Embodiment in Virtual Reality for Treatment of Chronic Pain: A Feasibility Study (Preprint)

BACKGROUND Chronic pain has long been a major health burden that has been addressed through numerous forms of pharmacological and non-pharmacological treatment. One of the tenets of modern medicine is to minimize risk while providing efficacy. Because of its non-invasive nature, Virtual Reality provides an attractive platform for potentially developing novel therapeutic modalities. OBJECTIVE We describe a feasibility study that use embodiment in virtual reality as a treatment for chronic pain. The purpose of this study was to determine the feasibility of a novel virtual reality-based digital therapeutic for the treatment of chronic pain. METHODS An open label study assessed the feasibility of using virtual embodiment in virtual reality to treat chronic pain (Clinicaltrials.gov Identifier: NCT04060875). Twenty-four chronic pain patients were recruited from local pain clinics and completed eight session of a novel digital therapeutic that combines virtual embodiment with graded motor imagery to deliver functional rehabilitation exercises over the course of four weeks. Pain intensity as measured by a visual analog scale before and after each virtual embodiment training session was used as a primary outcome measure. Additionally, a battery of patient reported pain questionnaires (Fear and Avoidance Beliefs Questionnaire, OSWESTRY, Pain Catastrophizing Scale, and Patient Health Questionnaire) were administered before and after eight sessions of virtual embodiment training as exploratory outcome measures to get an indication if the measures are appropriate and warrant a larger randomized controlled trial. RESULTS A two-way ANOVA on session x pre vs. post Virtual embodiment training revealed that individual virtual embodiment training sessions significantly reduced the intensity of pain as measured by visual analog scale. Perceived disability due to lower back pain as measured by OSWESTRY significantly improved over the four-week course of virtual embodiment regimen. Improvement was also observed on the helplessness subscale of the Pain Catastrophizing Scale. CONCLUSIONS This study provide evidence that functional rehabilitation exercises delivered in virtual reality are safe and may have positive effects on alleviating the symptoms of chronic pain. These results support the justification for a larger randomized controlled trial to assess the extent to which virtual embodiment training can exert an effect on symptoms associated with chronic pain. CLINICALTRIAL Clinicaltrials.gov Identifier: NCT04060875

Gait Characteristics Based on Pain Detect Questionnaire and Pain Catastrophizing Scale in Patients with Knee Osteoarthritis

Background Although patient-reported evaluation of knee osteoarthritis has been more common, little attention has been paid to the relationship between patient-reported questionnaire and gait analysis. The purpose was to investigate the relationship between patient-reported questionnaire and gait parameters. Methods A total of 31 knees in 31 patients (22 females and 9 males) who were diagnosed as end-stage medial compartmental knee osteoarthritis participated in the present study. All the patients were evaluated based on New Knee Society Score, pain detect questionnaire and pain catastrophizing scale. They were divided into two categories based on pain detect questionnaire scores: Group Low (12 ≥ score) and Group High (score > 12). Gait analysis was performed using three-dimensional motion analysis system. Statistical analysis was done using one-tailed Mann-Whitney U-test to compare age, body mass index, Knee Society Score, pain catastrophizing scale, and gait parameters between groups. Results Twenty-six patients were allocated to Group Low, and five patients were to Group High. Subjective pain during walking was significantly worse in Group Low (P = 0.037) and helplessness in pain catastrophizing scale was notably worse in Group High (P = 0.035). Peak vertical ground reaction force (P = 0.018) and knee adduction moment (P < 0.01) were significantly greater in Group Low. Moreover, flexion-extension excursion during mid-stance phase was significantly smaller in Group Low (P = 0.038). Conclusions Patients with likely neuropathic pain had atypical osteoarthritis-related pain as well as atypical gait pattern, compared to patients without neuropathic pain.

Krónikus gerincfájdalommal élő személyek életminőségét befolyásoló kognitív tényezők

Bevezetés A krónikus gerincfájdalom a második leggyakrabban előforduló betegség a krónikus betegségek listáján. Az állapottal való együttélés során a biológiai tényezők mellett kiemelt szerepet kapnak a pszichológiai tényezők is, amik alakíthatják a betegséghez való alkalmazkodás sikerességét. Vizsgálatunkban krónikus gerincfájdalommal élő személyek körében vizsgáltuk a mindfulness, a fájdalom katasztrofizáció és a félelem-elkerülési hiedelmek egészségi állapottal kapcsolatos életminőségre gyakorolt hatását. Módszertan Keresztmetszeti, kvantitatív kutatásunkban krónikus gerincfájdalommal élő személyek vettek részt, akik a közösségi médiában található specifikus csoportokból kerültek ki (n=65; férfi=10; nő=55; életkorátlag=49,2). A kutatásunkban a Mindful Attention Awareness Scale - MAAS, Pain Catastrophizing Scale - PCS, Fear and Avoidance Belief Questionnaire - FABQ-H és a Short Form Health Survey - SF-36 standardizált kérdőíveket alkalmaztuk. Hipotéziseink vizsgálata kapcsán Pearson korrelációanalízist és többszörös lineáris regresszió elemzést végeztünk. Eredmények A megkérdezettek körében a mindfulness, a fájdalom katasztrofizáció és a félelem-elkerülési hiedelmek között szignifikáns kapcsolatot találtunk. Az alacsonyabb fokú mindfulness magasabb fájdalom katasztrofizációval és félelem-elkerülési hiedelmekkel járt együtt, viszont pozitív kapcsolatot mutatott az életminőséggel. Az adatokat tovább vizsgálva azt az eredményt kaptuk, hogy az egészségi állapottal kapcsolatos rosszabb életminőséget az mindfulness kisebb mértéke, a magasabb fokú fájdalom katasztrofizáció és félelem-elkerülési hiedelmek jósolják be legerőteljesebben. Következtetések Eredményeink alapján elmondható, hogy a krónikus gerincfájdalommal élők egészségi állapottal kapcsolatos életminőségét az alacsonyabb fokú mindfulness, a magasabb fokú fájdalom katasztrofizáció és félelem-elkerülési hiedelmek negatívan befolyásolják. Eredményeink azonban aláhúzzák ezen pszichológiai tényezőknek a betegek életében betöltött szerepét, aminek kapcsán egy olyan multidiszciplináris kezelés fontosságát hangsúlyozzuk, amelyben a fizikai tünetek mellett a pszichológiai tényezők is kiemelt szerepet kapnak a magasabb hatásfokú egészségkimenet elérése érdekében.

Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia

Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.

Do Parental Pain Knowledge, Catastrophizing, and Hypervigilance Improve Following Pain Neuroscience Education in Healthy Children?

Pediatric chronic pain is a challenging problem for children and their families, although it is still under-recognized and under-treated. The aim of this study was to investigate whether a pain neuroscience education program for children (PNE4Kids) delivered to healthy children aged 8 to 12 years old and attended by their parents would result in improved parental knowledge about pain neurophysiology, decreased parental pain catastrophizing about their own pain and their children’s, decreased parental pain vigilance and awareness, and decreased fear of pain in children. Twenty-seven healthy child–parent dyads received a 45 min PNE4Kids session. Demographic data were collected, and the Neurophysiology of Pain Questionnaire (NPQ), Fear of Pain Questionnaire—Parent Proxy Report (FOPQ-P), Pain Catastrophizing Scale (PCS), Pain Catastrophizing Scale for Parents (PCS-P), and the Pain Vigilance and Awareness Questionnaire (PVAQ) were completed by the parents before and after the PNE4Kids session. Twenty-six dyads completed study participation. In response to the PNE4Kids session, significant short-term (1 week) improvements were shown in the NPQ (p < 0.001) and the FOPQ-P (p = 0.002). Parents’ level of pain knowledge and children’s fear of pain, reported by their parents, improved after a 45 min PNE4Kids session. Thus, PNE4Kids should likewise be further investigated in healthy child–parent dyads as it might be useful to target parental and children’s pain cognitions at a young age.

Pain catastrophizing in Flamenco dance students at professional dance conservatories

Introduction: Flamenco is marked by the deep emotional impression it creates and its percussive footwork steps, performed in traditional high-heeled shoes. It places high demands on the dancer which leads to risks of injury, pain and associated emotional repercussions. Catastrophizing is a key factor determining how the context is valued and pain is experienced. The objectives of this study were: firstly, to analyse the general incidence of catastrophizing among flamenco students and secondly, to determine the repercussion this has on catastrophizing in professional practice among dancers who perform on stage even though they are still students. Material and method: The sample analyses 70 students from the Conservatorios Profesionales de Danza de Andalucía (Andalusian Professional Conservatoires for Dance) (17.67±5.65 years old); 44.29% (n=31) also danced professionally. The dancers completed the Pain Catastrophizing Scale (PCS). Results: The results do not show significant differences in categories: rumination, magnification, nor in the overall catastrophizing of pain when comparing participants who were dance students with those who also danced professionally. However, in terms of helplessness, there is a significant difference between both groups, with those who danced both as students and professionals displaying higher levels of helplessness than those who were only students. Conclusions: The artistic professional development on stage before spectators can trigger anxiety states that can have a directly proportional association to the levels of catastrophism. Perhaps being a student at the same time as dancing professionally signifies a greater physical and mental load which can lead to certain psychological processes.

Cross-cultural adaptation of the Pain Catastrophizing Scale in Greek clinical population

Background: Catastrophizing is an important psychological construct in mediating the behavioral response toward pain. Objective: The purpose of this study is to examine the psychometric properties of the Pain Catastrophizing Scale (PCS) in Greek clinical population. Methods: The scale was administered in 376 patients with chronic cervical and lumbar pain. Test–retest reliability, internal consistency (Cronbach [Formula: see text]) and concurrent validity were assessed. Exploratory (EFA) and Confirmatory Factor Analysis (CFA) were used to test the factorial validity of the hypothesized three factor structure. Results: The PCS factors suggested high levels of test–retest reliability, whereas Cronbachs’ [Formula: see text] values were acceptable. The EFA yielded a three-factor solution and indicated a marginal fit to the data. CFA procedures indicated a rather acceptable fit to the data. The concurrent validity of the instrument was confirmed. Conclusion: PCS seems to be a reliable and valid instrument in Greek patients with chronic cervical and lumbar pain.