Effects of virtual walking on spinal cord injury-related neuropathic pain: A randomized, controlled trial.

Purpose: This study is an examination of the efficacy of a virtual walking protocol to treat spinal cord injury (SCI)-related pain. Method: A total of 59 individuals with SCI and neuropathic pain (NP) were randomly assigned to receive 20 min of virtual walking, the treatment condition, or virtual wheeling, the control condition. Although having NP was a requirement to participate in the study, participants also underwent pain classification of up to 3 worst pain sites to also examine the effects of virtual walking on nonneuropathic pain. Pain outcomes included changes in pain severity across all pain types, NP unpleasantness, and severity of various sensory qualities of NP. Design: This was a randomized, controlled, single-blinded trial. Results: There was no significant difference in change in pain between groups, though there was a significant pre- to posttreatment reduction across all pain types in the virtual walking condition, but not the control condition. Specific to NP, there was a significant reduction in pain unpleasantness, but not neuropathic pain intensity. NP experienced as "cold," "deep," and with increased skin sensitivity were significantly reduced following virtual walking compared with the control condition. Conclusion: Results from this trial suggest that virtual walking treatment may benefit certain aspects of NP, such as associated unpleasantness, as well as certain sensory qualities of that pain. Efficacy of this treatment modality to reduce overall pain severity remains unclear, and may be modulated by other injury, individual, or personality characteristics. Impact and Implications In the current study, we examined the efficacy of a brief, virtual walking session to treat spinal cord injury (SCI)-related pain using a randomized, controlled, single-blind methodology. This methodology has not been previously used to investigate first-person view of virtual walking specifically to treat SCI-related pain. Although repeated sessions may be needed, virtual walking may offer a nonmedication alternative for those with some forms of SCI-related neuropathic pain (SCI-NP). Moreover, virtual walking equipment used in this study can be brought home for those individuals for whom transportation is difficult.