Extended reality used in the treatment of phantom limb pain: a multicenter, double-blind, randomized controlled trial

Phantom limb pain (PLP) represents a significant challenge after amputation. This study investigated the use of phantom motor execution (PME) and phantom motor imagery (PMI) facilitated by extended reality (XR) for the treatment of PLP. Both treatments used XR, but PME involved overt execution of phantom movements, relying on the decoding of motor intent using machine learning to enable real-time control in XR. In contrast, PMI involved mental rehearsal of phantom movements guided by XR. The study hypothesized that PME would be superior to PMI. A multicenter, double-blind, randomized controlled trial was conducted in 9 outpatient clinics across 7 countries. Eighty-one participants with PLP were randomly assigned to PME or PMI training. The primary outcome was the change in PLP, measured by the Pain Rating Index, from baseline to treatment cessation. Secondary outcomes included various aspects related to PLP, such as the rate of clinically meaningful reduction in pain (CMRP; >50% pain decrease). No evidence was found for superiority of overt execution (PME) over imagery (PMI) using XR. PLP decreased by 64.5% and 68.2% in PME and PMI groups, respectively. Thirty-seven PME participants (71%) and 19 PMI participants (68%) experienced CMRP. Positive changes were recorded in all other outcomes, without group differences. Pain reduction for PME was larger than previously reported. Despite our initial hypothesis not being confirmed, PME and PMI, aided by XR, are likely to offer meaningful PLP relief to most patients. These findings merit consideration of these therapies as viable treatment options and alternatives to pharmacological treatments.

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Publication Details

Journal
Pain
Published
2024-09-05
DOI
https://doi.org/10.1097/j.pain.0000000000003384
Citations
17
Primary Topic
Pain Management and Treatment
Type
article
Field-Weighted Citation Impact
10.91

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article

Extended reality used in the treatment of phantom limb pain: a multicenter, double-blind, randomized controlled trial

Eric J. Earley, Thomas G. Weiss, Martin Diers, Brian E. McGuire et al.
17 citations
Pain
Pain Management and Treatment
10.91
article

Extended reality used in the treatment of phantom limb pain: a multicenter, double-blind, randomized controlled trial

Eric J. Earley, Thomas G. Weiss, Martin Diers, Brian E. McGuire, Corry K. van der Sluis, Sonam Iqbal, Liselotte Hermansson, Cathrine Widehammar, Els Keesom, Maria Munoz-Novoa, Eva Lendaro, Lina Bunketorp Käll, Kristi L. Turner, Anita Stockselius, Helena Burger, Max Ortiz-Catalan, Lena Gudmundson, Morten Kristoffersen, Wendy Hill, Paul O’Reilly
article en
17 citations

Abstract

Phantom limb pain (PLP) represents a significant challenge after amputation. This study investigated the use of phantom motor execution (PME) and phantom motor imagery (PMI) facilitated by extended reality (XR) for the treatment of PLP. Both treatments used XR, but PME involved overt execution of phantom movements, relying on the decoding of motor intent using machine learning to enable real-time control in XR. In contrast, PMI involved mental rehearsal of phantom movements guided by XR. The study hypothesized that PME would be superior to PMI. A multicenter, double-blind, randomized controlled trial was conducted in 9 outpatient clinics across 7 countries. Eighty-one participants with PLP were randomly assigned to PME or PMI training. The primary outcome was the change in PLP, measured by the Pain Rating Index, from baseline to treatment cessation. Secondary outcomes included various aspects related to PLP, such as the rate of clinically meaningful reduction in pain (CMRP; >50% pain decrease). No evidence was found for superiority of overt execution (PME) over imagery (PMI) using XR. PLP decreased by 64.5% and 68.2% in PME and PMI groups, respectively. Thirty-seven PME participants (71%) and 19 PMI participants (68%) experienced CMRP. Positive changes were recorded in all other outcomes, without group differences. Pain reduction for PME was larger than previously reported. Despite our initial hypothesis not being confirmed, PME and PMI, aided by XR, are likely to offer meaningful PLP relief to most patients. These findings merit consideration of these therapies as viable treatment options and alternatives to pharmacological treatments.

PainVol. 166(3)
University of New Brunswick (CA), Bionics Institute (AU), Shirley Ryan AbilityLab (US), University Medical Center Groningen (NL), McGovern Institute for Brain Research (US), University of Ljubljana (SI), The University of Melbourne (AU), University of Groningen (NL), Örebro University (SE), Sahlgrenska University Hospital (SE), Univerzitetni Rehabilitacijski Inštitut (SI), Treant Zorggroep (NL), Integrum (Sweden) (SE), LWL-Universitätsklinikum Bochum (DE), University of Colorado Anschutz Medical Campus (US), Massachusetts Institute of Technology (US), Chalmers University of Technology (SE), Friedrich Schiller University Jena (DE), University of Gothenburg (SE)
Stiftelsen Promobilia, Wenner-Gren Stiftelserna, VINNOVA, IngaBritt och Arne Lundbergs Forskningsstiftelse, Integrum
Good health and well-being
Openalex Percentile: Top 1%
Pain Management and Treatment
10.91
DOIOpen Access PDFOpenAlex
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