The VA recognizes pain as the 5th vital sign in healthcare delivery, encouraging advancements in the assessment and management of pain in Veterans. Due to both ongoing military conflicts and common chronic diseases such as diabetes, a growing number of Veterans are living with amputations. Among this group, many report a phenomenon called phantom limb pain, a form of pain experienced in the amputated limb of the Veteran that is often chronic, debilitating, and resistant to standard biomedical pain therapies. Developing effective alternative treatments for phantom limb pain can potentially improve the quality of life and functional status of these Veterans. In a previous VA-funded clinical trial, this team of investigators completed the first comparativeness effectiveness study for phantom limb pain that evaluated mirror therapy, a behavioral treatment with promise for the treatment of phantom limb pain. In the current proposal, we aim to advance mirror therapy to the next stage of development by developing an immersive virtual reality treatment that incorporates the effective components of standard mirror therapy while also addressing the known weaknesses of mirror therapy. For example, in standard mirror therapy, only patients with unilateral amputations can perform the exercises and the person needs to carry the mirror in order to perform the therapy. Using a virtual reality platform, we can circumvent these limitations by immersing Veterans in a highly portable simulated environment in which they can perform mirror therapy exercises irrespective of amputation pattern. We will also address important questions about the relative benefits of virtual reality treatments for pain in this study. At present, it is unknown if it is te nonspecific elements of virtual reality that produce pain reduction benefits or if it is more speciic features of the virtual reality environment. We will evaluate these questions using a protocol in which patients are randomized to either the virtual reality equipment over one month treatment periods or to a matched standard behavioral mirror therapy treatment. The objective of this two year study is to develop an develop a portable and user friendly virtual reality treatment platform for treating phantom limb pain and evaluating its feasibility among a group of Veterans.
The VA system performs more than 10% of all amputations in the U.S., a percentage translating into more than 50,000 upper and lower extremity amputations in the past decade. Among Veterans with amputations, research suggests that upwards of 70% experience phantom limb pain (PLP), an often chronic and debilitating condition with adverse effects on quality of life and poor responsiveness to conventional pain treatments. The use of virtual reality technology for chronic pain management is a novel and rapidly advancing area of study, with existing research suggesting that virtual reality treatments are effective for acute pain management, promising for chronic pain management, and as yet untested for PLP. In the current study, we will develop a virtual reality environment that simulates mirror therapy - the gold standard behavioral treatment for PLP - comparing the efficacy of this modality in a population of Veterans with PLP against a standard mirror therapy treatment validated by this research team in a previous RR&D supported clinical trial.