VR + Nerve Ablation for Chronic Knee Pain

Overseen By Paul Fitzgerald, RN,BSN,MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Northwestern University

Must not be taking: Opioids, Anticoagulants

Disqualifiers: Substance abuse, Seizure disorder, others

Stay on Your Current Meds You can continue your current medications while participating

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 2

Duration: 1 day

62 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether virtual reality during a nerve procedure can reduce knee pain more effectively than sedation alone. It focuses on individuals with chronic knee pain from osteoarthritis who are undergoing genicular RFA, a type of nerve ablation, without previous surgery on that knee. Participants will either use a VR headset to assess its impact on pain and satisfaction or receive standard care without VR. The study aims to determine if VR can enhance pain relief and overall outcomes one month after the procedure. This trial may suit those with long-term knee pain and no prior knee surgeries. As an unphased trial, it offers a unique opportunity to explore innovative pain management techniques.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but if you are on chronic opioid use or anticoagulation therapy that cannot be stopped, you may not be eligible to participate.

What prior data suggests that virtual reality is safe for use during nerve ablation procedures?

Research shows that virtual reality (VR) safely helps manage long-term pain. Studies have found that VR can ease pain by diverting attention from discomfort. For instance, one study reported significant pain relief when using VR for knee pain. Another review highlighted VR as a safe and effective tool for aiding chronic pain recovery.

These findings suggest that VR is generally well-tolerated and has few side effects. VR often complements other treatments, making it a flexible part of pain management plans. Using VR during procedures like nerve ablation might offer extra pain relief without additional risks. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using virtual reality (VR) in combination with nerve ablation for chronic knee pain because it offers a unique approach to managing discomfort. Unlike standard treatments like medications or physical therapy, VR provides a non-invasive way to potentially reduce anxiety and pain perception by immersing patients in a calming virtual environment. This method could enhance the overall experience of nerve ablation, making the procedure more tolerable and possibly improving outcomes. Additionally, VR's potential to act quickly and provide real-time distraction sets it apart from traditional pain management strategies.

What evidence suggests that virtual reality is effective for reducing chronic knee pain?

Research shows that Virtual Reality (VR), which participants in this trial may receive, can help reduce pain during and after medical procedures. Studies indicate that VR can manage ongoing pain and improve the quality of care, potentially reducing the need for medication. For knee pain, VR has been found to lessen pain and improve balance. Additionally, VR therapy strengthens the knee joint and enhances pain levels. Overall, VR is a promising tool for managing pain. ^{2 4 5 6 7}

Who Is on the Research Team?

Jason Ross, MD

Principal Investigator

Northwestern Univesity

Are You a Good Fit for This Trial?

This trial is for individuals experiencing chronic knee pain who are undergoing a specific nerve ablation procedure. Participants should be suitable for sedation and the study will explore if adding virtual reality to their treatment can help with pain.

Inclusion Criteria

My knee X-ray shows signs of osteoarthritis.

I am scheduled for or have had a genicular RFA procedure.

My knee pain averages more than 4 out of 10.

Exclusion Criteria

Secondary gain expected to influence treatment outcomes

Nursing

Individuals without evidence of osteoarthritis on X-ray

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo water-cooled genicular nerve ablation with or without virtual reality as a distraction modality

1 day

1 visit (in-person)

Immediate Post-procedure

Participants are assessed for procedural pain, anxiety, and satisfaction

10 minutes after procedure

Follow-up

Participants are monitored for pain and functional outcomes 1 month after the procedure

4 weeks

1 visit (virtual or in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Virtual Reality

Trial Overview The study is testing the effectiveness of using a virtual reality headset during genicular nerve ablations versus just sedation alone. It aims to see if VR can better manage pain, improve satisfaction, and enhance function and pain outcomes after one month.

How Is the Trial Designed?

Group I: Group #1: Virtual Reality Headset Experimental Treatment 1 Intervention

Group 1 will be assigned to the Virtual Realtity Headset. Participants will wear the headset for at least 10 minutes prior to the planned procedure. Subjects will receive standard procedure. The VR Headset will be removed 10 minutes after the planned procedure.

Group II: Group 2 No Virtual Reality Headset Active Control 1 Intervention

Group 2 will receive standard care without the use of the Virtuality Reality Headset.

Who Is Running the Clinical Trial?

Northwestern University

Lead Sponsor

Trials

1,674

Recruited

989,000+

Published Research Related to This Trial

In a feasibility study involving 14 veterans, a virtual reality (VR) treatment modeled after mirror therapy significantly reduced phantom limb pain (PLP) intensity, with only 28.6% of participants reporting PLP after treatment compared to 57.1% before.

Participants rated the VR treatment highly in terms of helpfulness, realism, and satisfaction, with no adverse experiences reported, indicating that VR could be a safe and effective option for managing PLP.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Virtual Reality Intervention for the Treatment of Phantom Limb Pain: Development and Feasibility Results. Rutledge, T., Velez, D., Depp, C., et al.[2020]

In a study involving 30 participants with chronic pain, a virtual reality application called Cool! significantly reduced pain levels, with a 33% decrease from pre-session to post-session and a remarkable 60% reduction during the session.

All participants experienced some level of pain relief during the VR session, and 33% reported complete pain relief, suggesting that VR could be a promising non-opioid treatment option for chronic pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Impact of Virtual Reality on Chronic Pain. Jones, T., Moore, T., Choo, J.[2022]

A scoping review of 14 randomized controlled trials found that virtual reality (VR) significantly alleviates pain and improves functional capacity in patients with chronic musculoskeletal disorders compared to standard care.

VR treatment also showed notable effectiveness in providing pain relief for burn patients with acute pain, but it was less effective for non-chronic pain conditions like total knee replacements or ankle sprains.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Scoping Review of The Efficacy of Virtual Reality and Exergaming on Patients of Musculoskeletal System Disorder. Lin, HT., Li, YI., Hu, WP., et al.[2020]

Virtual reality (VR) therapy shows promise as an effective treatment for phantom limb pain (PLP), with 14 out of 15 studies reporting reductions in pain scores after VR sessions.

Combining VR therapy with tactile stimulation enhances its effectiveness, leading to greater reductions in PLP compared to VR therapy alone.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of virtual reality for the management of phantom limb pain: a systematic review. Hali, K., Manzo, MA., Koucheki, R., et al.[2023]

A novel virtual reality (VR) method using motion capture from the stump of amputees showed promise in reducing phantom limb pain, with 5 out of 7 subjects in both arm and leg groups reporting sensations of movement and pain relief beyond mere distraction.

This technique demonstrated similar effectiveness to traditional mirror box therapy and is advantageous due to its cost-effectiveness and portability, making it suitable for further home-based trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploratory findings with virtual reality for phantom limb pain; from stump motion to agency and analgesia. Cole, J., Crowle, S., Austwick, G., et al.[2022]

A systematic review of 46 studies involving 1456 participants found that virtual, augmented, or mixed reality (VR/AR/MR) technology improved pain-related outcomes in 78% of randomized controlled trials (RCTs) for individuals with chronic pain.

Most positive effects were observed immediately or up to one month after treatment, highlighting the need for further RCTs to evaluate long-term benefits and accessibility for those facing pain management disparities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use and efficacy of virtual, augmented, or mixed reality technology for chronic pain: a systematic review. Matthie, NS., Giordano, NA., Jenerette, CM., et al.[2023]

Virtual reality (VR) therapies have shown promise in effectively distracting patients from both acute and chronic pain, suggesting a new approach to pain management beyond traditional methods like opioids and physical therapy.

Clinical studies indicate that VR can be beneficial for various pain conditions, including fibromyalgia and phantom limb pain, by immersing patients in interactive environments that reduce their perception of pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual Reality as a Clinical Tool for Pain Management. Pourmand, A., Davis, S., Marchak, A., et al.[2018]

Virtual reality (VR) has been found to be an effective method for reducing both acute and chronic pain, with significant improvements in pain intensity (72.1%) and quality (75.0%) observed across 70 studies involving 4105 participants.

The primary mechanism of pain relief through VR is distraction, especially for acute pain, while embodiment is more commonly associated with chronic pain, indicating that different types of pain may benefit from tailored VR approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The State of Science in the Use of Virtual Reality in the Treatment of Acute and Chronic Pain: A Systematic Scoping Review. Baker, NA., Polhemus, AH., Haan Ospina, E., et al.[2023]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39159449/

Immersive and Nonimmersive Virtual Reality-Assisted ... Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD -8.15, 95% CI -15.29 to - ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12064964/

The Efficacy of Virtual Reality on the Rehabilitation of ... In cases of knee joint pain, VR significantly reduces pain and improves balance but shows no significant difference compared to traditional rehabilitation in ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S1297319X24000800

Virtual reality as a treatment for chronic musculoskeletal ... Virtual Reality (VR) applications have demonstrated effectiveness in reducing pain, both during and after interventions, and in chronic conditions such as ...

4. frontiersin.org frontiersin.org/journals/physiology/articles/10.3389/fphys.2024.1424815/full

Efficacy of virtual reality exercise in knee osteoarthritis ... Our study results indicate that VR-based exercise therapy can improve pain and WOMAC scores while enhancing knee joint muscle strength, although ...

5. scientificarchives.com scientificarchives.com/article/virtual-reality-in-chronic-pain-rehabilitation-a-systematic-review

Virtual Reality in Chronic Pain Rehabilitation: A Systematic ... VR interventions are efficacious complementary methods for managing chronic pain, increasing the quality of care, and potentially reducing drug intake.

6. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/35750655/

The feasibility and effectiveness of virtual reality meditation ... Results suggest that VR meditation had significant moderate to large analgesic effects on knee pain intensity, primarily during VR (d = 1.10) and post VR (d = ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12283739/

Virtual reality for the management of musculoskeletal pain Deep immersion into a virtual environment can effectively divert attention from painful stimuli, promoting analgesic and anxiolytic effects (4).