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Abstract
Objectives To develop and test a new immersive digital technology for complex regional pain syndrome (CRPS) that combines principles from mirror therapy and immersive virtual reality and the latest research from multisensory body processing.
Methods In this crossover double-blind study, 24 patients with CRPS and 24 age- and sex-matched healthy controls were immersed in a virtual environment and shown a virtual depiction of their affected limb that was flashing in synchrony (or in asynchrony in the control condition) with their own online detected heartbeat (heartbeat-enhanced virtual reality [HEVR]). The primary outcome measures for pain reduction were subjective pain ratings, force strength, and heart rate variability (HRV).
Results HEVR reduced pain ratings, improved motor limb function, and modulated a physiologic pain marker (HRV). These significant improvements were reliable and highly selective, absent in control HEVR conditions, not observed in healthy controls, and obtained without the application of tactile stimulation (or movement) of the painful limb, using a readily available biological signal (the heartbeat) that is most often not consciously perceived (thus preventing placebo effects).
Conclusions Next to these specific and well-controlled analgesic effects, immersive HEVR allows the application of prolonged and repeated doses of digital therapy, enables the automatized integration with existing pain treatments, and avoids application of painful bodily cues while minimizing the active involvement of the patient and therapist.
Classification of evidence This study provides Class III evidence that HEVR reduces pain and increases force strength in patients with CRPS.
Glossary
- Bf=
- Bayes factor;
- CI=
- confidence interval;
- CRPS=
- complex regional pain syndrome;
- HEVR=
- heartbeat-enhanced virtual reality;
- HRV=
- heart rate variability;
- RHI=
- rubber hand illusion;
- VAS=
- visual continuous analog scale;
- VR=
- virtual reality
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Class of Evidence: NPub.org/coe
- Received August 30, 2017.
- Accepted in final form April 24, 2018.
- © 2018 American Academy of Neurology
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