Abstract
Background: Virtual reality (VR) allows people to embody avatars that are different from themselves in appearance and ability. These experiences provide opportunities to challenge bodily perceptions. We devised a novel VR Body Image Training (VR-BIT) approach to target self-perceptions and pain in people with persistent pain. Methods: A 45-year old male with a 5-year history of disabling chronic low back pain participated in a 4-week VR-BIT intervention. Pain began following a fall from a first-floor deck. Pain was central and on the right side of his lower back, radiating to his right buttock and thigh. Pain was constant and varying at a 5/10 average intensity. The 4-week intervention consistent of three face-to-face sessions 1-week apart, followed by 1-week of in-home VR-BIT. During the first face-to-face session, the participant embodied three athletic avatars: a superhero (Incredible Hulk), a boxer, and a rock climber. Since the participant strongly identified with the boxer, only boxing experiences were subsequently used. Primary outcomes relating to body image (self-perceived strength, vulnerability, agility, and confidence with activity) and pain intensity were assessed using numerical rating scales (0–10 NRS). Disability, kinesiophobia, overall change, and self-efficacy were assessed as secondary outcomes. Outcomes were assessed during each face-to-face session, and at 1-week and 3-month follow-up. Results: The participant reported a high degree of engagement. Positive changes were noted during and after VR for all body image and pain assessments. Improvements were retained at 3-months for body image ratings (mean change: 4.5/10 NRS) and average pain intensity (change: 2/10 NRS). Improvements in disability (45% improvement); self-efficacy (pre: 2/12; post: 10/12); and overall change (“Very much improved”) were noted at 3-month follow-up. No change in kinesiophobia was detected. No adverse advents were recorded. Conclusion: The participant engaged strongly with the intervention and showed clinically meaningful changes in body image, pain, disability, and self-efficacy. Despite his long history of pain and rapid improvements, reported changes may be due to non-treatment effects. Nonetheless, VR-BIT clearly warrants further investigation as a potential addition to usual care.
Highlights
Body perception is remarkably plastic and susceptible to states where it is out-of-step with reality (Moseley et al, 2012)
The advent of virtual reality (VR) has made it possible to extend such illusions to the entire body, such as where a virtual body is presented in place of one’s own body, resulting in the illusion of “body swapping,” commonly termed “embodiment” (Slater et al, 2010; Serino et al, 2016)
We present a case report where a participant with chronic low back pain (LBP) undertook a 4-week VR Body Image Training (VR-BIT) program, involving the embodiment of athletically enhanced avatars, with the goal of targeting negative self-perceptions and pain
Summary
Body perception is remarkably plastic and susceptible to states where it is out-of-step with reality (Moseley et al, 2012). Distorted body perception is possible, because brain-held representations of the body are continuously updated in line with new information (Moseley et al, 2012). Modern theories explain this by positing that perception is the result of maximum-likelihood estimations, derived from available multisensory information and prior expectation, in a way that aims to minimize perceptual errors (Samad et al, 2015). Virtual reality (VR) allows people to embody avatars that are different from themselves in appearance and ability. These experiences provide opportunities to challenge bodily perceptions. We devised a novel VR Body Image Training (VR-BIT) approach to target self-perceptions and pain in people with persistent pain
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