Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: a randomized controlled trial

Thomas Matheve,Katleen Bogaerts,Annick Timmermans

doi:10.1186/s12984-020-00688-0

Thomas Matheve, Katleen Bogaerts + Show 1 more

Open Access

https://doi.org/10.1186/s12984-020-00688-0

Copy DOI

Abstract

BackgroundAttentional distraction from pain has been shown to be largely ineffective for obtaining a hypoalgesic effect in patients with chronic pain when compared to a control condition. It has been hypothesized that this may be due to the non-engaging types of distraction that have been used so far. Moreover, it is suggested that the hypoalgesic effects of distraction may be attenuated by pain-related cognitions and emotions, as they may increase the attention to pain.MethodsIn this randomized controlled trial, patients with chronic nonspecific low back pain in the intervention group (n = 42) performed a single exercise session with nonimmersive VR games, while those in the control group (n = 42) performed the same exercises without VR games. We investigated whether VR distraction had a hypoalgesic effect during and immediately after the exercises, and whether it reduced the time spent thinking of pain during the exercises. We further explored whether pain-related fear, pain catastrophizing and baseline pain intensity moderated the effects of VR distraction.ResultsVR distraction had a hypoalgesic effect during (Cohen’s d = 1.29) and immediately after (Cohen’s d = 0.85) the exercises, and it also reduced the time spent thinking of pain (Cohen’s d = 1.31). Preliminary exploratory analyses showed that pain-related fear, pain catastrophizing and baseline pain intensity did not moderate the effects of VR distraction.ConclusionsLarge effect sizes of VR distraction induced hypoalgesia were observed. This suggests that nonimmersive VR games can be used when it is deemed important to reduce the pain during exercises in patients with chronic nonspecific low back pain.Trial registrationNCT02679300. This trial was registered on 10 February 2016.

Highlights

Attentional distraction from pain has been shown to be largely ineffective for obtaining a hypoalgesic effect in patients with chronic pain when compared to a control condition
Various hypotheses have been postulated to explain the lack of distraction induced hypoalgesia in patients with chronic pain
Patients with chronic pain have been shown to selectively pay attention to pain-related information [10, 11], and as a consequence, they might be less distracted from it [2, 12]. This attentional bias to pain develops when the pain is experienced as threatening [10], and as such, this bias is often associated with higher levels of pain-related fear and pain catastrophizing [10, 11]

Summary

Introduction

Attentional distraction from pain has been shown to be largely ineffective for obtaining a hypoalgesic effect in patients with chronic pain when compared to a control condition. Patients with chronic pain have been shown to selectively pay attention to pain-related information [10, 11], and as a consequence, they might be less distracted from it [2, 12]. It is thought that in order to draw the attention away from the pain, the competing stimulus should be sufficiently engaging [19] In this respect, interactive virtual reality (VR) games may prove to be a promising tool [20,21,22,23,24], as they are typically considered to be motivating [25]

Objectives

Methods

Results

Conclusion