For patients receiving spinal stimulation (SCS) for chronic pain, integration with a virtual immersion (VR) system – allowing patients to see as well as feel the effects of electrical stimulation on a meaningful image of the spine. their own body – they can promote the pain – achieve the effectiveness of SCS, reports a study in PAIN®, the official publication of the International Society for the Study of Pain (IASP). The magazine is published in a Lippincott folder by Wolters Kluwer.
The integrated SCS-VR approach improves pain control over SCS alone, with rapid and lasting effects that may be exacerbated with repeated use, according to the new collaborative study by Olaf Blanke, MD, of Ecole polytechnique fédérale de Lausanne (EPFL), Geneva, Switzerland, Ali Rezai, MD, of the University of West Virginia Institute of Neuroscience Rockefeller, and Vibhor Krishna MD, PhD, Ohio State University and colleagues. “To our knowledge this study shows that, for the first time, it is possible to integrate immersive and multitasking VR with spinal neuromodulation and chronic pain reduction,” the researchers write. .
Integrated SCS-VR puts patients in the picture to help control chronic pain
Drs. Blanke, Rezai, Krishna and their team tested their “digiceutical” integrated SCS-VR approach in 15 patients with leg pain. All patients already had SCS implants for leg pain, mainly associated with failed spinal surgery syndrome.
Spinal cord stimulation uses gentle electrical movements to prevent pain signals before they reach the brain. While SCS is an effective and increasingly common treatment for chronic pain, there are limitations: stimulation reduces pain in just about half of patients and rarely eliminates pain. tur.
Previous studies have shown that immersive and physical VR can have pain relief features – including an image of the patient’s or avatar’s body in a 3D view seen in a VR headset. The new approach links SCS to VR for the first time, allowing patients to “see” and “feel” the impact of SCS on a real-time virtual image of their own body or avatar. The excitatory area of the patient’s limb was visible as seen in VR “lit up” when the electric current was on.
For example, if the right thigh was tightened during SCS, the same area of the patient’s significant thigh was illuminated in VR. In the new study, pain scores with integrated SCS-VR were compared with VR alone, with SCS disabled; and with “inappropriate” SCS-VR, with SCS turned on but a different area of the meaningful view clarified.
The results showed lower pain levels when integrated SCS-VR was used. Average pain score (on a continuous visual analog scale) decreased from 6.2 before treatment to 2.72 with “appropriate” SCS-VR – when the stimulus area of the leg was “lit up” during SCS. Pain scores decreased by an average of 44 percent with inappropriate SCS-VR, compared with 23 percent with inappropriate SCS-VR. Pain scores alone had no real effect on pain scores.
All but 1 of the 15 patients had reduced pain scores during SCS-VR. Importantly and compared to the control conditions, the effect lasted for at least ten minutes after discontinuation of SCS; pain scores had a greater impact on SCS-VR applications again. VR-SCS also caused changes in “foot decoration” – when looking at the VR scene, patients got the impression that they were looking at their actual legs, and that the illuminated area caused a SCS-induced tingling sensation.
The immersive, personalized SCS-VR approach “combines neuromodulation, VR, and the latest research from cognitive neuroscience of multifactorial integration into a single therapeutic solution,” the researchers write. Integrated VR is a “completely noninvasive” addition to SCS, with the potential to increase the effectiveness of pain relief without any side effects.
It’s not entirely clear how immersive VR amplifies the impact of SCS, but the new results show it’s not just a pull-out effect. The matching visual and tactile symptoms may lead to “enhanced masking” of pain inputs, Dr. Blanke, Rezai, Krishna and colleagues suggest. They conclude: “The strength of the effect, its selectivity, its ease of application, and a steady increase over sessions and long-term analgesia will help with the application of long-acting doses. and more frequently in future SCS-VR studies, perhaps giving further impetus to the described effect. “
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Magazine Reference:
Solcà, M., et al. (2020) Advancing analgesic spinal stimulation for chronic pain with a truly immersive personal immersion reality. PAIN. doi.org/10.1097/j.pain.000000000000212160.