scholarly journals Investigating the Role of Having an Avatar in Virtual Reality on Pain Alleviation and Embodiment in Patients With Pain Using Electroencephalogram: A Neuroimaging Protocol

2022 ◽  
Vol 2 ◽  
Author(s):  
Seyedeh Pegah Kiaei Ziabari ◽  
Zahra Ofoghi ◽  
Emma A. Rodrigues ◽  
Diane Gromala ◽  
Sylvain Moreno

Chronic Pain (CP) is prevalent in industrialized countries and stands among the top 10 causes of disability. Given the widespread problems of pharmacological treatments such as opioids, a need to find alternative therapeutic approaches has emerged. Virtual Reality (VR) has shown potential as a non-pharmacological alternative for controlling pain over the past 20 years. The effectiveness of VR has been demonstrated in treating CP, and it has been suggested that VR’s analgesic effects may be associated with the Sense of Embodiment (SoE): the sensation of being inside, having and controlling a virtual body in VR. Studies have shown correlations among brain signals, reported pain and a SoE, and correlations have been observed between using an avatar in VR and pain alleviation among CP patients. However, little has been published about the changes in brain physiology associated with having an avatar in VR, and current published studies present methodological issues. Defining a proper methodology to investigate the underlying brain mechanisms of pain, a SoE associated with having an avatar in VR, and its effect on reducing pain in CP patients is key to the emerging field of VR-analgesia. Here, we propose an intervention trial design (test/intervention/test) to evaluate the effects of having a virtual avatar in VR on pain levels and SoE in CP patients using Electroencephalogram (EEG) recordings. Resting-state EEG recordings, perceived pain levels, and SoE scores will be collected before and after the VR intervention. Patients diagnosed with CP will be recruited from local pain clinics and pseudo-randomly assigned to one of two groups—with or without an avatar. Patients will experience a 10-min VR intervention built to treat CP while their EEG signals are recorded. In articulating the study procedure, we propose a framework for future studies that explores the mechanisms of VR-analgesia in patients with chronic pain.

Author(s):  
Régis Guieu ◽  
Marie-Françoise Tardy-Gervet ◽  
Pierre Giraud

ABSTRACT:By applying vibratory stimulation to patients suffering from pain, it is possible to set up an inhibitory control on the pain pathways which is based on the activation of large-sized afferent fibres. The exact mechanisms responsible for these analgesic effects still remain to be determined, however. For this purpose, we investigated in the present study whether or not the analgesic effects were accompanied by a decrease in the CSF substance P-like immunoreactivity levels (SPLI) of seven patients suffering from chronic pain, who were fitted with a ventriculo-peri-toneal drain. The SPLI levels were determined before and after 30-min vibratory stimulation sessions. The results show that the SPLI levels decreased as the result of the vibration, but this decrease seems to be too slight to account for the pain relief obtained.


2018 ◽  
Vol 1 (21;1) ◽  
pp. E603-E610
Author(s):  
Mohab Ibrahim

Background: The management of chronic nonmalignant pain with high-dose opioids has partially contributed to the current opioid epidemic, with some responsibility shared by chronic pain clinics. Traditionally, both primary care providers and patients used chronic pain clinics as a source for continued medical management of patients on high-dose opioids, often resulting in tolerance and escalating doses. Although opioids continue to be an important component of the management of some chronic pain conditions, improvement in function and comfort must be documented. Pain clinics are ideally suited for reducing opioid usage while improving pain and function with the use of a multimodal approach to pain management. We assessed whether the application of multimodal treatment directed by pain specialists in a pain clinic provides for improved function and reduced dosages of opioid analgesics. Objective: We evaluated the role of a pain clinic staffed by fellowship-trained pain physicians in reducing pain and opioid use in chronic nonmalignant pain patients. Study Design: This study used a retrospective design. Setting: The research took place in an outpatient pain clinic in a tertiary referral center/teaching hospital. Methods: Of 1268 charts reviewed, 296 patients were on chronic opioids at the time of first evaluation. After a thorough evaluation, the patients were treated with nonopioid pharmacotherapy and interventional pain procedures as necessary. The data utilized from patients’ latest follow-up visit included current pain level using the Numerical Rating Scale (NRS-11), opioid usage, and various functional parameters. Results: NRS-11 scores decreased by 33.8% from 6.8 (± 0.1)/10 to 4.5 (± 0.2)/10. The pain frequency and number of pain episodes improved by 36.8 ± 2 and 36.2 ± 2.1, respectively. Additionally, the ability to sleep, work, and perform chores significantly improved. Total opioid use decreased by about 55.4% from 53.8 ± 4 to about 24 ± 2.8 MME/patient/day. Limitation: This study is not a randomized prospective controlled study. The patients analyzed are still getting therapy and their pain status may change. Some opioids are underrepresented in the analyzed cohort. Finally, this study lacks in-depth stratification by type of pain, age, gender, and duration of opioid use. Conclusion: Chronic pain clinics can play a pivotal role in reducing opioid usage while improving pain and function in patients on chronic opioids. We wish to emphasize the importance of allocating resources toward nonopioid treatments that may improve the function and well-being of patients. Key words: Pain clinic, pain management, multimodal pain management, chronic pain, opioid reduction, improved pain, improved functional capacity


2021 ◽  
Vol 11 (10) ◽  
pp. 1311
Author(s):  
Barbara Ziółkowska

There is increasing recognition of the involvement of the nigrostriatal and mesolimbic dopamine systems in the modulation of chronic pain. The first part of the present article reviews the evidence indicating that dopamine exerts analgesic effects during persistent pain by stimulating the D2 receptors in the dorsal striatum and nucleus accumbens (NAc). Thereby, dopamine inhibits striatal output via the D2 receptor-expressing medium spiny neurons (D2-MSN). Dopaminergic neurotransmission in the mesostriatal pathways is hampered in chronic pain states and this alteration maintains and exacerbates pain. The second part of this article focuses on the glutamatergic inputs from the medial prefrontal cortex to the NAc, their activity changes in chronic pain, and their role in pain modulation. Finally, interactions between dopaminergic and glutamatergic inputs to the D2-MSN are considered in the context of persistent pain. Studies using novel techniques indicate that pain is regulated oppositely by two independent dopaminergic circuits linking separate parts of the ventral tegmental area and of the NAc, which also interact with distinct regions of the medial prefrontal cortex.


2018 ◽  
Vol 119 (4) ◽  
pp. 1254-1256 ◽  
Author(s):  
Duru G. Ozkan ◽  
Rachele Pezzetta

Error-related negativity (ERN) is a signal that is associated with error detection. Joch and colleagues (Joch M, Hegele M, Maurer H, Müller H, Maurer LK. J Neurophysiol 118: 486–495, 2017) successfully separated the ERN as a response to online prediction error from feedback updates. We discuss the role of ERN in action and suggest insights from virtual reality techniques; we consider the potential benefit of self-evaluation in determining the mechanisms of ERN amplitude; finally, we review the oscillatory activity that has been claimed to accompany ERN.


2021 ◽  
Author(s):  
Adam Saby ◽  
Anthony Alvarez ◽  
David Smolins ◽  
James Petros ◽  
Lincoln Nguyen ◽  
...  

BACKGROUND Chronic pain has long been a major health burden that has been addressed through numerous forms of pharmacological and non-pharmacological treatment. One of the tenets of modern medicine is to minimize risk while providing efficacy. Because of its non-invasive nature, Virtual Reality provides an attractive platform for potentially developing novel therapeutic modalities. OBJECTIVE We describe a feasibility study that use embodiment in virtual reality as a treatment for chronic pain. The purpose of this study was to determine the feasibility of a novel virtual reality-based digital therapeutic for the treatment of chronic pain. METHODS An open label study assessed the feasibility of using virtual embodiment in virtual reality to treat chronic pain (Clinicaltrials.gov Identifier: NCT04060875). Twenty-four chronic pain patients were recruited from local pain clinics and completed eight session of a novel digital therapeutic that combines virtual embodiment with graded motor imagery to deliver functional rehabilitation exercises over the course of four weeks. Pain intensity as measured by a visual analog scale before and after each virtual embodiment training session was used as a primary outcome measure. Additionally, a battery of patient reported pain questionnaires (Fear and Avoidance Beliefs Questionnaire, OSWESTRY, Pain Catastrophizing Scale, and Patient Health Questionnaire) were administered before and after eight sessions of virtual embodiment training as exploratory outcome measures to get an indication if the measures are appropriate and warrant a larger randomized controlled trial. RESULTS A two-way ANOVA on session x pre vs. post Virtual embodiment training revealed that individual virtual embodiment training sessions significantly reduced the intensity of pain as measured by visual analog scale. Perceived disability due to lower back pain as measured by OSWESTRY significantly improved over the four-week course of virtual embodiment regimen. Improvement was also observed on the helplessness subscale of the Pain Catastrophizing Scale. CONCLUSIONS This study provide evidence that functional rehabilitation exercises delivered in virtual reality are safe and may have positive effects on alleviating the symptoms of chronic pain. These results support the justification for a larger randomized controlled trial to assess the extent to which virtual embodiment training can exert an effect on symptoms associated with chronic pain. CLINICALTRIAL Clinicaltrials.gov Identifier: NCT04060875


1987 ◽  
Vol 50 (8) ◽  
pp. 262-263 ◽  
Author(s):  
Jenny Strong

This paper describes the contribution the occupational therapist makes in improving the quality of life of the patient with chronic benign pain. Working closely with medical specialists, the occupational therapist is able to contribute much towards the rehabilitation of the patient. Occupational therapists are currently providing pain patient services from specialist pain clinics, community centres, general hospitals and private practice settings. The role of the occupational therapist in chronic pain management is highlighted by a case history.


Author(s):  
George E. Muñoz

The role of a healthy, balanced exercise program is reviewed by Dr. Munoz from the perspective of an integrative, sports, wellness, and chronic pain specialist. The concepts are applied to the whole person approach of integrative recovery. The science involved in addiction systemic and brain inflammation is reviewed as well as the beneficial impact of exercise on these disturbances at the cytokine and molecular levels. The why, how, and what questions regarding exercise are reviewed. The role of a balanced exercise prescription in recovery and addiction treatment is reviewed with special attention to the needs of the recovering individual. Relevant supplements, specific types of exercise, and appropriate nutrition for a successful exercise prescription are reviewed including managing pain before and after exercise with safe supplements and other techniques.


US Neurology ◽  
2016 ◽  
Vol 12 (02) ◽  
pp. 82 ◽  
Author(s):  
Parisa Gazerani ◽  

Virtual Reality (VR) technology creates a sense of immersion in a virtual environment analogous to the real world. VR has increasingly gained attention for pain management based on current evidence demonstrating its analgesic effects in certain experimental, acute and chronic pain conditions. VR-based interventions shift the users’ attention towards active cognitive processing that can lead to higher pain threshold or tolerance. An understanding of neurobiological mechanisms underlying analgesic effects of VR will definitely facilitate optimal utility of this tool for pain control.


1984 ◽  
Vol 18 (3) ◽  
pp. 263-272
Author(s):  
N. D. Spence

The purpose of the present study was to clarify the role of EMG-based relaxation training for a diverse group of chronic pain patients by examining in detail both process and outcome changes. Eighteen pain clinic patients were each given 10 sessions of relaxation training using frontalis feedback. The results of the study do not support the use of relaxation training as a standard procedure for chronic pain patients. Psychophysiological assessment carried out before and after training indicated some reduction in EMG levels, with less change in GSR and HR activity. No significant alteration occurred in mean pain and medication measures after training, although there was a trend for sedative/hypnotic usage to be smaller. Most important, individual differences in outcome were not consistently related to process variables monitored during training. This lack of association supports the view that physiological change is not necessary for clinical benefit after relaxation training.


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