Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 12, 2024
Date Accepted: Nov 13, 2024
Neurobiological mechanisms of enhanced pain-relieving TENS via visuo-tactile stimulation in immersive virtual reality
ABSTRACT
Background:
Enhancing the effectiveness of current pain relief strategies is a persistent clinical challenge. Although transcutaneous electrical nerve stimulation (TENS) is used in various painful conditions, its effectiveness may decline over time, requiring additional pain management strategies. Immersive virtual reality (VR) with personalized visuo-tactile stimulation has demonstrated analgesic properties. Nevertheless, whether visuo-tactile stimulation can enhance the pain-relieving outcomes of TENS and its underlying neurophysiological mechanisms remains largely unknown.
Objective:
We investigated whether the integration of visuo-tactile stimulation with TENS can enhance the pain-relieving outcomes of TENS alone, and we also aimed to explore the brain mechanisms underlying the analgesic effect of this integrated intervention.
Methods:
Seventy-five healthy participants were enrolled and randomly assigned to one of three groups: congruent TENS-VR (TENS-ConVR) and two control groups (incongruent TENS-VR (TENS-InVR) and TENS alone). In the context of TENS-ConVR, we combined TENS and VR by connecting TENS-induced paresthesia with personalized visual bodily feedback. The visual feedback was designed to align with the spatiotemporal patterns of the paresthesia induced by TENS. A pain rating task and a 32-channel electroencephalography (EEG) was applied.
Results:
Two-way analysis of variances showed that TENS-ConVR exhibited a statistically greater reduction in pain rating (F1,48 = 6.84, p = 0.011) and brain responses (F1,48 = 5.69, p = 0.021) to pain stimuli before and after stimulation than TENS alone. The reduction of brain activity was stronger in participants who reported stronger pain-relieving. The TENS-ConVR reduced the brain oscillation in the gamma band, whereas this result was not found in the TENS alone.
Conclusions:
Our study observed that combining TENS and visual stimulation in a single solution could enhance the pain-relieving effect of TENS, which has the potential to improve the effectiveness of current pain management treatments.
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