Storz Claudia, Gutmann Marcus, Azad Shahnaz Christina, Holzapfel Boris Michael, Kraft Eduard
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.
Facultad de Medicina, Universidad CES, Medellin, Colombia.
Front Neurol. 2023 Sep 7;14:1069381. doi: 10.3389/fneur.2023.1069381. eCollection 2023.
Complex Regional Pain Syndrome (CRPS) is a severe pain disorder that does not yet have a specific treatment. Patients with CRPS not only suffer from a wide range of symptoms that affect their quality of life but also present psychological affections to the way they see their body and specifically their affected limb. Virtual Reality (VR) modalities have become a targeted treatment for chronic pain and in the case of CRPS, may be a valuable approach to the mechanisms that affect these patients.
Using the PRISMA Scoping Review guidelines, we intend to uncover the key information from the studies available about VR modalities in the treatment of CRPS. We focus on the improvement of pain levels, body perception disturbances (BPD), and limb movement/daily function.
Our search strategy resulted in 217 articles from PubMed. Twenty were assessed for eligibility and seven were included in the final qualitative synthesis. Of these seven articles, we included a clinical trial, three pilot studies, a blinded randomized controlled trial, a crossover double-blind trial, and a randomized controlled trial. These studies provide important subjective patient findings, along with some statistically significant results in the experiences of VR therapies modulating pain, BPD, and improving limb movement/daily function. However, not all the studies included statistical analysis, and there are contradicting data found from some patients that did not perceive any improvement from VR therapies.
We describe the results found in 7 articles that focus on the treatment of CRPS with VR modalities. Overall, the articles have various limitations, but the strategies related to immersive virtual reality, cardiac signaling, body switching and limb modulation have shown the most promising results for pain reduction and BPD improvement. These strategies reflect on pathophysiological mechanisms that are hypothesized to be affected in CRPS patients leading to the chronic pain and BPD that they experience. Not much evidence was found for improvement in limb movement and daily function. This review is a pathway for future studies on this topic and a more extensive data synthesis when more information is available.
复杂性区域疼痛综合征（CRPS）是一种严重的疼痛障碍，目前尚无特效治疗方法。CRPS患者不仅遭受多种影响生活质量的症状折磨，还对其身体认知，尤其是对患侧肢体，产生心理影响。虚拟现实（VR）模式已成为慢性疼痛的靶向治疗方法，对于CRPS而言，可能是影响这些患者的机制的一种有价值的方法。
使用PRISMA范围综述指南，我们旨在从现有关于VR模式治疗CRPS的研究中挖掘关键信息。我们关注疼痛水平的改善、身体感知障碍（BPD）以及肢体运动/日常功能。
我们的检索策略在PubMed上检索到217篇文章。对其中20篇进行了资格评估，7篇纳入最终的定性综合分析。这7篇文章中，包括一项临床试验、三项试点研究、一项单盲随机对照试验、一项交叉双盲试验和一项随机对照试验。这些研究提供了重要的患者主观发现，以及一些关于VR疗法调节疼痛、BPD和改善肢体运动/日常功能的具有统计学意义的结果。然而，并非所有研究都进行了统计分析，并且从一些患者中发现了相互矛盾的数据，这些患者认为VR疗法没有带来任何改善。
我们描述了7篇关注VR模式治疗CRPS的文章中的研究结果。总体而言，这些文章存在各种局限性，但与沉浸式虚拟现实、心脏信号、身体切换和肢体调节相关的策略在减轻疼痛和改善BPD方面显示出最有前景的结果。这些策略反映了据推测在CRPS患者中受到影响的病理生理机制，导致了他们所经历的慢性疼痛和BPD。在肢体运动和日常功能改善方面未发现太多证据。本综述为该主题的未来研究以及在有更多信息时进行更广泛的数据综合提供了一条途径。
