Title: Virtually painless? Steps towards mechanism-driven use of immersive virtual reality for chronic pain.
Funder: The Academy of Medical Sciences

Abstract: Virtual reality (VR) is an emerging digital therapeutic which has the potential to make a step change in the psychological management of chronic pain. Promising effects have been seen in both experimental and clinical pain states, however further mechanism-driven research is still required in order to help optimise therapeutic efficacy in chronic pain patients. The aim of this proposal is to investigate the relationships between descending pain control and VR-induced effects on the development of secondary hyperalgesia in a human surrogate model of central sensitisation. Using a within-subject design, I will measure temporal influences of an immersive 360⁰ 3-dimensional VR experience during the progression of secondary hyperalgesia alongside perceptual and neural correlates of descending pain control. Specifically, the objectives are: 1) Investigate the effects of VR exposure during the induction of central sensitisation on the subsequent development of secondary hyperalgesia. 2) Examine the relationship between conditioned pain modulation scores and VR-induced effects on secondary hyperalgesia. 3) Examine the relationship between the strength of functional connectivity between the medial prefrontal cortex and periaqueductal grey and VR-induced effects on secondary hyperalgesia. This multimodal approach to help better understand the top-down mechanisms associated with immersive VR therapy. Critically, this project will highlight the potential of psychophysical and neuroimaging techniques to be used as part of future phenotype stratified trials with VR in chronic pain patients with deficient descending pain control.

Lay abstract: There are around 28 million people living with chronic pain in the UK and over half of these patients are unsatisfied with their pain relief via traditional therapies. This is likely due to these therapies being used in an attempt to treat chronic pain symptoms and not the underlying cause of the pain. A common underlying cause of chronic pain involves a reduced ability to naturally suppress pain in the brain and spine via a descending pain modulation system. Patients often respond differently to therapies based on how active their descending pain modulation system is. We think that the same could be true for virtual reality (VR), however more research is required. VR is emerging as a new way to tackle chronic pain by changing the way the brain responds to pain. Through our previous research, we believe that this might involve an interaction with the descending pain modulation system. To explore this further, we aim to take measurements of pain behaviours alongside MRI scans of the brain to assess the descending pain modulation system in healthy participants. We will then see whether this natural ability to suppress pain can explain how well VR works to reduce types of pain typically seen in chronic pain patients. We anticipate that these findings will help us to understand how VR can best be used in groups of patients with reduced activity in their descending pain modulation system.

Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: NEUROLOGICAL