Neural Mechanisms of Immersive Virtual Reality in Chronic Pain

沉浸式虚拟现实治疗慢性疼痛的神经机制

基本信息

批准号：
10455010
负责人：
Luana Colloca
金额：
$ 63.83万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-01 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10455010
关键词：
Absence of pain sensation Acute Adjuvant Affect Anxiety Behavioral Mechanisms COVID-19 COVID-19 pandemic Categories Chronic Clinical Cognitive Collaborations Consensus Controlled Environment Devices Ecological momentary assessment Electroencephalography Esthetics Frequencies Future Generations Goals Health Personnel Immersion Individual Intervention Maryland Measurement Measures Methods Modeling Monitor Moods Naloxone Normalcy Opioid Orofacial Pain Outcome Pain Pain Measurement Pain Threshold Pain management Participant Patients Pattern Pharmacology Phenotype Placebo Effect Placebos Population Proxy Recording of previous events Research Research Personnel Resolution Rest Risk Role Schools Shapes Site Stimulus System Techniques Technology Telemedicine Temporomandibular Joint Disorders Therapeutic Time Universities antagonist associated symptom base biobehavior chronic pain chronic pain patient cohort design disability endogenous opioids evidence base experience information processing innovation intervention cost knowledge of results mu opioid receptors multisensory neural information processing neuromechanism novel opioid epidemic pain outcome pain reduction placebo analgesia predict clinical outcome prospective relating to nervous system responders and non-responders response standard of care virtual reality virtual reality environment virtual reality intervention

项目摘要

Summary The COVID-19 pandemic and its effect on the opioid crisis have created a pressing need for telemedicine and consideration for use of non-pharmacological, low cost interventions as adjuvants in pain management arsenal. We propose a project investigating neural mechanisms underlying pain reduction induced by immersive Virtual Reality (VR). VR consists of immersion in artificial environments through the use of real-time rendering technologies and latest generation devices. We have recently demonstrated that VR increases pain tolerance limits and vagal activity with a parallel improvement in individual pain unpleasantness, mood, and situational anxiety. To enhance the translatability of this project, we will directly dive into the neural mechanisms of VR in chronic pain participants suffering from Temporomandibular Disorder(s) (TMD), a population with which the PI and her collaborators have had fruitful results. The overarching goal is to investigate the pain modulation mechanisms underlying VR-induced hypoalgesia by determining 1) the involvement of endogenous mu opioids, 2) the relationship between responsiveness to acute VR and long-term pain-related outcomes, and 3) the changes in cortical excitability related to 3-week VR. We will use three main approaches: 1) a pharmacological antagonist approach, 2) An ecological momentary assessment (EMA) for tracking dynamics of pain outcomes over 6 months; and 3) a high-resolution electroencephalography to measure synchronization of peak alpha frequency (PAF). We will disentangle the mechanisms of VR-induced hypoalgesia from placebo effects among participants with distinct disabilities and grades of TMD. We expect that 1) VR, similar to placebo effects, will reduce pain through the engagement of endogenous opioid systems, 2) VR-induced pain modulation capability will result in better long-term pain outcomes, and 3) 3-week VR will favor a synchronization of PAF oscillations paralleled by individual VR therapeutic benefits. This project will combine pharmacologic, the EMA, and electroencephalographic techniques employed within TMD patients to maximize the translational value of the resulting knowledge. The team has a history of successful collaboration and the expertise to generate innovative, relevant, and timely findings. The successful completion of this research will generate mechanistic-based evidence for the potential application of VR-based interventions which might empower TMD patients with new, accessible, and affordable therapeutic solutions.

概括 COVID-19 大流行及其对阿片类药物危机的影响迫切需要远程医疗和考虑使用非药物、低成本干预措施作为疼痛管理手段的辅助剂。我们提出了一个项目，研究沉浸式虚拟疗法减轻疼痛的神经机制现实（VR）。 VR 包括通过使用实时渲染沉浸在人工环境中技术和最新一代设备。我们最近证明 VR 可以提高疼痛耐受力限制和迷走神经活动，同时改善个人疼痛、不愉快、情绪和情境焦虑。为了增强这个项目的可翻译性，我们将直接深入研究 VR 的神经机制患有颞下颌关节紊乱病 (TMD) 的慢性疼痛参与者，这是 PI 所针对的人群和她的合作者取得了丰硕的成果。总体目标是研究疼痛调节通过确定 1) 内源性 mu 阿片类药物的参与，了解 VR 引起的痛觉减退的机制， 2) 对急性 VR 的反应与长期疼痛相关结果之间的关系，以及 3) 与 3 周 VR 相关的皮质兴奋性变化。我们将使用三种主要方法：1）药理学拮抗剂方法，2) 用于跟踪疼痛结果动态的生态瞬时评估 (EMA) 超过6个月； 3) 高分辨率脑电图测量峰值 α 的同步频率（PAF）。我们将把 VR 引起的痛觉减退的机制与安慰剂效应分开具有明显残疾和 TMD 等级的参与者。我们预计 1) VR，类似于安慰剂效应，将通过内源性阿片类药物系统的参与减轻疼痛，2) VR 诱导的疼痛调节能力将带来更好的长期疼痛结果，并且 3) 3 周 VR 将有利于 PAF 振荡的同步与个人 VR 治疗效果并行。该项目将结合药理学、EMA 和 TMD 患者采用脑电图技术，最大限度地提高 TMD 的转化价值由此产生的知识。该团队拥有成功合作的历史和产生创新、相关且及时的发现。这项研究的成功完成将产生基于机械的基于 VR 的干预措施的潜在应用证据可能使 TMD 患者能够获得新的、可获得且负担得起的治疗解决方案。