Enhancing analgesic spinal cord stimulation for chronic pain with personalized immersive virtual reality

被引:21
作者
Solca, Marco [1 ,2 ,3 ]
Krishna, Vibhor [4 ]
Young, Nicole [4 ]
Deogaonkar, Milind [5 ]
Herbelin, Bruno [1 ,2 ]
Orepic, Pavo [1 ,2 ]
Mange, Robin [1 ,2 ]
Rognini, Giulio [1 ,2 ]
Serino, Andrea [1 ,2 ,6 ]
Rezai, Ali [5 ]
Blanke, Olaf [1 ,2 ,7 ]
机构
[1] Swiss Fed Inst Technol EPFL, Ctr Neuroprosthet, Lab Cognit Neurosci, Lausanne, Switzerland
[2] Swiss Fed Inst Technol EPFL, Brain Mind Inst, Sch Life Sci, Lausanne, Switzerland
[3] Geneva Univ Hosp, Dept Psychiat, Geneva, Switzerland
[4] Ohio State Univ, Dept Neurol Surg, Columbus, OH 43210 USA
[5] West Virginia Univ, Rockefeller Neurosci Inst, Morgantown, WV 26506 USA
[6] Univ Hosp Lausanne, Dept Clin Neurosci, MySpace, Lausanne, Switzerland
[7] Geneva Univ Hosp, Dept Neurol, Geneva, Switzerland
基金
瑞士国家科学基金会;
关键词
Neuropathic pain; Neurostimulation; Augmented reality; Embodiment; BACK SURGERY SYNDROME; MULTISENSORY INTEGRATION; BRAIN-STIMULATION; NEUROPATHIC PAIN; THERAPY; COMPLICATIONS; MECHANISMS; MISUSE; ABUSE;
D O I
10.1097/j.pain.0000000000002160
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Spinal cord stimulation (SCS) is an approved treatment for truncal and limb neuropathic pain. However, pain relief is often suboptimal and SCS efficacy may reduce over time, requiring sometimes the addition of other pain therapies, stimulator revision, or even explantation. We designed and tested a new procedure by combining SCS with immersive virtual reality (VR) to enable analgesia in patients with chronic leg pain. We coupled SCS and VR by linking SCS-induced paresthesia with personalized visual bodily feedback that was provided by VR and matched to the spatiotemporal patterns of SCS-induced paresthesia. In this cross-sectional prospective interventional study, 15 patients with severe chronic pain and an SCS implant underwent congruent SCS-VR (personalized visual feedback of the perceived SCS-induced paresthesia displayed on the patient's virtual body) and 2 control conditions (incongruent SCS-VR and VR alone). We demonstrate the efficacy of neuromodulation-enhanced VR for the treatment of chronic pain by showing that congruent SCS-VR reduced pain ratings on average by 44%. Spinal cord stimulation-VR analgesia was stronger than that in both control conditions (enabling stronger analgesic effects than incongruent SCS-VR analgesia or VR alone) and kept increasing over successive stimulations, revealing the selectivity and consistency of the observed effects. We also show that analgesia persists after congruent SCS-VR had stopped, indicating carry over effects and underlining its therapeutic potential. Linking latest VR technology with recent insights from the neuroscience of body perception and SCS neuromodulation, our personalized new SCS-VR platform highlights the impact of immersive digiceutical therapies for chronic pain. Registration: clinicaltrials.gov, Identifier: NCT02970006.
引用
收藏
页码:1641 / 1649
页数:9
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