复杂区域疼痛综合征(CRPS)是一种罕见且严重的慢性疼痛疾病,对于许多患者来说,有效的治疗方案尚未确立。潜在的病理生理学仍不清楚,但是人们越来越认识到中枢机制的作用,这些机制已成为基于脑的治疗的基础,例如经颅磁刺激和镜像视觉反馈(MVF)。MVF已被部署在使用传统镜子和虚拟现实(VR)的CRPS治疗中。
这项研究的目的是进一步研究VR在单侧上肢CRPS患者治疗中的应用。VR具有更灵活和更有动力的任务的潜在优势,以及通过使用运动数据跟踪患者改善的选项。
我们描述了发展,可接受性,可行性,以及开源VR程序MVF模块的可用性,该模块旨在与消费者VR系统一起使用以治疗CRPS。开发团队是一个跨学科的物理治疗师小组,疼痛研究人员,VR研究人员从疼痛诊所招募的患者每次完成3-5次访问以试验该系统,并在治疗前和治疗后问卷中评估他们的经验。
所有9名(100%)参与者均能够使用该系统进行3、4或5次试验。没有参与者因网络疾病而退出任何试验。所有9名(100%)参与者都表示有兴趣将来使用该模块。参与者报告的患肢平均疼痛评分在治疗期间或治疗后与基线无显著差异(P=0.16)。我们没有发现对参与者自我报告的平均疼痛评分有统计学意义的影响。
我们建议该模块可以成为其他研究人员进行修改和测试的有用起点。我们共享修改,以使该模块可用于独立耳机和手指跟踪。接下来的步骤包括使这个模块适合家庭使用,或用于下肢疼痛的参与者。
Complex regional pain syndrome (CRPS) is a rare and severe chronic pain condition, with effective treatment options not established for many patients. The underlying pathophysiology remains unclear, but there is a growing appreciation for the role of central mechanisms which have formed the basis for brain-based therapies such as transcranial magnetic stimulation and mirror visual feedback (MVF). MVF has been deployed in the treatment of CRPS using both conventional mirrors and virtual reality (VR).
The aim of this
study was to further investigate the use of VR in the treatment of patients with unilateral upper limb CRPS. VR has the potential advantage of more flexible and more motivating tasks, as well as the option of tracking patient improvement through the use of movement data.
We describe the development, acceptability, feasibility, and usability of an open-source VR program MVF module designed to be used with consumer VR systems for the treatment of CRPS. The development team was an interdisciplinary group of physical therapists, pain researchers, and VR researchers. Patients recruited from a pain clinic completed 3-5 visits each to
trial the system and assessed their experiences in pre- and post-treatment questionnaires.
All 9 (100%) participants were able to use the system for 3, 4, or 5 trials each. None of the participants quit any
trial due to cybersickness. All 9 (100%) participants reported interest in using the module in the future. Participants\' reported average pain scores in the affected limb were not significantly different from baseline during treatment or after treatment (P=.16). We did not find a statistically significant effect on participants\' self-reported average pain scores.
We propose that this module could be a useful starting point for modification and testing for other researchers. We share modifications to make this module usable with standalone headsets and finger tracking. Next steps include adapting this module for at-home use, or for use with participants with lower limb pain.