Sustained symptom reduction in complex regional pain syndrome with a novel home-based virtual reality program: a pilot study

BACKGROUND: Complex regional pain syndrome (CRPS) often leads to limb disuse, pain catastrophizing, and depression. While physical movement of CRPS affected limbs is essential for improvement, pain discourages movement. Home-based virtual reality (VR) interventions may reduce movement-related pain, improve adherence, and promote sustained symptom reduction. METHODS: In this exploratory pilot study, seven patients with CRPS completed a 4-month home-based VR program integrating three treatment modules (1) embodied cyberhands VR physical movement treatment, (2) VR-mindfulness-based-stress-reduction, and (3) VR-pain-neuroscience-education. The primary outcomes were patient-reported global impressions of change in CRPS-related pain and physical ability. Secondary outcomes included central sensitization, cold sensitivity, depression, pain catastrophizing, and upper-limb function. RESULTS: On the primary outcome global impression of change measures, six of seven patients reported sustained improvement in CRPS-related pain and physical ability, with three reporting being "much" or "very much" improved at 4 months. Gains were maintained at 1-year follow-up. Secondary outcomes showed significant improvements at 4 months: central sensitization (CSI: 46.7 ± 11.97 to 38.4 ± 11.53), cold pain threshold (27.12 °C ± 3.89 to 24.56 °C ± 5.56), depression (CES-D: 23.0 ± 11.27 to 15.6 ± 8.85), pain catastrophizing (PCS: 24.3 ± 11.06 to 15.1 ± 9.67), and upper-limb function (QuickDASH: 47.7 ± 20.43 to 34.8 ± 17.47). Improvements were sustained at 1-year follow-up. No serious adverse events occurred, and study adherence was 100%. CONCLUSION: Results provide preliminary evidence that a home-based VR program may produce sustained improvements in CRPS-related pain, physical ability, and associated symptoms. Larger randomized controlled trials are recommended. CLINICAL TRIAL REGISTRATION: The study was registered on September 21, 2024, with the identifier number NCT05888142.