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Review
. 2023 Apr 5;13(4):617.
doi: 10.3390/brainsci13040617.

Role of Immersive Virtual Reality in Motor Behaviour Decision-Making in Chronic Pain Patients

Javier Guerra-Armas  1 , Mar Flores-Cortes  2 , Consolacion Pineda-Galan  2 , Alejandro Luque-Suarez  2   3 , Roy La Touche  4   5   6
Affiliations
Review

Role of Immersive Virtual Reality in Motor Behaviour Decision-Making in Chronic Pain Patients

Javier Guerra-Armas et al. Brain Sci. .

Abstract

Primary chronic pain is a major contributor to disability worldwide, with an estimated prevalence of 20-33% of the world's population. The high socio-economic impact of musculoskeletal pain justifies seeking an appropriate therapeutic strategy. Immersive virtual reality (VR) has been proposed as a first-line intervention for chronic musculoskeletal pain. However, the growing literature has not been accompanied by substantial progress in understanding how VR exerts its impact on the pain experience and what neurophysiological mechanisms might be involved in the clinical effectiveness of virtual reality interventions in chronic pain patients. The aim of this review is: (i) to establish the state of the art on the effects of VR on patients with chronic pain; (ii) to identify neuroplastic changes associated with chronic pain that may be targeted by VR intervention; and (iii) to propose a hypothesis on how immersive virtual reality could modify motor behavioral decision-making through an interactive experience in patients with chronic pain.

Keywords: body embodiment; chronic pain; decision-making; motor behavior; virtual reality.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of sensorimotor decision-making and how virtual reality can impact brain networks related to it. A four-stage model of the dynamic relationship between motor behavior decision-making in people with chronic pain and immersive virtual reality intervention is presented. In the first phase, sensory information (visual, auditory, and haptic) provided by VR may impact both the sensory network and the salience network, modifying the relevance of the stimulus and the integration of sensory modalities. Subsequently, this new information could influence the person’s body image and their relationship to the environment associated with the default network. In this process, VR can modulate different features of body image (ownership and agency) through the body illusion induced by full-body virtual avatars. The congruence between the movements of this avatar and those of the patient can generate a new motor learning process associated with the sensorimotor network, which could modulate pain-associated motor responses and behaviors such as movement-evoked pain. Finally, the change in valence of the perceived threat of a motor task and its influence on pain-related executive processes may trigger reinforced motor re-learning processes. The safe context provided by VR could facilitate the optimization of motor behavior, thus enhancing the relationship between the individual and the environment and his or her own body, by influencing these four stages described above, which were created with Biorender.
Figure 2
Figure 2
Therapeutic targets of immersive virtual reality intervention according to the distinct dimensions of the experience of chronic pain.
See this image and copyright information in PMC

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