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摘要: 疼痛问题不仅影响个人的身心健康，更对社会造成巨大负担。传统的疼痛治疗措施种类繁多，但各具有其局限性。目前，数字疗法正蓬勃发展，其中虚拟现实技术得到了广泛应用，尤其在疼痛治疗领域展现出较大潜力。虚拟现实技术借助头戴式设备等辅助工具，为使用者构建一个视觉、听觉、嗅觉等多感官参与的三维虚拟世界，从而让使用者产生一种身临其境的感觉。本文围绕虚拟现实技术在疼痛治疗领域的应用及其作用机制进行阐述，以期提高临床医护人员的认识，为疼痛治疗提供新选择。Abstract: Pain not only affects the physical and mental health of individuals, but also imposes a huge burden on society as a whole. Traditional pain management measures are diverse, but each has its limitations. Therefore, there is an urgent need for new tools. Digital therapies are booming, and virtual reality (VR) has been widely used, especially in the field of pain management. VR uses assistive tools, such as headsets, to build a three-dimensional virtual world with the participation of multiple senses, including vision, hearing, and smell, so that it can make user feel being there. This review aims to summarize the application and mechanism of VR in the field of pain management, with the hope of making VR a new choice for pain management.
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Key words:
- pain /
- chronic pain /
- virtual reality /
- digital therapeutics
作者贡献：吴辰负责查阅文献、撰写论文；刘栩铭、张珂浦、王腾悌负责整理资料；张丽、马超、刘红菊负责提供指导、修订论文。利益冲突：所有作者均声明不存在利益冲突 -
表 1 数字疗法在疼痛领域的应用实例
Table 1. Examples of digital therapeutics in the field of pain
产品名称 企业名称 美国FDA批准年份 应用实例 EaseVRx AppliedVR 2021 基于认知行为疗法的VR设备，通过深度放松、注意力转移、内感受意识、换位思考、分心、沉浸式享受等方法，利用“呼吸放大器”进行深呼吸练习，帮助慢性腰痛患者(≥18岁)减轻疼痛 Nerivio，FGD000075-4.7 Theranica 2021 通过智能手机控制电脉冲的释放，抑制神经信号传递，从而缓解疼痛，为成人和青少年偏头痛的急性和预防性治疗提供选择 Nervio Migra 2019 SPRINT SPR Therapeutics 2018 作为可穿戴疼痛管理设备，应用外周神经刺激系统缓解急性和慢性疼痛 Intellis Medtronic 2017 植入式可充电脊髓电刺激系统，通过刺激脊髓神经以治疗慢性疼痛 Quell Neurometrix 2016 作为一款经皮神经刺激仪，采用安全、精确的电脉冲刺激感觉神经，以触发自然的疼痛缓解反应 FDA(Food and Drug Administration)：食品药品监督管理局；VR(virtual reality)：虚拟现实 
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表 2 VR在疼痛领域的应用研究
Table 2. Study on application effect of virtual reality in the field of pain
文献 设计原则 样本量(n) 试验设计 结论 Tejera[23] 单盲、随机试验 44 将受试者分为两组，一组通过“Fulldive VR”(通过颈部的倾斜来改变取景器中的图像)和“VR Ocean Aquarium 3D”(增加了颈部屈伸和旋转动作，使沉浸在虚拟海洋环境中的患者观察不同的海洋动物)两款应用进行颈部锻炼；另一组接受固定的物理功能锻炼 VR可减少慢性非特异性颈部疼痛患者的疼痛相关运动恐惧 Garcia[24] 双盲、单队列研究 179 将受试者分为两组，一组使用EaseVRx(沉浸式疼痛缓解VR程序)；另一组使用头戴式显示器，提供2D自然内容的VR程序 VR在疼痛治疗方面发挥出色的治疗效果 Deo[25] 前瞻性、随机对照试验 40 将受试者分为两组，一组接受虚拟现实干预(引导式放松体验为观看一段名为“宁静之林”的8 min的视频，该程序模拟了1个宁静的雨林和1个湖泊环境，湖泊里有栩栩如生的野生动物，可使用头戴式追踪器进行探索)；另一组接受标准护理 VR可有效减少门诊宫腔镜检查过程中患者的疼痛和焦虑 Weynants[26] 前瞻性、随机对照试验 166 将受试者分为两组，一组接受VR镇痛；另一组不接受VR镇痛治疗 VR在体外冲击波碎石中可发挥出色的镇痛作用 Merlot[27] 双盲、随机试验 102 将受试者分为两组，一组为Endocare(该程序共20 min，结合了三维VR环境中的听觉和视觉刺激治疗，包括双耳节拍、口头催眠指令、模拟自然声音、注意力分散等)干预组，接受VR治疗；另一组为对照组，使用相同VR设备但无Endocare刺激 对于患有中重度盆腔疼痛的子宫内膜异位症患者，VR是一种有效且安全的方法。此外，还有助于减少患者对止痛药物的依赖程度 Gold[28] 随机对照试验 107 将受试者分为两组，一组为VR干预组(一款虚拟游戏，患者在其中沿着预设的路径穿过一个充满动画景观、建筑和云朵的三维环境，利用视线控制大炮的发射方向，以击倒泰迪熊)；另一组为标准护理组 相较于对照组，VR干预组患者的焦虑和疼痛程度显著降低 VR：同表 1
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