Using Visual Feedback Manipulation in Virtual Reality to Influence Pain‐Free Range of Motion in People with Nonspecific Neck Pain

Abstract

Background Based on associative learning theories it is hypothesized that pain might be a conditioned response. In people with musculoskeletal pain, the occurrence of movement‐induced pain might be a protective response, influenced by visual cues suggesting that the person is approaching a painful position. This study aimed to determine (1) whether the pain‐free range of motion (ROM) increased and decreased when visual feedback understated or overstated true rotation in people with neck pain and (2) whether this effect was more pronounced if pain was chronic. Method People with subacute and chronic nonspecific neck pain wore a VR‐headset and rotated their head to the left and right until the onset of pain. Visual feedback about the amount of movement was either equal, 20% less, or 20% greater than their actual rotation. Maximal pain‐free ROM was measured using the VR‐headset sensors. Data were analyzed using a mixed‐design ANOVA. Results There was no effect of visual feedback manipulation on pain‐free ROM (P = 0.13) and no interaction effect between the visual feedback condition and duration of pain (P = 0.86). Discussion The inability to influence pain‐free ROM by manipulating visual feedback in people with subacute or chronic neck pain does not support associative learning theories for the perception of neck pain.

Virtual Reality in Fibromyalgia: Does Altering Visual Feedback Impact on Pain and Movement During Reaching?

“…However, recently published work makes it less clear whether altering VF has an impact on pain. For instance, results from Harvie et al were not replicated in a multicenter study undergone with a larger sample (Kragting et al, 2020). Moreover, recent systematic review (Heinrich et al, 2020) and meta-analysis (Wittkopf et al, 2018) put in light mitigated results obtained from studies altering the size of painful body parts in the treatment of chronic pain populations.…”

“…A recent study shows that altering VF to create the perception of smaller movement amplitude in people with chronic neck pain increases actual movement amplitude despite the fact that some participants did not notice the mismatch between the actual and the displayed movement (Chen et al, 2017). Moreover, manipulating the perceived neck rotation via a head-mounted display influenced the onset of pain (Harvie et al, 2015), although there is mitigated evidence on this matter (Kragting et al, 2020). Thus, a VR intervention based on altered VF for people with FM could potentially promote greater movement amplitude and alleviate pain intensity, as participants would perform greater movements without necessarily noticing it.…”

Visual feedback manipulation in virtual reality to influence pain-free range of motion. Are people with non-specific neck pain who are fearful of movement more susceptible?

“…However, participant selection in that study (N = 24) was not based on the presence of fear, the gain change was 20% and the influence of fear was not studied. Another study in a larger sample (N = 75) of people with neck pain, that used a similar design and gain conditions of 0.8 and 1.2, found a small effect of visual feedback manipulation on cervical pain-free range of motion (p = 0.133, ղ p 2 = 0.031) [ 7 ]. The role of fear was also not investigated in that study.…”

“…The total range of motion (i.e., from maximal left rotation to maximal right rotation) for each repetition was measured in degrees using the sensors of the VR-headset which was connected to a computer running Windows 10 (Microsoft Corporation, Redmond, WA, USA). This method of data acquisition and its validation has been described in detail in a previous publication [ 7 ]. Subsequently, the average range of motion of six repetitions was calculated for each gain condition (i.e., absolute data).…”

“…However, a large variability between participants existed regarding the size of the effect of visual feedback manipulation on changes in pain-free range of motion [ 6 ]. Another study using a similar methodology [ 2 ] did not find an effect of visual feedback manipulation on cervical pain-free range of motion in a larger group of people with non-specific neck pain [ 7 ]). Hence, further research into the role of visual stimuli on pain perception is needed.…”