Virtual Reality-assisted training for Chronic Pain Rehabilitation: The VIREP proof-of-concept study

Chronic pain is an important public health problem: 20% of the adult population
has some degree of chronic pain, corresponding to 2.2 million sufferers in the
Netherlands alone. Treatment outcomes show only weak to moderate improvements
and 79% of Dutch patients believe their pain is inadequately treated. In
addition, treatment adherence can be a weakness and the transfer towards daily
life difficult. Immersive virtual reality assisted training has shown promising
results in the treatment of anxiety disorders and distraction of acute pain.
However, research indicates solely distracting from pain is not suitable for
chronic pain due to its complex and ongoing pain experience. The application of
virtual reality for chronic pain shows a promising perspective. In the VR
world, the patient can train a specific experience virtually * like reaching or
grasping, which e.g. normally causes pain. Supposedly, you could develop new
realistic experiences, and re-learn what was assumed to be true (e.g. movement
causes pain). So far, evidence-based VR solutions are not yet applied. Our aim
is to develop an engaging VR-assisted training environment (VIREP) for chronic
pain rehabilitation from a clinical perspective.

In this proof-of-concept study we aim to investigate the acceptance and
potential (clinical) added value of a virtual reality environment to assist
occupational therapy in the chronic pain rehabilitation.

Proof-of-concept study in which the VIREP technology is integrated as part of
the regular chronic pain rehabilitation programmes at Roessingh Rehabilitation
Centre. The VIREP-assisted training will be offered once a week in individual
sessions with the occupational therapist, as part of the regular occupational
therapy and for the duration of the regular rehabilitation programme (7 * 12
weeks).

The VIREP system has two main components (1) an immersive virtual reality
training environment for rehabilitation of chronic pain installed in a computer
in a training room of Roessingh, and (2) an online portal used by the
therapists to prepare training sessions and keep track of performance results.
When starting the session, the patient finds him/herself in a familiar home
environment. Living room, kitchen and garden are the spaces that can be
explored. In a pin board on the wall the main goal is stated: prepare a meal
for a group of friends that will come over for dinner. The dinner consists of a
soup, and to complete this task, the player needs to collect several types of
vegetables from the garden outside the house. The harvesting of the vegetables
was selected to resemble movements from daily practice: carrots
(squatting/reaching down), tomatoes (middle-height reaching) and apples
(high-height reaching). Virtual rewards are given to the patient every time one
of the main tasks is completed with the aim of enriching the experience of the
patient and can always be used for additional interactions. Visual and audio
distracting elements (e.g. bees flying in the field of view) were added to
learn the patient to keep focused on a pre-defined task. A relaxing virtual
environment was created where the patient is invited to relax with or without
guidance of the therapist. Finally, through an online portal the therapist can
create and edit patient accounts, plan personalized training sessions and
evaluate performance of the patients over time.

The risk for adverse events due to participation in this study is negligible.
Patients will receive their usual rehabilitation training for chronic pain. The
virtual reality assisted training will always be performed in individual
sessions with the occupational therapist. Some people might experience motion
sickness due to the VR experience. If that is the case, the patient is asked to
remove the head-mounted device and the training is stopped immediately. The
patient can stop the training session or the full training programme at any
moment in time.