Background & Aims

Chronic pain causes immense suffering and entails a major financial burden. Previous studies demonstrated analgesic effects of virtual reality (VR). Furthermore, there is evidence for reduced parietal alpha activity in pain patients, which can be modulated using a brain-computer interface (BCI). The research project “VirtualNoPain” funded by the German Federal Ministry of Education and Research (BMBF, 13GW034) investigates the therapeutic potential of these interventions and their combination using an especially developed VR-BCI system.

Methods

48 healthy participants underwent four experimental conditions in a within-subjects design: 1) Neurofeedback training in immersive VR, 2) guided relaxation in immersive VR, 3) watching a nature video or 4) a fixation cross on a computer screen (control conditions). During each scenario, painful heat stimuli were applied to the forearm. Main outcome measures were ratings of pain intensity and unpleasantness and skin conductance responses. After each condition, participants rated the experienced presence, valence, arousal, and attentional capture. During the neurofeedback task, participants were asked to increase the water jet of a fountain, which represented their parietal alpha activity visualized in VR.

Results

In line with our hypothesis, neurofeedback and meditation in virtual reality decreased pain ratings and evoked higher presence and attention. Pain was similarly reduced when watching a video, but not when watching a fixation cross. In the neurofeedback task, more than half of the participants performed significantly above their alpha power threshold indicating successful control.

Conclusions

Neurofeedback and virtual reality are promising methods in non-pharmacological pain management. Our next step includes testing their feasibility and effectiveness in patients with chronic pain.

References

Ahn et al. (2019). Identifying and engaging neuronal oscillations by transcranial alternating current stimulation in patients with chronic low back pain: A randomized, crossover, double-blind, sham-controlled pilot study. Journal of Pain, 20(3), 277 e271-277 e211.
Hassaan et al. (2020). The brain alpha rhythm in the perception and modulation of pain. Advances in Clinical Neuroscience & Rehabilitation, 19 (4). pp. 31-34. ISSN 1473-9348
Hesam-Shariati et al. (2022). The analgesic effect of electroencephalographic neurofeedback for people with chronic pain: A systematic review and meta-analysis. European Journal of Neurology, 29(3), 921-936.
Kenney & Milling (2016). The effectiveness of virtual reality distraction for reducing pain: A meta-analysis. Psychology of Consciousness: Theory, Research, and Practice, 3(3), 199–210.
Malloy & Milling (2010). The effectiveness of virtual reality distraction for pain reduction: A systematic review. Clin. Psychol. Rev. 30, 1011–1018.

Presenting Author

Eleni Kakavela

Poster Authors

Eleni Kakavela

Department of Neurology, University Hospital Würzburg, Würzburg, Germany

Lead Author

Loic Botrel

Dr.

Department of Psychology I, University of Würzburg, Würzburg, Germany

Lead Author

Markus Heinrich Winkler

Dr.

Department of Psychology I, University of Würzburg, Würzburg, Germany

Lead Author

Ivo Käthner

Dr.

Department of Psychology I, University of Würzburg, Würzburg, Germany

Lead Author

Daniel Gromer

Dr.

Department of Psychology I, University of Würzburg, Würzburg, Germany

Lead Author

Peter Collins

Dr.

Department of Psychology I, University of Würzburg, Würzburg, Germany

Lead Author

Mathias Müller

VTplus GmbH, Würzburg, Germany

Lead Author

Manfred Jaschke

Dr.

Brain Products GmbH, Gilching, Germany

Lead Author

Paul Pauli

Prof. Dr.

Department of Psychology I, University of Würzburg, Würzburg, Germany

Lead Author

Andrea Kübler

Prof. Dr.

Department of Psychology I, University of Würzburg, Würzburg, Germany

Lead Author

Claudia Sommer

University of Wuerzburg

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Other