Virtual Reality for Phantom Limb Pain

The VA system performs more than 10% of all amputations in the U.S., a percentage translating
into more than 50,000 upper and lower extremity amputations in the past decade. Among
Veterans with amputations, research suggests that upwards of 70% experience phantom limb pain
(PLP), an often chronic and debilitating condition with adverse effects on quality of life
and poor responsiveness to conventional pain treatments. The use of virtual reality
technology for chronic pain management is a novel and rapidly advancing area of study, with
existing research suggesting that virtual reality treatments are effective for acute pain
management, promising for chronic pain management, and as yet untested for PLP. In the
current study, the investigators will develop a virtual reality environment that simulates
mirror therapy - the gold standard behavioral treatment for PLP - comparing the efficacy of
this modality in a population of Veterans with PLP against a standard mirror therapy
treatment validated by this research team in a previously supported clinical trial.

Inclusion Criteria:

- Ages 21-75 Veteran receiving care at VASDHS

- Upper or lower extremity amputation with reported PLP for at least six months

- PLP intensity > 3/10

- English-speaking, literate, with stable residence

- Able to operate a VR headset as evidenced by direct observation

Exclusion Criteria:

- Major medical illness that might confound effects of pain on function, e.g.:

- advanced cardiac

- pulmonary disease

- current active alcohol or substance use disorder as evidenced from medical record

- currently active suicidality

- homicidality, or unstable psychiatric status in previous three months as measured by
direct observation, patient self-report, or medical record

- moderate or severe cognitive impairment as demonstrated by medical diagnosis or
clinical observation

- prior mirror therapy experience