Extended reality used in the treatment of phantom limb pain: a multicenter, double-blind, randomized controlled trial
Journal article, 2025
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.
Rehabilitation
Virtual reality exposure therapy
Phantom limb
Pain management
Augmented reality
Pain
Amputation
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
Institute for Rehabilitation Ljubljana
University of Ljubljana
Els Keesom
University of Groningen
Treant Hospitals
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
University of Colorado Anschutz Medical Campus
Chalmers, Electrical Engineering, Systems and control
Center for Bionics and Pain Research
Colorado School of Public Health
Sonam Iqbal
Integrum AB
Center for Bionics and Pain Research
Morten B. Kristoffersen
University of Gothenburg
Center for Bionics and Pain Research
University of Groningen
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. 166 3 571-586Neural control of bionic legs
VINNOVA (2018-03235), 2018-11-26 -- 2020-10-31.
Subject Categories (SSIF 2011)
Physiotherapy
General Practice
Applied Psychology
DOI
10.1097/j.pain.0000000000003384
PubMed
39250328