Virtual Reality Treatment Displaying the Missing Leg Improves Phantom Limb Pain: A Small Clinical Trial

Abstract

Background Phantom limb pain (PLP) is a common and in some cases debilitating consequence of upper- or lower-limb amputation for which current treatments are inadequate. Objective This small clinical trial tested whether game-like interactions with immersive VR activities can reduce PLP in subjects with transtibial lower-limb amputation. Methods Seven participants attended 5–7 sessions in which they engaged in a visually immersive virtual reality experience that did not require leg movements (Cool! TM), followed by 10–12 sessions of targeted lower-limb VR treatment consisting of custom games requiring leg movement. In the latter condition, they controlled an avatar with 2 intact legs viewed in a head-mounted display (HTC Vive TM). A motion-tracking system mounted on the intact and residual limbs controlled the movements of both virtual extremities independently. Results All participants except one experienced a reduction of pain immediately after VR sessions, and their pre session pain levels also decreased over the course of the study. At a group level, PLP decreased by 28% after the treatment that did not include leg movements and 39.6% after the games requiring leg motions. Both treatments were successful in reducing PLP. Conclusions This VR intervention appears to be an efficacious treatment for PLP in subjects with lower-limb amputation.

Altered bodily perceptions in chronic neuropathic pain conditions and implications for treatment using immersive virtual reality

“…Ambron et al ( 2021 ) conducted a small clinical trial where seven transtibial amputees were exposed to repeated immersive VR gaming activities with a non-embodied control condition and an embodied condition that involved playing games by controlling two intact legs (see Figure 2A ). They found that six of the seven experienced a pain reduction immediately post-session, with an overall reduction over the course of repeated sessions.…”

Virtual and Augmented Reality in Management of Phantom Limb Pain: A Systematic Review

“…Only one of the studies was an RCT, and the rest were non-randomized, uncontrolled experimental studies. The sample size ranged from 7 14 to 75 15 patients. The etiologies of PLP comprised of upper limb amputation, [16][17][18][19][20][21] lower limb amputation, 14,15,20 and BPA injury.…”

“…The sample size ranged from 7 14 to 75 15 patients. The etiologies of PLP comprised of upper limb amputation, [16][17][18][19][20][21] lower limb amputation, 14,15,20 and BPA injury. 17,19,22 Three studies did not follow up with patients in time, 17,19,22 and the most extended follow-up was 6 months posttreatment.…”

A novel mixed reality system to manage phantom pain in-home: results of a pilot clinical trial

“…Phantom limb is a persistent sensation of the missing limb experienced in those who undergo amputations. This is a common event, with up to 90% of those who lose a limb experiencing phantom limb at some point (1). Moreover, between 50% and 85% of those with amputations also experience pain located at the missing limb, a condition termed phantom limb pain (PLP) (2)(3)(4)(5).…”

“…Reducing frequency and severity of PLP in these individuals can help restore their function and QOL (11). Currently, the treatments available for PLP include surgical options, non-pharmacologic therapies such as mirror therapy (MT), and pharmacologic intervention (1). However, general consensus is that most current treatment options for PLP show limited evidence of efficacy (1,(12)(13)(14)(15)(16)(17).…”