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Principal Investigator: Luana Colloca
Organization: UNIVERSITY OF MARYLAND BALTIMORE
Fiscal Year: 2024
Award: $614,581
Funding agency: National Center for Complementary and Integrative Health
Summary
The COVID-19 pandemic and its effect on the opioid crisis have created a pressing need for telemedicine and
consideration for use of non-pharmacological, low cost interventions as adjuvants in pain management arsenal.
We propose a project investigating neural mechanisms underlying pain reduction induced by immersive Virtual
Reality (VR). VR consists of immersion in artificial environments through the use of real-time rendering
technologies and latest generation devices. We have recently demonstrated that VR increases pain tolerance
limits and vagal activity with a parallel improvement in individual pain unpleasantness, mood, and situational
anxiety. To enhance the translatability of this project, we will directly dive into the neural mechanisms of VR in
chronic pain participants suffering from Temporomandibular Disorder(s) (TMD), a population with which the PI
and her collaborators have had fruitful results. The overarching goal is to investigate the pain modulation
mechanisms underlying VR-induced hypoalgesia by determining 1) the involvement of endogenous mu opioids,
2) the relationship between responsiveness to acute VR and long-term pain-related outcomes, and 3) the
changes in cortical excitability related to 3-week VR. We will use three main approaches: 1) a pharmacological
antagonist approach, 2) An ecological momentary assessment (EMA) for tracking dynamics of pain outcomes
over 6 months; and 3) a high-resolution electroencephalography to measure synchronization of peak alpha
frequency (PAF). We will disentangle the mechanisms of VR-induced hypoalgesia from placebo effects among
participants with distinct disabilities and grades of TMD. We expect that 1) VR, similar to placebo effects, will
reduce pain through the engagement of endogenous opioid systems, 2) VR-induced pain modulation capability
will result in better long-term pain outcomes, and 3) 3-week VR will favor a synchronization of PAF oscillations
paralleled by individual VR therapeutic benefits. This project will combine pharmacologic, the EMA, and
electroencephalographic techniques employed within TMD patients to maximize the translational value of the
resulting knowledge. The team has a history of successful collaboration and the expertise to generate innovative,
relevant, and timely findings. The successful completion of this research will generate mechanistic-based
evidence for the potential application of VR-based interventions which might empower TMD patients with new,
accessible, and affordable therapeutic solutions.
Terms: <Absence of pain sensation><Absence of sensibility to pain><Acute><Adjuvant><Affect><Analgesia Tests><Anxiety><Behavioral Mechanisms><Brain><Brain Nervous System><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Categories><Chronic><Classification><Clinical><Collaborations><Consensus><Controlled Environment><Devices><Diagnosis><EEG><Ecological momentary assessment><Electroencephalogram><Electroencephalography><Encephalon><Esthetics><Feels no pain><Frequencies><Future><General Population><General Public><Generations><Goals><Health Care Providers><Health Personnel><Healthcare Providers><Healthcare worker><History><Immersion><Individual><Intervention><Intervention Strategies><Investigators><Maryland><Measurement><Measures><Mechanisms of Behavior and Behavior Change><Methods><Modeling><Monitor><Moods><Naloxone><Narcan><Narcanti><No sensitivity to pain><Nociception Tests><Non-pharmacologic Therapy><Nonpharmacologic Intervention><Nonpharmacologic Therapy><Nonpharmacologic approach><Nonpharmacologic treatment><Normalcy><Normalities><Opiates><Opioid><Orofacial Pain><Outcome><Pain><Pain Assessment><Pain Control><Pain Measurement><Pain Therapy><Pain Threshold><Pain Tolerance Level><Pain management><Pain measure><Painful><Participant><Patients><Pattern><Phenotype><Placebo Effect><Placebos><Population><Proxy><Recording of previous events><Research><Research Personnel><Researchers><Resolution><Rest><Risk><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Schools><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Sham Treatment><Shapes><Site><Stimulus><System><Systematics><TMJ Diseases><TMJ Disorders><TMJD><Techniques><Technology><Telemedicine><Temporomandibular Disorders><Temporomandibular Joint Diseases><Temporomandibular Joint Disorders><Temporomandibular Joint and Muscle Disorder><Therapeutic><Time><Universities><analgesia><antagonism><antagonist><artificial environment><associated symptom><behavior mechanism><biobehavior><biobehavioral><chronic pain><chronic pain patient><co-morbid symptom><co-occuring symptom><cognitive function><cohort><comorbid symptom><concurrent symptom><cooccuring symptom><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><design><designing><disability><empowerment><endogenous opiate><endogenous opioids><evidence base><expectancy effect><expectation effect><experience><health care personnel><health care worker><health provider><health workforce><healthcare personnel><histories><immersive digital environment><immersive environment><immersive virtual environment><immersive virtual reality><improved><information processing><innovate><innovation><innovative><intervention cost><interventional strategy><knowledge of results><medical personnel><mu opioid receptors><multisensory><neural><neural information processing><neural mechanism><neuromechanism><nocebo><non-drug therapy><non-drug treatment><nondrug therapy><nondrug treatment><normality><novel><opiate crisis><opioid crisis><opioid epidemic><oral facial pain><pain assay><pain outcome><pain reduction><pain tolerance><pain treatment><pain-related outcome><patient with chronic pain><pharmacologic><placebo analgesia><placebo response><predict clinical outcome><prospective><reduce pain><resolutions><responders and non-responders><responders from non-responders><responders or non-responders><responders versus non-responders><responders vs non-responders><responders/nonresponders><response><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><sham therapy><social role><standard of care><symptom association><symptom comorbidity><systematic review><treatment provider><virtual reality><virtual reality environment><virtual reality intervention><virtual reality-based intervention><μ opioid receptors><μ-OR><μOR>