Embodiment in Virtual Reality for the Treatment of Chronic Low Back Pain: A Case Series

Michael S Trujillo, Anthony F Alvarez, Lincoln Nguyen, James Petros, Michael S Trujillo, Anthony F Alvarez, Lincoln Nguyen, James Petros

Abstract

Purpose: We describe two case studies that use embodiment in virtual reality as a treatment for chronic low back pain. The purpose of this case series was to determine the feasibility of a novel virtual reality-based digital therapeutic for the treatment of chronic pain.

Patients and methods: Two patients with chronic low back pain received seven sessions, two sessions per week, of a novel digital therapeutic that combines virtual embodiment with graded motor imagery to deliver functional rehabilitation exercises using an off-the-shelf virtual reality system. Pain intensity was measured using a visual analog scale before and after each session to get an indication whether individual sessions of virtual embodiment training decrease pain intensity. Pain catastrophizing scale was assessed before the first session and after the seventh session to determine the extent to which virtual embodiment training can improve psychological symptoms of chronic low back pain.

Results: In both patients, pain intensity was improved after individual sessions of virtual embodiment training as measured by a paired t-test: (Patient A: t = 2.890, P < 0.05) and (Patient B: t = 5.346, P < 0.005). This indicates that individual sessions of virtual embodiment training decrease pain intensity. In both patients, improvements were observed in three subscales of the pain catastrophizing scale (rumination, magnification, and helplessness). This indicates that virtual embodiment training may have benefits for chronic pain symptoms such as pain intensity, pain-related mobility impairment, and disability.

Conclusion: This case series provides evidence that embodiment in virtual reality improves symptoms of persistent chronic low back pain. We propose a mechanism by which virtual embodiment may improve chronic pain symptoms by recontextualizing sensory feedback from the body as patients engage in functional rehabilitation exercises while in virtual reality.

Keywords: centralized pain; digital therapeutics; pain catastrophizing scale; sensorimotor; visual analog scale.

Conflict of interest statement

Michael S. Trujillo, Anthony F. Alvarez, and Lincoln Nguyen are employed by Karuna Labs, Inc. James Petros has stock options in Karuna Labs, Inc. The authors report no other conflicts of interest in this work.

© 2020 Trujillo et al.

Figures

Figure 1
Figure 1
An example of KVET™ low back exercises. The patient sees the virtual avatar in the first person (front facing forward). A model avatar demonstrates proper lumbar spine exercises which include lumbar flexion, extension, and left and right lateral extension. The avatar to the left produces mirror images of movements performed by the embodied avatar.
Figure 2
Figure 2
Visual analog scale (VAS) before and after KVET™ for patient A (top) and patient B (bottom).

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