title: Using visual illusion to reduce at-level neuropathic pain in paraplegia.
abstract: Neuropathic pain after spinal cord injury is not well understood and is difficult to treat. One possible cause is mismatch between motor commands and sensory feedback. This two-part study in five paraplegic patients investigated whether a visual illusion aimed to correct this mismatch reduces pain. In study 1, patients undertook three conditions: (i) virtual walking: with a mirror placed in front of a screen, patients aligned their own upper body with a film of a lower body walking. Patients imagined walking and 'watched themselves' walk; (ii) guided imagery; (iii) watching a film. One patient withdrew from virtual walking because of distress. For all patients, the mean (95% CI) decrease in pain (100 mm VAS) was 42 mm (approximately 65%) (11-73 mm) for virtual walking, 18 mm (4-31 mm) for guided imagery and 4mm (-3 to 11 mm) for watching the film. Mean (95% CI) time to return to pre-task pain was 34.9 min (20.1-49.8 min) for virtual walking; 13.9 min (-0.9 to 28.8 min) for the guided imagery and 16.3 min (1.5-31.2 min) for the film. To investigate its clinical utility, four patients underwent virtual walking every weekday for 3 weeks. Mean (95% CI) decrease in pain was 53 mm (45-61 mm) at post training and 43 mm (27-58 mm) at 3-month follow-up. Virtual walking may be a viable treatment for pain after spinal cord injury. A clinical trial seems warranted.
authors.affiliation: Department of Physiology, Anatomy and Genetics and fMRIB Centre, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, United Kingdom.
authors.forename: Lorimer G
authors.initials: LG
authors.lastname: Moseley
mesh_terms: D000328:Adult; D000344:Afferent Pathways / Q000502:physiology; D004525:Efferent Pathways / Q000502:physiology; D006801:Humans; D007088:Illusions; D019018:Imagery, Psychotherapy; D007092:Imagination; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology / Q000534:rehabilitation / Q000628:therapy*; D010264:Paraplegia / Q000150:complications* / Q000534:rehabilitation; D010775:Photic Stimulation; D026741:Physical Therapy Modalities; D011597:Psychomotor Performance; D013119:Spinal Cord Injuries / Q000150:complications* / Q000534:rehabilitation; D016896:Treatment Outcome; D014584:User-Computer Interface; D016138:Walking