Pain Neuroscience Education Delivered Through Virtual Reality for Common Musculoskeletal Conditions Seen in Physical Therapy: An Exploratory Study

Abstract

Treating persistent musculoskeletal pain in healthcare and globally is clinically challenging and emerging digital therapeutic treatments such as augmented and virtual reality may help ease this burden. Current best evidence supports pain neuroscience education (PNE) as a viable strategy to ease pain and disability of patients attending physical therapy with persistent musculoskeletal pain. The objective of this exploratory study was to determine what, if any, positive effects PNE delivered via virtual reality may yield on the four largest patient groups seen in physical therapy and healthcare in general – low back, neck, knee, and shoulder pain. Forty patients (10 patients each with low back, neck, knee, and shoulder pain) underwent a 12-minute PNE session following an in-person physical therapy session. Prior to and immediately following treatment, heart rate, self-reported pain ratings (numeric pain rating scale – NPRS), pain catastrophizing (pain catastrophization scale – PCS), fear-avoidance (fear-avoidance beliefs questionnaire – FABQ) and active range of motion was measured. Additionally, the global rating of change (GROC) scale was used following treatment to assess the patient experience. No significant changes were found in heart rate and blood pressure. FABQ-PA (physical activity) improved significantly in patients with neck, shoulder, and back pain, with large effect sizes. PCS improved significantly (p = 0.034) for patients with low back pain, while only patients with shoulder pain showed a significant change in self-reported pain (p = 0.04). Active range of motion improved significantly in both peripheral joint patient populations (knee flexion [p = 0.003], knee extension [p = 0.002] and shoulder flexion [p = 0.023]), but not spinal patients (back and neck). Mean GROC scores for patients with shoulder (3.0) and knee pain (3.4) were above the minimal clinically important difference. This is the first study to explore PNE-VR for different body regions in patients with persistent pain attending PT. The largest positive shifts were seen for fear of physical activity. Patients with shoulder pain and disability received the greatest benefit from PNE-VR, followed by patients with LBP and knee pain. Future research is needed to develop, test and implement larger scale, controlled trails of virtual reality for patients seeking care for musculoskeletal pain in healthcare. Citation: Louw A, Zimney K, Stopher D, Saldanha KG, Shockley J, et al. (2023) Pain Neuroscience Education Delivered Through Virtual Reality for Common Musculoskeletal Conditions Seen in Physical Therapy: An Exploratory Study. Rep Glob Health Res 6: 157. DOI: 10.29011/2690-9480.100157. 2 Volume 06; Issue 02