Extended reality used in the treatment of phantom limb pain: a multicenter, double-blind, randomized controlled trial
Journal article, 2024

Phantom limb pain (PLP) represents a significant challenge after amputation. This study investigated the use of phantom motor execution (PME) and phantom motor imagery (PMI) facilitated by extended reality (XR) for the treatment of PLP. Both treatments used XR, but PME involved overt execution of phantom movements, relying on the decoding of motor intent using machine learning to enable real-time control in XR. In contrast, PMI involved mental rehearsal of phantom movements guided by XR. The study hypothesized that PME would be superior to PMI. A multicenter, double-blind, randomized controlled trial was conducted in 9 outpatient clinics across 7 countries. Eighty-one participants with PLP were randomly assigned to PME or PMI training. The primary outcome was the change in PLP, measured by the Pain Rating Index, from baseline to treatment cessation. Secondary outcomes included various aspects related to PLP, such as the rate of clinically meaningful reduction in pain (CMRP;.50% pain decrease). No evidence was found for superiority of overt execution (PME) over imagery (PMI) using XR. PLP decreased by 64.5% and 68.2% in PME and PMI groups, respectively. Thirty-seven PME participants (71%) and 19 PMI participants (68%) experienced CMRP. Positive changes were recorded in all other outcomes, without group differences. Pain reduction for PME was larger than previously reported. Despite our initial hypothesis not being confirmed, PME and PMI, aided by XR, are likely to offer meaningful PLP relief to most patients. These findings merit consideration of these therapies as viable treatment options and alternatives to pharmacological treatments.

Amputation

Augmented reality

Phantom limb

Rehabilitation

Virtual reality exposure therapy

Pain

Pain management

Author

Eva Lendaro

McGovern Institute

Chalmers, Electrical Engineering

Corry K. Van Der Sluis

University of Groningen

Liselotte Hermansson

Faculty of Medicine and Health

Lina Bunketorp-Käll

University of Gothenburg

Sahlgrenska University Hospital

H. Burger

University of Ljubljana

Institute for Rehabilitation Ljubljana

Els Keesom

Treant Hospitals

University of Groningen

C. Widehammar

Faculty of Medicine and Health

Maria Munoz-Novoa

Center for Bionics and Pain Research

Integrum AB

Brian E. McGuire

National University of Ireland

Paul O. Reilly

National University of Ireland

Eric Earley

Center for Bionics and Pain Research

University of Colorado Anschutz Medical Campus

Colorado School of Public Health

Chalmers, Electrical Engineering, Systems and control

Sonam Iqbal

Integrum AB

Center for Bionics and Pain Research

Morten B. Kristoffersen

University of Gothenburg

University of Groningen

Center for Bionics and Pain Research

A. Stockselius

Bräcke Diakoni

Lena Gudmundson

Bräcke Diakoni

Wendy Hill

Institute of Biomedical Engineering

Martin Diers

LWL-Universitätsklinikum der Ruhr-Universität Bochum

Kristi L. Turner

Center for Bionic Medicine

Thomas Weiss

Friedrich Schiller University Jena

Max Jair Ortiz Catalan

University of Melbourne

Center for Bionics and Pain Research

Chalmers, Electrical Engineering, Systems and control

Bionics Institute

Pain

0304-3959 (ISSN) 18726623 (eISSN)

Vol. In Press

Neural control of bionic legs

VINNOVA (2018-03235), 2018-11-26 -- 2020-10-31.

Subject Categories

Physiotherapy

General Practice

Applied Psychology

DOI

10.1097/j.pain.0000000000003384

PubMed

39250328

More information

Latest update

9/24/2024