Identifying Virtual Reality Analgesia Mechanisms by Pharmacologic Manipulation

通过药理操作识别虚拟现实镇痛机制

• 批准号: 8467698
• 负责人: SAM R SHARAR
• 金额: $ 35.95万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8467698
• 关键词: Absence of pain sensation; Acute; Acute Pain; Address; Adverse effects; Affect; Affective; Age; Agonist; Amygdaloid structure; Analgesics; Anesthetics; Anterior; Anxiety; Attention; Blood Pressure; Brain; Brain imaging; Brain region; Clinical; Cognitive; Diagnostic; Dose; Emotions; Ethnic Origin; Event; Foundations; Frequencies; Functional Magnetic Resonance Imaging; Future; Goals; Health Personnel; Heart Rate; Insula of Reil; Investigation; Ketamine; Laboratories; Measurement; Measures; Mediating; Medical; Modeling; Moods; N-Methyl-D-Aspartate Receptors; N-Methylaspartate; Naloxone; Neuraxis; Opioid; Opioid Analgesics; Opioid Receptor; Pain; Pain Measurement; Pain Research; Pain management; Pathway interactions; Patients; Perception; Pharmaceutical Preparations; Pharmacotherapy; Procedures; Regimen; Reporting; Research; Research Design; Risk; Series; Sex Functioning; Somatosensory Cortex; Structure; System; Techniques; Testing; Thalamic structure; Therapeutic; Time; Translating; Variant; Work; abstracting; biobehavior; cingulate cortex; clinical application; clinically relevant; comparative; cost effective; design; effective therapy; endogenous opioids; experience; healthy volunteer; improved; insight; interest; meetings; midbrain central gray substance; neuroimaging; non-drug; primary outcome; psychologic; response; secondary outcome; sedative; tool; virtual; virtual reality

6. Project Summary/Abstract This proposal addresses the research objectives identified in PA-07-282 (Mechanisms, Models, Measurement, and Management in Pain Research) and specifically targets the topics of Biobehavioral Pain, Pain Management, and Translational Pain Research. We propose a series of studies in the laboratory pain setting (thermal and/or electrical pain in healthy volunteers) designed to test three specific and related hypotheses exploring the neurophysiologic mechanisms that underlie immersive Virtual Reality (VR) as a non- pharmacologic pain management technique. The concurrent pharmacologic manipulation of VR analgesia in these studies will likely yield mechanistic insights that will improve future clinical application of VR exposure, and make immersive VR a more effective analgesic tool for more patients. The ideal clinical use of VR will likely be as one component of a "multimodal analgesia" regimen, administered in combination with pharmacologic analgesics. However, the additive and potential synergistic analgesic effects of these techniques have yet to be examined. This proposal focuses on the concomitant use of VR exposure and systemic analgesic agonists or antagonists known to affect pain perception, and builds on previous work by our group that has compared concurrent subjective and neuroimaging evidence of analgesia with immersive VR and systemic opioid therapy. This proposal has two broad goals: (1) to test specific hypotheses concerning the neurophysiologic mechanisms of VR analgesia, using concomitant subjective and functional brain imaging (fMRI) assessments of the pain experience, and (2) to determine the potential additive and/or synergistic analgesic effects of combined immersive VR and pharmacologic analgesic administration. These goals will be met through three Specific Aims: (1) To determine the extent to which subjective analgesic effects of VR analgesia are inhibited (or not) by opioid receptor antagonism with naloxone; (2) To determine the comparative and additive effects of immersive VR and N-methyl-D-aspartate (NMDA) antagonism with low- dose ketamine (at a sub-anesthetic dose devoid of hallucinatory effects, but associated with analgesia, expansive mood, and heightened perception); (3) To determine the comparative effects of immersive VR and NMDA antagonism with low-dose ketamine on pain-related brain activity in standard brain regions of the "pain matrix", as well as in brain structures associated with modulation of the pain experience, and to correlate observed brain activity with subjective reports of the pain experience. Information gained from the proposed studies will guide (1) future investigations that define specific analgesic mechanisms of immersive VR, (2) the thoughtful clinical combination of VR exposure and pharmacologic analgesics in a "multimodal analgesia" approach to reducing procedural pain, and (3) future assessments of the cost-effective application of VR systems designed to maximize the analgesic effect of immersive VR in various clinical pain settings.

6. 项目总结/摘要 该提案解决了 PA-07-282 中确定的研究目标（机制、模型、测量、 和疼痛研究管理），特别针对生物行为疼痛、疼痛等主题 管理和转化疼痛研究。我们在实验室疼痛环境中提出了一系列研究 （健康志愿者的热痛和/或电痛）旨在测试三个特定和相关的假设 探索沉浸式虚拟现实 (VR) 作为一种非虚拟现实技术背后的神经生理学机制。 药物疼痛管理技术。 VR 镇痛的同时药物操作 这些研究可能会产生机制见解，从而改善 VR 暴露的未来临床应用， 让沉浸式VR成为更多患者更有效的镇痛工具。 VR 的理想临床应用将 可能作为“多模式镇痛”方案的一个组成部分，与 药理镇痛药。然而，这些药物的相加和潜在的协同镇痛作用 技术还有待检验。该提案重点关注 VR 曝光和 VR 曝光的同时使用 已知影响疼痛感知的全身镇痛激动剂或拮抗剂，并建立在以前的工作基础上 我们的小组比较了镇痛与沉浸式镇痛的同时主观和神经影像证据 VR 和全身阿片类药物治疗。该提案有两个广泛的目标：（1）测试有关以下方面的具体假设： VR 镇痛的神经生理机制，使用伴随的主观和功能性脑成像 (fMRI) 疼痛体验评估，以及 (2) 确定潜在的相加和/或协同作用 沉浸式 VR 与药物镇痛联合给药的镇痛效果。这些目标将是 通过三个具体目标来实现：（1）确定 VR 的主观镇痛效果的程度 纳洛酮的阿片受体拮抗作用会抑制（或不抑制）镇痛作用； (2) 确定 沉浸式 VR 和 N-甲基-D-天冬氨酸 (NMDA) 拮抗作用的比较和相加效应 剂量氯胺酮（亚麻醉剂量，无幻觉作用，但与镇痛有关， 开阔的情绪和增强的感知力）； (3) 确定沉浸式VR与沉浸式VR的对比效果 低剂量氯胺酮对 NMDA 对标准脑区疼痛相关脑活动的拮抗作用 “疼痛矩阵”，以及与疼痛体验调节相关的大脑结构，并 将观察到的大脑活动与疼痛经历的主观报告联系起来。获得的信息来自 拟议的研究将指导（1）定义沉浸式具体镇痛机制的未来研究 VR，（2）VR暴露和药物镇痛药在“多模式”中的深思熟虑的临床组合 镇痛”方法来减少手术疼痛，以及（3）未来对成本效益应用的评估 VR 系统旨在最大限度地提高沉浸式 VR 在各种临床疼痛环境中的镇痛效果。