Characteristics of Phantom Limb Pain Alleviated with Virtual Reality Rehabilitation

Michihiro Osumi; Kazunori Inomata; Yuji Inoue; Yuko Otake; Shu Morioka; Masahiko Sumitani

doi:10.1093/pm/pny269

Characteristics of Phantom Limb Pain Alleviated with Virtual Reality Rehabilitation

Pain Med. 2019 May 1;20(5):1038-1046. doi: 10.1093/pm/pny269.

Authors

Michihiro Osumi^{1

2}, Kazunori Inomata^{3

4}, Yuji Inoue⁵, Yuko Otake³, Shu Morioka^{1

2}, Masahiko Sumitani³

Affiliations

¹ Graduate School of Health Science, Kio University, Nara, Japan.
² Neurorehabilitation Research Center, Kio University, Nara, Japan.
³ Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan.
⁴ KIDS Co., Ltd.
⁵ Visualization Design Department, Power Place Inc., Tokyo, Japan.

PMID: 30576543
DOI: 10.1093/pm/pny269

Abstract

Objectives: Neurorehabilitation techniques using virtual reality (VR) systems have recently become widespread as a rehabilitation method for restoring phantom limb movement and alleviating phantom limb pain (PLP). However, analgesic effects have varied between studies, possibly because of differences in the characteristics of PLP between patients (e.g., cramping, burning, shooting). We aimed to reveal the relationship between VR effects and PLP characteristics using an exploratory factor analysis.

Methods: PLP characteristics of 19 patients were measured using the Short-Form McGill Pain Questionnaire (SF-MPQ), and all PLP patients performed the VR rehabilitation protocol for 20 minutes. During VR rehabilitation, mirror-reversed computer graphic images of an intact arm (the virtual phantom limb) were presented to patients via a head-mounted display, inducing the perception of voluntary execution of movements of their phantom limb when intending bimanual movements.

Results: VR rehabilitation significantly restored movement representation (P < 0.0001) quantified using the bimanual coupling effect and significantly alleviated PLP intensity (P < 0.0001). The factor analysis revealed that PLP characteristics could be divided into two factors: "somatosensory-related pain characteristics" and "kinesthesia-related pain characteristics." PLP alleviation via VR rehabilitation was significantly correlated with "kinesthesia-related pain characteristics" (r = 0.47, P = 0.02) but not "somatosensory-related pain characteristics" (r = 0.22, P = 0.17).

Conclusions: The current findings indicate that VR rehabilitation may be particularly effective for PLP associated with distorted phantom limb movement and body representations (e.g., clamping, gnawing), compared with typical neuropathic sensations (e.g., shooting, burning, dysesthesia).

Keywords: Factor Analysis; Neurorehabilitation; Pain Characteristics; Phantom Limb Pain; Virtual Reality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Female
Humans
Illusions / physiology
Kinesthesis / physiology
Male
Middle Aged
Neuralgia / etiology
Neurological Rehabilitation
Phantom Limb / rehabilitation*
Virtual Reality Exposure Therapy / methods*