Virtual reality technologies in multimodal rehabilitation for post-stroke pain: a randomized controlled trial

Objective. To evaluate the impact of virtual reality technology on severity and characteristics of post-stroke pain syndrome (PSPS) and indicators of neurotrophin and neurotransmitter metabolism. Material and methods. Rehabilitation with multimodal stimulation was performed in 59 patients of the main group with PSPS (mean age 58.5±9.94 years, 38 (64.4%) men and 21 (35.6%) women). The control group included 38 patients with PSPS, in whose rehabilitation virtual reality training was not used (mean age 62.1±8.8 years, 21 men (55.3%) and 17 (44.7%) women). The virtual reality program “VRZdorovye” was used in rehabilitation of our patients after stroke. Pain syndrome was examined using the visual analogue scale, Douleur Neuropathique 4 (DN4), PainDetect, McGill pain questionnaire. We assessed serum concentration of neurotrophic factors (BDNF, NGF, VGF) and mediators (dopamine, serotonin, substance P, norepinephrine) using solid-phase enzyme immunoassay. Statistical analysis was carried out using the Statistica 12.0 software. Results. There was less severe pain, smaller number of patients with high risk of neuropathic pain, sensory and affective components of post-stroke pain syndrome in virtual reality group. There was higher serum serotonin and lower substance P after multimodal approach with virtual reality. Conclusion. Multimodal influence including virtual reality in complex medical rehabilitation of patients with post-stroke pain syndrome decrease pain syndrome. Changes in serum concentration of neurotrophic proteins and neurotransmitters in patients with post-stroke pain syndrome indicate possible effect of virtual reality on central pathogenetic mechanisms of post-stroke pain syndrome.