The Clinical journal of pain
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To evaluate the effect of combining pain education and virtual reality (VR) exposure therapy using a cognitive-behavioral therapy-informed approach (virtual reality-based cognitive behavioral therapy [VR-CBT]) on pain intensity, fear of movement, and trunk movement in individuals with persistent low back pain. ⋯ A VR-CBT intervention improved pain, pain-related fear of movement, and trunk kinematics. Further research should explore increased VR-CBT dosage and mechanisms underlying improvement.
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Acute orthopedic traumatic musculoskeletal injuries are prevalent, costly, and often lead to persistent pain and functional limitations. Psychological risk factors (pain catastrophizing and anxiety) exacerbate these outcomes but are often overlooked in acute orthopedic care. Addressing gaps in current treatment approaches, this mixed methods pilot study explored the use of a therapeutic virtual reality (VR; RelieVRx), integrating mindfulness and cognitive behavioral therapy, for pain self-management at home following orthopedic injury. ⋯ The results support a larger randomized clinical trial of RelieVRx versus a sham placebo control to replicate the findings and explore mechanisms. There is potential for self-guided VR to promote evidence-based pain management strategies and address the critical mental health care gap for patients following acute orthopedic injuries.
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Available treatment for chronic neuropathic pain is still limited, and the effect is modest. Thus, clinicians aim to improve activity and quality of life despite pain. The objective monitoring of activity is attracting attention in chronic pain assessments. Therefore, we objectively evaluated daytime activity and sleep in patients with post-herpetic neuralgia, using actigraphy to determine risk factors for decreased activity. ⋯ The discrepancy between the subjective and objective scores in this study may be due to 1) features of post-herpetic neuralgia, an archetype of peripheral neuropathic pain affecting no motor nerves, 2) actigraph measurement limitations regarding the sedentary life of the elderly, or 3) activity misperception, a new proposition explaining the discrepancy between subjective and objective measures of activity, similar to the sleep state misperception. In patients with post-herpetic neuralgia, high pain intensity may be reported in those with highly maintained activity, in which treatment must be selected cautiously to prevent interruption of their physical abilities.