Abstract
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.
Highlights
One in five adults in the Western world suffers from pain that persists for more than three months without objective threat to the body, known as Chronic Pain (CP) (Mills et al, 2019; Scholz et al, 2019)
This paper aimed to establish a blueprint for neuroimaging studies in Virtual Reality (VR) for CP patients using EEG by presenting a research protocol exploring the changes in EEG oscillation during an embodied VR
Its effectiveness for pain alleviation has been demonstrated through numerous studies (Li et al, 2011; Gupta et al, 2018), yet little is known about VR-analgesia (Gold et al, 2007; Indovina et al, 2018; Riva et al, 2019; Slater et al, 2009; González Franco, 2014), in particular for CP patients
Summary
One in five adults in the Western world suffers from pain that persists for more than three months without objective threat to the body, known as Chronic Pain (CP) (Mills et al, 2019; Scholz et al, 2019). Abnormal neuronal firing in the thalamus and thalamocortical malfunctioning might play a central role in the pathology of CP (Llinás et al, 2005; Ploner et al, 2017) since denervation in this region can cause failure in neurophysiological adjustment to sensory inputs (Ecsy, 2014; Alshelh et al, 2016; Tu et al, 2020) Some studies tracked this thalamocortical dysrhythmia (Llinás et al, 2005) in the changes of the power of brain oscillations in the frequency range of 4–8 Hz It is suggested that distorted “body image” might be linked to developing some types of CP conditions, such as in Complex Regional Pain Syndrome (CRPS) (Moseley, 2005; Lotze and Moseley, 2007; Romano and Maravita, 2014; Senkowski and Heinz, 2016)
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