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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：
10617854
负责人：
Luana Colloca
金额：
$ 63.75万
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/10617854
关键词：
Absence of pain sensation Acute Adjuvant Affect Anxiety Behavioral Mechanisms Brain COVID-19 COVID-19 pandemic Categories Chronic Classification Clinical Collaborations Consensus Controlled Environment Devices Diagnosis Ecological momentary assessment Electroencephalography Esthetics Frequencies Future General Population 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 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 biobehavior chronic pain chronic pain patient cognitive function cohort design disability empowerment endogenous opioids evidence base experience improved information processing innovation intervention cost knowledge of results mu opioid receptors multisensory neural neural information processing neuromechanism novel opioid epidemic pain outcome pain reduction pharmacologic placebo analgesia predict clinical outcome prospective responders and non-responders response standard of care systematic review 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.

总结 COVID-19大流行及其对阿片类药物危机的影响对远程医疗产生了迫切需求，考虑使用非药物、低成本干预作为疼痛管理武器库中的佐剂。我们提出了一个研究沉浸式虚拟现实技术引起的疼痛减轻的神经机制的项目现实（VR）。虚拟现实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。我们最近证明了VR可以增加疼痛耐受力限制和迷走神经活动，同时改善个体疼痛、不愉快、情绪和情境焦虑为了提高这个项目的可翻译性，我们将直接深入到VR的神经机制中，患有颞下颌关节紊乱病（TMD）的慢性疼痛参与者，PI 和她的合作者取得了丰硕的成果。首要目标是研究疼痛调制 VR诱导的痛觉减退的潜在机制通过确定1）内源性μ阿片样物质的参与， 2)对急性VR的反应性与长期疼痛相关结局之间的关系，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） 6个月以上; 3）高分辨率脑电图，以测量峰值α的同步性频率（PAF）。我们将从安慰剂效应中解开VR诱导的痛觉减退的机制，参与者有明显的残疾和TMD等级。我们预计1）VR，类似于安慰剂效应，将通过参与内源性阿片系统减轻疼痛，2）VR诱导的疼痛调节能力将导致更好的长期疼痛结局，3）3周VR将有利于PAF振荡的同步通过个人VR治疗的好处。该项目将联合收割机药理学、EMA和在TMD患者中采用脑电图技术，以最大限度地提高结果的知识。该团队拥有成功合作的历史以及产生创新、及时、准确的调查结果。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的证据可能使TMD患者获得新的，可获得且负担得起的治疗方案。