Using visual illusion to reduce at-level neuropathic pain in paraplegia

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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 (∼65%) (11–73 mm) for virtual walking, 18 mm (4–31 mm) for guided imagery and 4 mm (−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.

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