• B Chi, B Chau, E Yeo, and P Ta.
• Department of Physical Medicine and Rehabilitation, Loma Linda University Health, 11406 Loma Linda Drive, Suite 516, 92354 Loma Linda, CA, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, 11549 Hempstead, NY, USA. Electronic address: bchi1@pride.hofstra.edu.
• Ann Phys Rehabil Med. 2019 Jan 1; 62 (1): 49-57.

BackgroundTreatment of spinal cord injury (SCI)-associated neuropathic pain is challenging, with limited efficacy and no definitive options, and SCI patients often show resistance to pharmacologic treatment. Virtual reality (VR) therapy is a non-invasive, non-pharmacologic alternative with minimal adverse effects.ObjectiveTo investigate the effect of VR therapy on SCI-associated neuropathic pain in a systematic review.MethodsArticles needed to 1) be written in English; 2) include adult subjects, with at least half the study population with a SCI diagnosis; 3) involve any form of VR therapy; and 4) assess neuropathic pain by quantitative outcome measures. Articles were searched in MEDLINE/PubMed, CINAHL®, EMBASE, and PsycINFO up to April 2018. Reference lists of retrieved articles were hand-searched. Methodologic quality was assessed by the Physiotherapy Evidence Database Score (PEDro) for randomized controlled trials and Modified Downs and Black Tool (D&B) for all other studies. Level of evidence was determined by using a modified Sackett scale.ResultsAmong 333 studies identified, 9 included in this review (n=150 participants) evaluated 4 methods of VR therapy (virtual walking, VR-augmented training, virtual illusion, and VR hypnosis) for treating neuropathic pain in SCI patients. Each VR method reduced neuropathic pain: 4 studies supported virtual walking, and the other 3 VR methods were each supported by a different study. Combined treatment with virtual walking and transcranial direct current stimulation was the most effective. The quality of studies was a major limitation.ConclusionVR therapy could reduce SCI-associated neuropathic pain, although the clinical significance of this analgesic effect is unclear. Clinical trials evaluating VR therapy as standalone and/or adjunct therapy for neuropathic pain in SCI patients are warranted.Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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