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Pain Med. 2018 Dec 21. doi: 10.1093/pm/pny269. [Epub ahead of print]

Characteristics of Phantom Limb Pain Alleviated with Virtual Reality Rehabilitation.

Author information

1
Graduate School of Health Science, Kio University, Nara, Japan.
2
Neurorehabilitation Research Center, Kio University, Nara, Japan.
3
Equal contribution.
4
Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan.
5
KIDS Co., Ltd.
6
Visualization Design Department, Power Place Inc., Tokyo, Japan.

Abstract

Objectives:

Neurorehabilitation techniques using virtual reality (VR) systems have recently become widespread as a rehabilitation method for restoring phantom limb movement and alleviating phantom limb pain (PLP). However, analgesic effects have varied between studies, possibly because of differences in the characteristics of PLP between patients (e.g., cramping, burning, shooting). We aimed to reveal the relationship between VR effects and PLP characteristics using an exploratory factor analysis.

Methods:

PLP characteristics of 19 patients were measured using the Short-Form McGill Pain Questionnaire (SF-MPQ), and all PLP patients performed the VR rehabilitation protocol for 20 minutes. During VR rehabilitation, mirror-reversed computer graphic images of an intact arm (the virtual phantom limb) were presented to patients via a head-mounted display, inducing the perception of voluntary execution of movements of their phantom limb when intending bimanual movements.

Results:

VR rehabilitation significantly restored movement representation (P < 0.0001) quantified using the bimanual coupling effect and significantly alleviated PLP intensity (P < 0.0001). The factor analysis revealed that PLP characteristics could be divided into two factors: "somatosensory-related pain characteristics" and "kinesthesia-related pain characteristics." PLP alleviation via VR rehabilitation was significantly correlated with "kinesthesia-related pain characteristics" (r = 0.47, P = 0.02) but not "somatosensory-related pain characteristics" (r = 0.22, P = 0.17).

Conclusions:

The current findings indicate that VR rehabilitation may be particularly effective for PLP associated with distorted phantom limb movement and body representations (e.g., clamping, gnawing), compared with typical neuropathic sensations (e.g., shooting, burning, dysesthesia).

PMID:
30576543
DOI:
10.1093/pm/pny269

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