• Marco Solcà, Roberta Ronchi, Javier Bello-Ruiz, Thomas Schmidlin, Bruno Herbelin, François Luthi, Michel Konzelmann, Jean-Yves Beaulieu, François Delaquaize, Armin Schnider, Adrian G Guggisberg, Andrea Serino, and Olaf Blanke.
• From the Department of Mental Health and Psychiatry (M.S.), University Hospital, Geneva; Department of Basic Neurosciences (R.R.), Faculté de médecine, Laboratory of Cognitive Neuroscience, University of Geneva (M.S., R.R., J.B.R., B.H., A. Serino, O.B.), Center for Neuroprosthetics, and BrainMind Institute & Center for Neuroprosthetics (T.S.), School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Campus Biotech, Geneva; Department for Musculoskeletal Rehabilitation (F.L., M.K.), Clinique romande de réadaptation suvacare, Sion; Department of Orthopedic Surgery (J.-Y.B., F.D.), Division of Neurorehabilitation (A. Schnider, A.G.G.), and Department of Neurology (O.B.), University Hospital, Geneva; and Laboratory MySpace (A. Serino), Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Switzerland.
• Neurology. 2018 Jul 31; 91 (5): e479-e489.

ObjectivesTo develop and test a new immersive digital technology for complex regional pain syndrome (CRPS) that combines principles from mirror therapy and immersive virtual reality and the latest research from multisensory body processing.MethodsIn this crossover double-blind study, 24 patients with CRPS and 24 age- and sex-matched healthy controls were immersed in a virtual environment and shown a virtual depiction of their affected limb that was flashing in synchrony (or in asynchrony in the control condition) with their own online detected heartbeat (heartbeat-enhanced virtual reality [HEVR]). The primary outcome measures for pain reduction were subjective pain ratings, force strength, and heart rate variability (HRV).ResultsHEVR reduced pain ratings, improved motor limb function, and modulated a physiologic pain marker (HRV). These significant improvements were reliable and highly selective, absent in control HEVR conditions, not observed in healthy controls, and obtained without the application of tactile stimulation (or movement) of the painful limb, using a readily available biological signal (the heartbeat) that is most often not consciously perceived (thus preventing placebo effects).ConclusionsNext to these specific and well-controlled analgesic effects, immersive HEVR allows the application of prolonged and repeated doses of digital therapy, enables the automatized integration with existing pain treatments, and avoids application of painful bodily cues while minimizing the active involvement of the patient and therapist.Classification Of EvidenceThis study provides Class III evidence that HEVR reduces pain and increases force strength in patients with CRPS.© 2018 American Academy of Neurology.

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