Virtual Reality Distraction Induces Hypoalgesia in Patients with Chronic Nonspecific Low Back Pain
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摘要:
目的 探讨一种沉浸式虚拟现实游戏是否减少慢性非特异性腰背痛并帮助患者恢复健康。 方法 在这项随机对照试验中，实验组（n = 40）的慢性非特异性腰背痛患者在沉浸式虚拟现实游戏中进行一段时间锻炼，对照组（n = 40）在非虚拟现实游戏的情况下进行了相同的锻炼。探讨虚拟现实分散注意力在锻炼期间和之后是否具有镇痛作用，进一步研究疼痛恐惧、灾难性疼痛和初始疼痛强度是否削弱虚拟现实的镇痛效果。 结果 重复测量方差分析结果表明，实验组组间疼痛强度为主效应，时间和疼痛强度有交互作用，在练习中思考疼痛的时间明显少于对照组[实验组(32.26±12.32)；对照组(51.21±17.18)；t80 = 5.80，P < 0.001]，在运动期间（Cohen’s d = 0.86）和运动后（Cohen’s d = 0.46）均有镇痛作用。方差分析结果显示疼痛恐惧，灾难性疼痛和初始疼痛强度均存在主效应，但对思考时间没有交互作用（所有P < 0.05），认为不影响虚拟现实分散注意力的镇痛效果。 结论 虚拟现实分散注意力诱导痛觉减退有成效。表明沉浸式虚拟现实游戏可以用于慢性非特异性腰痛患者在锻炼过程中的疼痛缓解，帮助患者恢复健康。 Abstract:Purpose To investigate whether a virtual reality game can reduce the chronic nonspecific low back pain and help patients recover. Methods In this randomized controlled trial, the patients with the chronic nonspecific low back pain were taken as the experimental group （n = 40） and underwent a period of exercise in an immersive virtual reality game, while those performed the same exercises without VR games were taken as the control group （n = 40） so as to investigate whether VR distraction had a hypoalgesia effect during and immediately after the exercises, and whether it reduced the time spent thinking of pain during the exercises. Thereafter, we further explored whether pain-related fear, pain catastrophizing and baseline pain intensity moderated the effects of VR distraction. Results The results of repeated measures analysis of variance showed that the pain intensity among the patients of the experimental group was the main effect, and time and pain intensity had an interactive effect. The time to think about pain during the exercise was significantly less than that of the control group （Experimental group M = 32.26, SD = 12.32; Control group M = 51.21, SD = 17.18; t80 = 5.80, P < 0.0001）, both had an analgesic effect during the exercise （Cohen’s d = 0.86） and after the exercise （Cohen’s d = 0.46）. The results of analysis of variance showed that fear of pain, catastrophic pain, and initial pain intensity all have the main effects, but there was no interaction on thinking time （all p values > 0.05）, and it was believed that it did not affect the distracting analgesic effect of virtual reality. Conclusion Virtual reality is effective in distracting attention and inducing pain reduction and it indicates that immersive virtual reality games can be used to relieve the pain of patients with chronic non-specific low back pain during the exercise and help them recover their health. -
Key words:
- Virtual reality /
- Distraction /
- Nonspecific low back pain /
- Immersive
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表 1 参与者人口学特征（
$\bar x \pm s $ ）Table 1. Characteristics of participants in each group （
$\bar x \pm s $ ）项目 对照组（n = 40） VR组（n = 40） t P 性别（男/女） 30/10 28/12 年龄（年） 34 ± 12.1 32 ± 14.4 0.36 0.62 BMI（kg/m2） 24.9 ± 4.0 25.3 ± 4.6 0.74 0.55 病史（月） 6.3 ± 2.1 7 ± 1.2 0.89 0.53 初始疼痛值 5.5 ± 2 5.0 ± 1 0.44 0.51 RMDQ（0-24） 15 ± 1 16 ± 2 0.67 0.80 TSK（0-44） 31 ± 11 30 ± 10 0.28 0.15 PCS（0-52） 24 ± 18 28 ± 17 1.03 0.08 分类变量用数字表示，连续变量用均值（SD）表示。 
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表 2 初始疼痛值与练习期间/后疼痛强度值的差异变化
Table 2. Raw values for pain intensity and for the differences with baseline
分组 初始疼痛值 练习期间疼痛值 练习后疼痛值 M SD M SD 与初始值的差异 M SD 与初始值的差异 对照组 4.73 0.93 4.13 0.12 0.47 0.46～0.51 3.4 0.16 1.32 1.3～1.4 VR组 4.76 0.94 3.15 0.89 2.28 2.21～2.3 2.5 0.11 1.9 2.0～2.1 初始值的差异计算：初始疼痛强度-练习期间/后的疼痛强度。因此，一个正值表明，相对于初始强度，练习期间/后疼痛强度降低。95%CI = 95%置信区间，M = 均值，SD = 标准差，VR = 虚拟现实。
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