Cortical Mechanisms Underlying Immersive Interactive Virtual Walking Treatment for Amelioration of Neuropathic Pain after Spinal Cord Injury: Findings from a Preliminary Investigation of Thalamic Inhibitory Function
Authors:
- Sylvia M. GustinSGSylvia M. Gustin
- Mark BoldingMBMark Bolding
- William WilloughbyWWWilliam Willoughby
- Monima AnamMAMonima Anam
- Corey ShumCSCorey Shum
- Deanna RumbleDRDeanna Rumble
- Victor W. MarkVMVictor W. Mark
- Lucie MitchellLMLucie Mitchell
- Rachel E. CowanRCRachel E. Cowan
- Elizabeth RichardsonERElizabeth Richardson
- Scott RichardsSRScott Richards
- Zina TrostZTZina Trost
Open Access
- 4 September 2023
- journal article
- research article
- Published by MDPI AG in Journal of Clinical Medicine
- Vol. 12 (17) , 5743
Abstract
Background: Neuropathic pain following spinal cord injury (SCI) affects approximately 60% of individuals with SCI. Effective pharmacological and non-pharmacological treatments remain elusive. We recently demonstrated that our immersive virtual reality walking intervention (VRWalk) may be effective for SCI NP. Additionally, we found that SCI NP may result from a decrease in thalamic γ-aminobutyric-acid (GABA), which disturbs central sensorimotor processing. Objective: While we identified GABAergic changes associated with SCI NP, a critical outstanding question is whether a decrease in SCI NP generated by our VRWalk intervention causes GABA content to rise. Method: A subset of participants (n = 7) of our VRWalk trial underwent magnetic resonance spectroscopy pre- and post-VRWalk intervention to determine if the decrease in SCI NP is associated with an increase in thalamic GABA. Results: The findings revealed a significant increase in thalamic GABA content from pre- to post-VRWalk treatment. Conclusion: While the current findings are preliminary and should be interpreted with caution, pre- to post-VRWalk reductions in SCI NP may be mediated by pre- to post-treatment increases in thalamic GABA by targeting and normalizing maladaptive sensorimotor cortex reorganization. Understanding the underlying mechanisms of pain recovery can serve to validate the efficacy of home-based VR walking treatment as a means of managing pain following SCI. Neuromodulatory interventions aimed at increasing thalamic inhibitory function may provide more effective pain relief than currently available treatments.Keywords
Funding Information
- Craig H. Neilsen Foundation
- International Association for the Study of Pain
- Congressionally Designated Medical Research Program
- University of Alabama at Birmingham (UAB) Department of Radiology
- Rebecca L. Cooper Medical Research Foundation
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