Virtual Walking for Neuropathic Pain in Spinal Cord Injury
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Hospital, Neurology, Orthopedic |
| Therapuetic Areas: | Neurology, Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | 19 - 65 |
| Updated: | 12/5/2018 |
| Start Date: | September 2012 |
| End Date: | September 30, 2019 |
Virtual Walking for Reducing Spinal Cord Injury-Related Neuropathic Pain
Spinal cord injury neuropathic pain (SCI-NP) is a common problem, and when severe, is one of
the most problematic of secondary conditions that is minimally to modestly responsive to
currently available treatments. It is usually described as burning or stabbing, and is
located at or below the level at which their sensation changes from normal to impaired;
persons with no feeling at all in their legs for example can experience pain in the legs. The
purpose of this project is to further investigate the use of a novel visual stimulation
treatment; a technique that has shown benefit in other populations with chronic pain
secondary to deafferentation. To accomplish this, a novel treatment - virtual reality (VR)
walking - will be examined. Should this treatment show benefit, a portable, accessible means
of treatment will be available for persons with SCI and for whom transportation to health
care providers is often difficult.
the most problematic of secondary conditions that is minimally to modestly responsive to
currently available treatments. It is usually described as burning or stabbing, and is
located at or below the level at which their sensation changes from normal to impaired;
persons with no feeling at all in their legs for example can experience pain in the legs. The
purpose of this project is to further investigate the use of a novel visual stimulation
treatment; a technique that has shown benefit in other populations with chronic pain
secondary to deafferentation. To accomplish this, a novel treatment - virtual reality (VR)
walking - will be examined. Should this treatment show benefit, a portable, accessible means
of treatment will be available for persons with SCI and for whom transportation to health
care providers is often difficult.
This treatment will be investigated in two-phase project:
Phase 1: Determine the efficacy of VR treatments as a home-based approach and determine the
effect of VR treatment on reversal of maladaptive cortical reorganization associated with
SCI-NP, as has been shown in other populations with neuropathic pain secondary to
deafferentation.
Phase 2: Determine the effectiveness and immediate analgesic effect of VR treatment among
persons with both tetraplegia and paraplegia.
The primary outcome variable of this research is the severity of SCI-NP with a secondary
outcome of level of pain interference with daily activities.
In the phantom pain literature for persons with amputations, treatment paradigms based on
visual stimulation, called mirror therapies, have proven helpful. These approaches involve
the person viewing a mirror image of their intact limb to produce the visual illusion of a
return of the missing limb, often with a marked reduction in pain following. Investigations
have demonstrated that such approaches reduce pain in some individuals and that this change
is associated with reversal of the functional reorganization in the somatosensory cortex.
There has been one study of neuropathic pain in SCI that demonstrated good neuropathic pain
relief with a mirror image of the upper half of the individual with SCI with the lower half
of their body represented by a rear projection screen generated image of walking legs. We
have collaborated with this author, and developed and pilot tested a virtual walking DVD that
is presented via virtual reality goggles to enhance the first person sense of immersion.
Results were sufficiently encouraging to cause us to seek funding for current, broader
project
Phase 1: Determine the efficacy of VR treatments as a home-based approach and determine the
effect of VR treatment on reversal of maladaptive cortical reorganization associated with
SCI-NP, as has been shown in other populations with neuropathic pain secondary to
deafferentation.
Phase 2: Determine the effectiveness and immediate analgesic effect of VR treatment among
persons with both tetraplegia and paraplegia.
The primary outcome variable of this research is the severity of SCI-NP with a secondary
outcome of level of pain interference with daily activities.
In the phantom pain literature for persons with amputations, treatment paradigms based on
visual stimulation, called mirror therapies, have proven helpful. These approaches involve
the person viewing a mirror image of their intact limb to produce the visual illusion of a
return of the missing limb, often with a marked reduction in pain following. Investigations
have demonstrated that such approaches reduce pain in some individuals and that this change
is associated with reversal of the functional reorganization in the somatosensory cortex.
There has been one study of neuropathic pain in SCI that demonstrated good neuropathic pain
relief with a mirror image of the upper half of the individual with SCI with the lower half
of their body represented by a rear projection screen generated image of walking legs. We
have collaborated with this author, and developed and pilot tested a virtual walking DVD that
is presented via virtual reality goggles to enhance the first person sense of immersion.
Results were sufficiently encouraging to cause us to seek funding for current, broader
project
Inclusion Criteria: traumatic onset SCI, at least three months post onset, between 19 and
65; at least 6th grade reading level; neuropathic pain averaging at least 4/10.
Exclusion Criteria: Unable to independently transfer to the fMRI scanning table, current
pressures sores, contraindications to scanning; non-compliance with a pre-assignment task.
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