Complex regional pain syndrome (CRPS) is a rare but highly problematic condition that leaves sufferers in chronic pain with limited treatment options.
AUT psychologist Dr Debbie Bean is part of a research group looking at how virtual reality (VR) can be used to help manage chronic pain. The group includes clinical researchers, working clinicians, pain specialists, Māori and Pasifika advisors, VR experts and programmers, and a designer.
Bean has a background in pain management with the Auckland Regional Pain Service. Her research focuses on taking a health psychology, critical and cultural lens to the experience and management of chronic pain.
CRPS mostly affects the hands or feet, and while we don’t completely understand the cause, it’s generally triggered by an injury or trauma. Symptoms range from continuous burning or throbbing pain, sensitivity to touch or cold, and swelling through to changes in skin temperature, colour and texture. CRPS can also cause motor dysfunction. Patients often have a sense of dis-ownership of their affected limb, creating a significant barrierto rehabilitation.
While CRPS is considered rare in New Zealand, occurring in only 26 of 100,000 people, Bean says it’s enough of a problem because it so severely affects patients’ lives. It is most common in middle age and women rather than men. Pain medication is not that effective.
“We know that with certain pain conditions like CRPS and phantom limb pain that there are changes in the brain regions associated with that limb, and the extent of that change correlates with the amount of pain.
“Along with this, people with CRPS often feel like the limb doesn’t belong to them and feel disconnected from it. The more disconnected they feel, the worse their pain. So, if we can use something like VR to help them re-connect with their painful body part, could it help them with pain and rehabilitation?”
People with CRPS often misperceive the painful area in terms of size, shape, location or the way it looks. They can take longer to recognise a picture of it. It’s as if the brain has disconnected from the hand, almost as though it’s protecting the patient from seeing how their hand looks.
“But, what if we changed how the patient perceived their hand? Would that help if combined with an inter-disciplinary approach to therapy based around movement and emotion? Would it help if the patient could do their therapy at home?” says Bean.
“The task is then to re-integrate the hand by using VR to adjust the appearance of virtual limbs, providing a new way to manage pain perception through visual feedback .
She and her team worked with Auckland company RUSH Digital and now with AUT's own VR development experts to deliver a prototype that uses a pair of virtual hands. Early results show that headset wearers are quick to adopt the computerised hands as their own, even if they appear through the goggles as cartoon-like. Patients had reduced pain levels and increased willingness to engage with their affected limb during sessions.
The product is still at clinical trial level, but the team is aiming to join up with a commercial partner to get it into the healthcare world.
Bean hopes VR could make treatment for pain management more accessible, especially in a country like New Zealand where there are few pain clinics outside main cities.
Bean says they want to ensure their tool connects with Māori and Pasifika people, so they might include games or cultural elements to make it more accessible, and to make it home-based.
