虚拟现实交付的疼痛心理治疗在癌症相关神经性疼痛中的可行性：一项初步随机对照试验

近年来，虚拟现实交付的心理治疗已被研究作为急性和慢性疼痛的非药物管理方法。然而，尚无满足癌症患者神经性疼痛需求的虚拟现实疼痛治疗软件。本研究开发了一款定制的虚拟现实疼痛治疗软件，旨在帮助癌症患者管理神经性疼痛，结合引导式可视化和渐进式肌肉放松技术，同时最大限度减少此类脆弱患者群体中的网络晕动症风险。此项随机对照试点研究评估了该疼痛治疗软件的可行性、接受度、招募率及网络晕动症风险。次要指标包括阿片类药物使用量、疼痛严重程度、疼痛干扰程度以及全球生活质量评分等临床结果。在87名符合条件的癌症神经性疼痛患者中，招募了39人（占47%），随机分配至干预组（20人，虚拟现实疼痛治疗软件）或对照组（19人，观看虚拟现实视频）。在随访3个月前，4名患者退出（全部在对照组）。预存眩晕（Spearman ρ 0.37，p=0.02）和预存恶心（Spearman ρ 0.81，p<0.001）在两组中均与网络晕动症风险显著相关。干预组患者报告的网络晕动症较少，并能耐受且完成所有治疗会话。在1个月和3个月随访中，干预组在以下方面显示出趋势性改善：口服吗啡每日等效剂量（-8 mg和-4 mg；对照组为0 mg和+15 mg）；修订版简明疼痛量表（Brief Pain Inventory）疼痛严重程度（-0.4，-0.8；对照组为+0.4，-0.3）；以及疼痛干扰（-0.9，-1.8；对照组为-0.2，-0.3）分数。欧洲肿瘤研究与治疗组织生活质量问卷-C30中的总体生活质量子量表在1和3个月时，两组间差异未达统计学显著（干预组：-5，-8；对照组：+3，+4）。这款新开发的虚拟现实疼痛治疗软件已被证明对患有神经性疼痛的癌症患者具有可行性和接受度。结果将有助于设计一项具有多中心规模的确定性随机对照试验。

Virtual reality-delivered psychological therapies have recently been investigated as non-pharmacological management for acute and chronic pain. However, no virtual reality pain therapy software existed that met the needs of cancer patients with neuropathic pain. We created a bespoke virtual reality-delivered pain therapy software programme to help cancer patients manage neuropathic pain incorporating guided visualisation and progressive muscle relaxation techniques, whilst minimising the risk of cybersickness in this vulnerable patient population. This randomised controlled pilot study evaluated the feasibility, acceptability, recruitment rates and risk of cybersickness of this pain therapy software programme. Clinical outcomes including opioid consumption, pain severity, pain interference and global quality of life scores were secondary aims. Of 87 eligible cancer patients with neuropathic pain, 39 were recruited (47%), allocated to either the intervention (20 patients, virtual reality pain therapy software programme) or control (19 patients, viewing virtual reality videos). Four patients withdrew before the 3-month follow-up (all in the control group). Pre-existing dizziness (Spearman ρ 0.37, p = 0.02) and pre-existing nausea (Spearman ρ 0.81, p < 0.001) were significantly associated with risk of cybersickness in both groups. Patients in the intervention group reported less cybersickness, as well as tolerated and completed all therapy sessions. At 1- and 3-month follow-up, there were trends in the intervention group towards reductions in: oral morphine equivalent daily dose opioid consumption (-8 mg and -4 mg; vs. control: 0 mg and +15 mg respectively); modified Brief Pain Inventory pain severity (-0.4, -0.8; vs. control +0.4, -0.3); and pain interference (-0.9, -1.8; vs. control -0.2, -0.3) scores. The global quality of life subscale from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 was not significantly changed between groups at 1 and 3 months (intervention: -5, -8; vs. control: +3, +4). This newly created virtual reality-delivered pain therapy software programme was shown to be feasible and acceptable to cancer patients with neuropathic pain. These results will aid the design of a definitive multicentre randomised controlled trial.