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Ann Phys Rehabil Med. 2019 Jan;62(1):49-57. doi: 10.1016/j.rehab.2018.09.006. Epub 2018 Oct 9.

Virtual reality for spinal cord injury-associated neuropathic pain: Systematic review.

Author information

1
Department of Physical Medicine and Rehabilitation, Loma Linda University Health, 11406 Loma Linda Drive, Suite 516, 92354 Loma Linda, CA, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, 11549 Hempstead, NY, USA. Electronic address: bchi1@pride.hofstra.edu.
2
Department of Physical Medicine and Rehabilitation, Loma Linda University Health, 11406 Loma Linda Drive, Suite 516, 92354 Loma Linda, CA, USA; VA Loma Linda Healthcare System, 11201 Benton Street, 92357 Loma Linda, CA, USA.
3
Loma Linda University School of Medicine, 11175 Campus Street, 92350 Loma Linda, CA, USA.
4
Department of Physical Medicine and Rehabilitation, Loma Linda University Health, 11406 Loma Linda Drive, Suite 516, 92354 Loma Linda, CA, USA.

Abstract

BACKGROUND:

Treatment of spinal cord injury (SCI)-associated neuropathic pain is challenging, with limited efficacy and no definitive options, and SCI patients often show resistance to pharmacologic treatment. Virtual reality (VR) therapy is a non-invasive, non-pharmacologic alternative with minimal adverse effects.

OBJECTIVE:

To investigate the effect of VR therapy on SCI-associated neuropathic pain in a systematic review.

METHODS:

Articles needed to 1) be written in English; 2) include adult subjects, with at least half the study population with a SCI diagnosis; 3) involve any form of VR therapy; and 4) assess neuropathic pain by quantitative outcome measures. Articles were searched in MEDLINE/PubMed, CINAHL®, EMBASE, and PsycINFO up to April 2018. Reference lists of retrieved articles were hand-searched. Methodologic quality was assessed by the Physiotherapy Evidence Database Score (PEDro) for randomized controlled trials and Modified Downs and Black Tool (D&B) for all other studies. Level of evidence was determined by using a modified Sackett scale.

RESULTS:

Among 333 studies identified, 9 included in this review (n=150 participants) evaluated 4 methods of VR therapy (virtual walking, VR-augmented training, virtual illusion, and VR hypnosis) for treating neuropathic pain in SCI patients. Each VR method reduced neuropathic pain: 4 studies supported virtual walking, and the other 3 VR methods were each supported by a different study. Combined treatment with virtual walking and transcranial direct current stimulation was the most effective. The quality of studies was a major limitation.

CONCLUSION:

VR therapy could reduce SCI-associated neuropathic pain, although the clinical significance of this analgesic effect is unclear. Clinical trials evaluating VR therapy as standalone and/or adjunct therapy for neuropathic pain in SCI patients are warranted.

KEYWORDS:

Neuropathic pain; Spinal cord injury; Virtual reality

PMID:
30312665
DOI:
10.1016/j.rehab.2018.09.006
[Indexed for MEDLINE]

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