Virtual Walking for Neuropathic Pain in Spinal Cord Injury
Condition: Spinal Cord Injury; Neuropathic Pain
MeSH terms: Spinal Cord Injuries; Neuralgia; Wounds and Injuries
Study type: Interventional

Summary: 
      Spinal cord injury neuropathic pain (SCI-NP) is a common problem, and when severe, is one of
      the most problematic of secondary conditions that is minimally to modestly responsive to
      currently available treatments. It is usually described as burning or stabbing, and is
      located at or below the level at which their sensation changes from normal to impaired;
      persons with no feeling at all in their legs for example can experience pain in the legs. The
      purpose of this project is to further investigate the use of a novel visual stimulation
      treatment; a technique that has shown benefit in other populations with chronic pain
      secondary to deafferentation. To accomplish this, a novel treatment - virtual reality (VR)
      walking - will be examined. Should this treatment show benefit, a portable, accessible means
      of treatment will be available for persons with SCI and for whom transportation to health
      care providers is often difficult.
    

Detailed description: 
      This treatment will be investigated in two-phase project:

      Phase 1: Determine the efficacy of VR treatments as a home-based approach and determine the
      effect of VR treatment on reversal of maladaptive cortical reorganization associated with
      SCI-NP, as has been shown in other populations with neuropathic pain secondary to
      deafferentation.

      Phase 2: Determine the effectiveness and immediate analgesic effect of VR treatment among
      persons with both tetraplegia and paraplegia.

      The primary outcome variable of this research is the severity of SCI-NP with a secondary
      outcome of level of pain interference with daily activities.

      In the phantom pain literature for persons with amputations, treatment paradigms based on
      visual stimulation, called mirror therapies, have proven helpful. These approaches involve
      the person viewing a mirror image of their intact limb to produce the visual illusion of a
      return of the missing limb, often with a marked reduction in pain following. Investigations
      have demonstrated that such approaches reduce pain in some individuals and that this change
      is associated with reversal of the functional reorganization in the somatosensory cortex.
      There has been one study of neuropathic pain in SCI that demonstrated good neuropathic pain
      relief with a mirror image of the upper half of the individual with SCI with the lower half
      of their body represented by a rear projection screen generated image of walking legs. We
      have collaborated with this author, and developed and pilot tested a virtual walking DVD that
      is presented via virtual reality goggles to enhance the first person sense of immersion.
      Results were sufficiently encouraging to cause us to seek funding for current, broader
      project
    

Intervention name(s): Virtual walking; Wheeling tape
Intervention type(s): Behavioral; Behavioral
Intervention description(s): As in mirror therapy for amputee phantom pain, there is evidence that neuropathic SCI pain responds to images of the person with SCI's legs "walking"; we achieve this via a virtual reality approach where the subject perceives it is his/her legs walking.; This control condition mirrors the experimental condition in all respects except it shows still legs in a wheelchair traversing the same path as the virtual walking condition
Other intervention name(s): A video of a person's legs in a wheelchair traversing a path
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: spinal cord injury; neuropathic pain