Virtual Reality Treatment for Phantom Limb Pain

Approximately 90% of patients with limb amputations experience the persistent sensation of
the missing extremity, a phenomenon known as phantom limb (PL). Most patients with PL also
experience a persistent and debilitating pain in the missing limb, a condition known as
phantom limb pain (PLP).PLP is often attributed to a disruption of the primary sensory-motor
representation, generating "noise" in the representation of the missing extremity,
manifesting as pain. If loss of sensory feedback causes degradation of the these cortices,
interventions that provide visual feedback about the missing extremity might fine-tune the
primary sensory-motor cortices, thereby reducing pain. Within this framework, the present
study explores the use of virtual reality (VR) training as a possible treatment of PLP.
Twenty-five subjects with lower-limb amputation and chronic PLP will undergo a Virtual
Reality (VR) treatment (17 one-hour sessions) consisting in two phases: a Distraction VR
phase (5-7 sessions) in which they will explore VR environments using a joystick and a
Lower-Limb VR treatment phase (10-12 sessions) in which they will participate in a variety of
games and activities using their VR lower-limbs. A comprehensive battery for the assessment
of the characteristics, intensity and the daily-life implication of PLP will be presented
before and after the treatment and in three follow up testing sessions (1,4, 8 weeks).
Furthermore, pain intensity will be assessed before and after each VR session. A dramatic
reduction of PLP is expected after the VR treatment and that these beneficial effects remain
stable in time.

Inclusion Criteria:

- Subjects will have undergone amputation of one leg (either above or below the knee) at
least 6 months before the enrollment in the study;

- Will have chronic pain in the phantom limb:

Exclusion Criteria:

- History of stroke or traumatic brain injury;

- Major active psychiatric illness that may interfere with required study procedures or
treatments as determined by the PI on the study, who is a behavioral neurologist;

- Subjects with major medical illness that would be expected to interfere with their
ability to complete the study will be excluded.

- Subjects with implanted electronic devices.