A Therapeutic Matrix: Virtual Reality as a Clinical Tool for Spinal Cord Injury-Induced Neuropathic Pain

Abstract

Neuropathic pain (NP) is a chronic, debilitating, and resistant form of pain. The onset rate of NP following spinal cord injuries (SCI) is high and may reduce the quality of life more than the sensorimotor loss itself. The long-term ineffectiveness of current treatments in managing symptoms and counteracting maladaptive plasticity highlights the need to find alternative therapeutic approaches. Virtual reality (VR) is possibly the best way to administer the specific illusory or reality-like experience and promote behavioral responses that may be effective in mitigating the effects of long-established NP. This approach aims to promote a more systematic adoption of VR-related techniques in pain research and management procedures, highlighting the encouraging preliminary results in SCI. We suggest that the multisensory modulation of the sense of agency and ownership by residual body signals may produce positive responses in cases of brain-body disconnection. First, we focus on the transversal role embodiment and how multisensory and environmental or artificial stimuli modulate illusory sensations of bodily presence and ownership. Then, we present a brief overview of the use of VR in healthcare and pain management. Finally, we discus research experiences which used VR in patients with SCI to treating NP, including the most recent combinations of VR with further stimulation techniques.

Rethinking the Body in the Brain after Spinal Cord Injury

“…Importantly, the mechanisms underlying SCI are multifactorial, and changes to a patient's temporal dynamics and experiences as well as spinal and supraspinal modifications may be the main drivers of neuroplasticity in the sensorimotor centers [11,12]. Furthermore, reorganization of the neural system appears to represent a response to body pain [83][84][85]. The approach proposed in this paper offers new insight for the body rehabilitation and the use of assistive devices [84,[86][87][88].…”

Exoskeletons for Mobility after Spinal Cord Injury: A Personalized Embodied Approach

“…SCIs include the development of chronic and neuropathic pain (from 26% to 96% individuals) [ 31 ] that is notoriously difficult to treat [ 32 , 33 ]. Although various treatments are available (such as drugs and physical and psychological therapies), pain is refractory in a significant proportion of people with SCIs (from 5 to 37%) [ 31 ].…”

Future Treatment of Neuropathic Pain in Spinal Cord Injury: The Challenges of Nanomedicine, Supplements or Opportunities?

“…In addition to tactile signals, other signals could also serve as mediators (interoceptive) [ 156 , 157 ]. Body signals may be transmitted via robotic prostheses [ 156 , 158 ] or virtual reality [ 159 , 160 , 161 , 162 , 163 ] in order to prevent maladaptive cortical reorganization and to alleviate pain [ 164 ]. Therefore, therapeutic approaches for any person with SCI should start in the short term after injury.…”