Chronic pain remains poorly managed. The integration of immersive technologies (ie, virtual reality [VR]) with neuroscience-based principles may provide effective pain treatment by targeting cognitive and affective neural processes that maintain pain and therefore potentially changing neurobiological circuits associated with pain chronification and amplification. We tested the effectiveness of a novel VR neuroscience-based therapy (VRNT) to improve pain-related outcomes in n = 31 participants with chronic back pain, evaluated against usual care (waitlist control; n = 30) in a 2-arm randomized clinical trial (NCT04468074). We also conducted pre-treatment and post-treatment MRI to test whether VRNT affects brain networks previously linked to chronic pain and treatment effects. Compared with the control condition, VRNT led to significantly reduced pain intensity (g = 0.63) and pain interference (g = 0.84) at post-treatment vs pre-treatment, with effects persisting at 2-week follow-up. These improvements were partially mediated by reduced kinesiophobia and pain catastrophizing. Several secondary clinical outcomes were also improved by VRNT, including disability, quality of life, sleep, and fatigue. In addition, VRNT was associated with increases in dorsomedial prefrontal functional connectivity with the superior somatomotor, anterior prefrontal and visual cortices, and decreased white matter fractional anisotropy in the corpus callosum adjacent to the anterior cingulate, relative to the control condition. Thus, VRNT showed preliminary efficacy in significantly reducing pain and improving overall functioning, possibly through changes in somatosensory and prefrontal brain networks.

中文翻译：

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基于虚拟现实神经科学的治疗对慢性背痛患者临床和神经影像结果的影响：一项随机临床试验。

慢性疼痛仍然管理不善。沉浸式技术（即虚拟现实 [VR]）与基于神经科学的原理的整合可以通过针对维持疼痛的认知和情感神经过程来提供有效的疼痛治疗，从而可能改变与疼痛慢性化和放大相关的神经生物学回路。我们在 31 名慢性背痛参与者中测试了一种新型 VR 神经科学疗法 (VRNT) 改善疼痛相关结果的有效性，并在一项 2 组随机临床中对照常规护理（候补名单对照；n = 30）进行评估试验（NCT04468074）。我们还进行了治疗前和治疗后 MRI，以测试 VRNT 是否会影响先前与慢性疼痛和治疗效果相关的大脑网络。与对照条件相比，VRNT 治疗后与治疗前相比，疼痛强度 (g = 0.63) 和疼痛干扰 (g = 0.84) 显着降低，且效果在 2 周随访时持续存在。这些改善部分是由运动恐惧症和疼痛灾难化的减少所介导的。VRNT 还改善了一些次要临床结果，包括残疾、生活质量、睡眠和疲劳。此外，与对照条件相比，VRNT 与背内侧前额叶与上躯体运动、前前额叶和视觉皮层的功能连接增加有关，并且与前扣带回相邻的胼胝体白质各向异性分数减少有关。因此，VRNT 在显着减轻疼痛和改善整体功能方面显示出初步功效，这可能是通过体感和前额叶大脑网络的变化来实现的。