Marco Solcà1, Roberta Ronchi1, Javier Bello-Ruiz1, Thomas Schmidlin1, Bruno Herbelin1, François Luthi1, Michel Konzelmann1, Jean-Yves Beaulieu1, François Delaquaize1, Armin Schnider1, Adrian G Guggisberg1, Andrea Serino1, Olaf Blanke2. 1. From the Department of Mental Health and Psychiatry (M.S.), University Hospital, Geneva; Department of Basic Neurosciences (R.R.), Faculté de médecine, Laboratory of Cognitive Neuroscience, University of Geneva (M.S., R.R., J.B.R., B.H., A. Serino, O.B.), Center for Neuroprosthetics, and BrainMind Institute & Center for Neuroprosthetics (T.S.), School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Campus Biotech, Geneva; Department for Musculoskeletal Rehabilitation (F.L., M.K.), Clinique romande de réadaptation suvacare, Sion; Department of Orthopedic Surgery (J.-Y.B., F.D.), Division of Neurorehabilitation (A. Schnider, A.G.G.), and Department of Neurology (O.B.), University Hospital, Geneva; and Laboratory MySpace (A. Serino), Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Switzerland. 2. From the Department of Mental Health and Psychiatry (M.S.), University Hospital, Geneva; Department of Basic Neurosciences (R.R.), Faculté de médecine, Laboratory of Cognitive Neuroscience, University of Geneva (M.S., R.R., J.B.R., B.H., A. Serino, O.B.), Center for Neuroprosthetics, and BrainMind Institute & Center for Neuroprosthetics (T.S.), School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Campus Biotech, Geneva; Department for Musculoskeletal Rehabilitation (F.L., M.K.), Clinique romande de réadaptation suvacare, Sion; Department of Orthopedic Surgery (J.-Y.B., F.D.), Division of Neurorehabilitation (A. Schnider, A.G.G.), and Department of Neurology (O.B.), University Hospital, Geneva; and Laboratory MySpace (A. Serino), Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Switzerland. olaf.blanke@epfl.ch.
Abstract
OBJECTIVES: To develop and test a new immersive digital technology for complex regional pain syndrome (CRPS) that combines principles from mirror therapy and immersive virtual reality and the latest research from multisensory body processing. METHODS: In this crossover double-blind study, 24 patients with CRPS and 24 age- and sex-matched healthy controls were immersed in a virtual environment and shown a virtual depiction of their affected limb that was flashing in synchrony (or in asynchrony in the control condition) with their own online detected heartbeat (heartbeat-enhanced virtual reality [HEVR]). The primary outcome measures for pain reduction were subjective pain ratings, force strength, and heart rate variability (HRV). RESULTS:HEVR reduced pain ratings, improved motor limb function, and modulated a physiologic pain marker (HRV). These significant improvements were reliable and highly selective, absent in control HEVR conditions, not observed in healthy controls, and obtained without the application of tactile stimulation (or movement) of the painful limb, using a readily available biological signal (the heartbeat) that is most often not consciously perceived (thus preventing placebo effects). CONCLUSIONS: Next to these specific and well-controlled analgesic effects, immersive HEVR allows the application of prolonged and repeated doses of digital therapy, enables the automatized integration with existing pain treatments, and avoids application of painful bodily cues while minimizing the active involvement of the patient and therapist. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that HEVR reduces pain and increases force strength in patients with CRPS.
RCT Entities:
OBJECTIVES: To develop and test a new immersive digital technology for complex regional pain syndrome (CRPS) that combines principles from mirror therapy and immersive virtual reality and the latest research from multisensory body processing. METHODS: In this crossover double-blind study, 24 patients with CRPS and 24 age- and sex-matched healthy controls were immersed in a virtual environment and shown a virtual depiction of their affected limb that was flashing in synchrony (or in asynchrony in the control condition) with their own online detected heartbeat (heartbeat-enhanced virtual reality [HEVR]). The primary outcome measures for pain reduction were subjective pain ratings, force strength, and heart rate variability (HRV). RESULTS: HEVR reduced pain ratings, improved motor limb function, and modulated a physiologic pain marker (HRV). These significant improvements were reliable and highly selective, absent in control HEVR conditions, not observed in healthy controls, and obtained without the application of tactile stimulation (or movement) of the painful limb, using a readily available biological signal (the heartbeat) that is most often not consciously perceived (thus preventing placebo effects). CONCLUSIONS: Next to these specific and well-controlled analgesic effects, immersive HEVR allows the application of prolonged and repeated doses of digital therapy, enables the automatized integration with existing pain treatments, and avoids application of painful bodily cues while minimizing the active involvement of the patient and therapist. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that HEVR reduces pain and increases force strength in patients with CRPS.
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