Mind The Gap: Steps towards precision rehabilitation in chronic pain

Summary

Using Virtual Reality technology at the VSimulators Centre, we hope to improve our understanding of the brain’s role in chronic lower back pain (CLBP) and develop a new method to measure changes in symptoms and underlying causes after treatments.

What are we doing?

By bringing together interdisciplinary expertise (researchers, clinicians, patients), and multimodal research (neuroimaging, psychophysics, psychometrics, VR) and accurately recreating everyday situations, such as commuting on the train, we hope to understand the brain mechanisms which result in repetitive false predictions of instability, causing anxiety. Through randomized controlled trials, we’ll check if our findings can be consistently replicated and use them to design better treatments, like virtual reality therapy for back pain. Ultimately, we hope these findings will attract partnerships with VR companies to create approved treatments.

How are we doing it?

Our study will involve a within-subjects design with at least 30 patients diagnosed with chronic low back pain (CLBP) and anxiety. Using the Vsimulators platform, participants will experience being on a moving train with jolts that are destabilising. We’ll measure their posture adjustments through body tracking, aiming to detect how impaired prediction error (PE) manifest as inaccuracies or an absence of preparatory postures. We’ll collect concurrent data from body trackers and fNIRS to identify the brain regions which are involved in prediction. Additionally, qualitative feedback from patients will inform the development of VR-based interventions targeting dysfunctional PE processing, potentially serving as biomarkers or treatment outcomes.

What happens next?

We will establish the test/retest reliability of our behavioural and neural correlates of PE so that suitable measures can be taken forward into future randomised controlled trials (e.g., using VR-based rehabilitation targeting maladaptive PE processing in low back pain patients), representing a springboard for future fellowship and grant applications. The overarching aim is that the results from this research will lead to commercial partnership with clinical VR companies interested in developing approved VR treatments.