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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[1] Birnie K A,Chambers C T,Spellman C M. Mechanisms of distraction in acute pain perception and modulation[J]. Pain,2017,158(6):1012-1013. doi: 10.1097/j.pain.0000000000000913 [2] Van Ryckeghem D,Van Damme S,Eccleston C,et al. The efficacy of attentional distraction and sensory monitoring in chronic pain patients:A meta-analysis[J]. Clin Psychol Rev,2018,59(12):16-29. [3] Boerner K E,Birnie K A,Chambers C T,et al. Simple psychological interventions for reducing pain from common needle procedures in adults:Systematic review of randomized and quasi-randomized controlled trials[J]. Clin J Pain,2015,31(10):S90-98. [4] Kola S,Walsh J C,Hughes B M,et al. Attention focus,trait anxiety and pain perception in patients undergoing colposcopy[J]. Eur J Pain,2012,16(6):890-900. doi: 10.1002/j.1532-2149.2011.00068.x [5] Verhoeven K,Crombez G,Eccleston C,et al. The role of motivation in distracting attention away from pain:An experimental study[J]. Pain,2010,149(2):229-234. doi: 10.1016/j.pain.2010.01.019 [6] Indovina P,Barone D,Gallo L,et al. Virtual reality as a distraction intervention to relieve pain and distress during medical procedures:A comprehensive literature review[J]. Clin J Pain,2018,34(9):858-877. doi: 10.1097/AJP.0000000000000599 [7] Todd J,Van Ryckeghem D M L,Sharpe L,et al. Attentional bias to pain-related information:A meta-analysis of dot-probe studies[J]. Health Psychol Rev,2018,12(4):419-436. doi: 10.1080/17437199.2018.1521729 [8] Crombez G,Van Ryckeghem D M,Eccleston C,et al. Attentional bias to pain-related information:A meta-analysis[J]. Pain,2013,154(4):497-510. doi: 10.1016/j.pain.2012.11.013 [9] Van Ryckeghem D,Rost S,Kissi A,et al. Task interference and distraction efficacy in patients with fibromyalgia:An experimental investigation[J]. Pain,2018,159(6):1119-1126. doi: 10.1097/j.pain.0000000000001196 [10] Schreiber K L,Campbell C,Martel M O,et al. Distraction analgesia in chronic pain patients:The impact of catastrophizing[J]. Anesthesiology,2014,121(6):1292-1301. doi: 10.1097/ALN.0000000000000465 [11] Goubert L,Crombez G,Eccleston C,et al. Distraction from chronic pain during a pain-inducing activity is associated with greater post-activity pain[J]. Pain,2004,110(2):220-227. [12] Buck R,Morley S. A daily process design study of attentional pain control strategies in the self-management of cancer pain[J]. Eur J Pain,2006,10(5):385-398. doi: 10.1016/j.ejpain.2005.04.001 [13] Hadjistavropoulos H D,Hadjistavropoulos T,Quine A. Health anxiety moderates the effects of distraction versus attention to pain[J]. Behav Res Ther,2000,38(5):425-438. [14] Van Damme S, Crombez G. A motivational perspective on coping with pain. In: Motivational perspectives on chronic pain[M]. New York: Oxford University Press, 2018: 445–478. [15] Van Damme S,Legrain V,Vogt J,et al. Keeping pain in mind:A motivational account of attention to pain[J]. Neurosci Biobehav Rev,2010,34(3):204-213. [16] Scheffler M,Koranyi S,Meissner W,et al. Efficacy of on pharmacological interventions for procedural pain relief in adults undergoing burn wound care:A systematic review and meta-analysis of randomized controlled trials[J]. Burns,2018,44(5):1709-1720. [17] Chan E,Foster S,Sambell R,Leong P. Clinical efficacy of virtual reality for acute procedural pain management:A systematic review and meta-analysis[J]. PLoS One,2018,13(7):1301-1313. [18] Andersson G B. Epidemiological features of chronic low-back pain[J]. Lancet,1999,354(79):581-585. [19] Matheve T,Claes G,Olivieri E,Timmermans A. Timmermans A. Serious gaming to support exercise therapy for patients with chronic nonspecific low Back pain:A feasibility study[J]. Games Health J,2018,7(5):262-720. [20] Hodges P W, Van Dillen L R, McGill S M, et al. Integrated clinical approach to motor control interventions in low back and pelvic pain. In: Hodges PW, Cholewicki J, Van dieen JH, editors. Spinal control: The rehabilitation of back pain state of the art and science[M]. 1st edition. London: Churchill Livingstone, 2013: 243–309. [21] Chapman J R,Norvell D C,Hermsmeyer J T,et al. Evaluating common outcomes for measuring treatment success for chronic low back pain[J]. Spine (Phila Pa,1976),2011,36(3):S54-68. [22] Chiarotto A,Maxwell L J,Ostelo R W,et al. Measurement properties of visual analogue scale,numeric rating scale,and pain severity subscale of the brief pain inventory in patients with low back pain:A systematic review[J]. J Pain,2018,20(3):245-263. [23] Roland M,Morris R. A study of the natural history of back pain. Part I:development of a reliable and sensitive measure of disability in low-back pain[J]. Spine (Phila Pa,1976),1983,8(7):141-144. [24] Sullivan M J,Bishop F L,Pivik J. The pain catastrophizing scale:Development and validation[J]. Psychol Assess,1995,7(12):524-532. [25] Van Damme S,Crombez G,Bijttebier P,et al. A confirmatory factor analysis of the pain Catastrophizing scale:Invariant factor structure across clinical and non-clinical populations[J]. Pain,2002,96(8):319-324. [26] Vlaeyen J W,Kole-Snijders A M,Boeren R G,et al. Fear of movement/ (re)injury in chronic low back pain and its relation to behavioral performance[J]. Pain,1995,62(6):363-372. [27] Schrooten M G,Van Damme S,Crombez G,et al. Non pain goal pursuit inhibits attentional bias to pain[J]. Pain,2012,153(6):1180-1186. doi: 10.1016/j.pain.2012.01.025 [28] Van Damme S,Crombez G,Eccleston C. Disengagement from pain:The role of catastrophic thinking about pain[J]. Pain,2004,107(2):70-76. [29] Goubert L,Crombez G,Van Damme S. The role of neuroticism,pain catastrophizing and pain-related fear in vigilance to pain:A structural equations approach[J]. Pain,2004,107(5):234-241. [30] Campbell C M,Witmer K,Simango M,et al. Catastrophizing delays the analgesic effect of distraction[J]. Pain,2010,149(2):202-207. doi: 10.1016/j.pain.2009.11.012 [31] Roelofs J,Peters M L,Van der Zijden M,et al. Does fear of pain moderate the effects of sensory focusing and distraction on cold pressor pain in pain-free individuals?[J]. J Pain,2004,5(5):250-256. doi: 10.1016/j.jpain.2004.04.001 [32] Vlaeyen J,Morley S,Crombez G. The experimental analysis of the interruptive,interfering,and identity-distorting effects of chronic pain[J]. Behav Res Ther,2016,86(3):23-34. [33] Crombez G,Lauwerier E,Goubert L,et al. Goal pursuit in individuals with chronic pain:A personal project analysis[J]. Front Psychol,2016,28(7):966-972. [34] Vlaeyen J W S,Maher C G,Wiech K,et al. Low back pain[J]. Nat Rev Dis Primers,2018,4(2):52-55. [35] Mannion A F,Helbling D,Pulkovski N,et al. Spinal segmental stabilization exercises for chronic low back pain:Programme adherence and its influence on clinical outcome[J]. Eur Spine J,2009,18(12):1881-1891. doi: 10.1007/s00586-009-1093-7 [36] Palazzo C,Klinger E,Dorner V,et al. Barriers to home-based exercise program adherence with chronic low back pain:Patient expectations regarding new technologies[J]. Ann Phys Rehabil Med,2016,59(2):107-113. doi: 10.1016/j.rehab.2016.01.009 [37] Bunzli S,Smith A,Watkins R,et al. What do people who score highly on the tampa scale of kinesiophobia really believe?A mixed methods investigation in people with chronic nonspecific low back pain[J]. Clin J Pain,2015,31(7):621-632. doi: 10.1097/AJP.0000000000000143 -
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