Virtual Reality Protocol Improves Fibromyalgia Symptoms

Alejandro Rubio-Zarapuz, PhD

Credit: LinkedIn

A combination of neuromodulation, virtual reality, and targeted exercises can improve fibromyalgia symptoms, according to a study published in Medicina.¹ This regimen can offer an alternative option for non-pharmacological treatment among this patient population.

The complicated nature of fibromyalgia symptoms requires a multidisciplinary approach, often encompassing both clinical and psychological approaches, including yoga, meditation, and patient education. These treatments may include muscle relaxants, cannabinoids, analgesics, antipsychotic drugs, and antidepressants. Currently, only 1 in 4 patients are able to obtain a 30% improvement in symptoms with strategies such as antidepressents.²

“In the management of fibromyalgia, a condition characterized by widespread musculoskeletal pain, fatigue, and a myriad of other symptoms, a holistic approach that includes both pharmacological and non-pharmacological interventions is paramount,” wrote a team of investigators led by, Alejandro Rubio-Zarapuz, PhD, professor of Sports Medicine at the Universidad Europea de Madrid in Spain. “The initial strategy often recommends prioritizing non-pharmacological interventions, with a particular focus on exercise and dietary modifications, due to their broad-spectrum benefits and minimal side effects.”

The randomized controlled trial evaluated and compared the effects of a variety of treatments in a cohort of patients with fibromyalgia. Treatment included the EXOPULSE Mollii suit with a virtual reality protocol as well as an exercise protocol.

For the patients in the virtual reality cohort, patients were placed in the suit and were given a virtual reality visor (Oculus Go). These patients were then directed to lay down on the massage table facing upwards and were able to see themselves lying down from their point of view in the form of an avatar wearing a comparable suit. During their session, the avatar was given commands and performed movements mimicking the patient. These exercises involved both the upper and lower extremities, performing 2 sets of 10 repetitions with each extremity.

In total, 89 female patients with fibromyalgia were randomly assigned to the suit group (n = 22), exercise group (n = 26), suit and virtual reality combination group (n = 21), or the control group (n = 20).

Results indicated significant differences among groups in several key parameters. Among the controls, there were significant changes in Force Expiratory Volume (FEV 1/FEV 6), the Numeric Rating Scale (NRS) for pain, pressure pain threshold (PPT) at the epicondyle, the 10 m up-and-go test, cortical arousal levels, and all measured variables related to temperature and muscle oxygenation.

Among the suit and virtual reality cohort, there were significant changes in the PPT at the knee, the handgrip and strength test, the 10 m up-and-go test, one-leg balance test with the right leg, the NRS, muscle oxygen saturation (SmO2), deoxygenated hemoglobin (HHb), and oxygenated hemoglobin (O2Hb). Lastly, those assigned to the exercise cohort demonstrated significant differences in FEV 1/FEV 6, NRS, PPT at the epicondyle and knee, cortical arousal, the chair stand test, the 10-m up-and-go test, chest perimeter difference, and in SmO2, HHb, and O2Hb levels.

Investigators highlight the importance of implementing a comprehensive perspective in the management of fibromyalgia, particularly in ongoing research to expand treatment options. They urge future research to assess potential synergies to explore different therapeutic modalities to evaluate their combined effects on the condition’s symptoms as well as the wellbeing of the patient.

“By continuing to investigate and innovate, we can move closer to optimizing treatment strategies for fibromyalgia, ultimately contributing to more effective and personalized patient care,” investigators concluded.

References

1. ^{Rubio-Zarapuz A, Apolo-Arenas MD, Tomas-Carus P, Tornero-Aguilera JF, Clemente-Suárez VJ, Parraca JA. Comparative Analysis of Psychophysiological Responses in Fibromyalgia Patients: Evaluating Neuromodulation Alone, Neuromodulation Combined with Virtual Reality, and Exercise Interventions. Medicina (Kaunas). 2024;60(3):404. Published 2024 Feb 27. doi:10.3390/medicina60030404}
2. ^{Boomershine, C.S.; Crofford, L.J. A Symptom-Based Approach to Pharmacologic Management of Fibromyalgia. Nat. Rev. Rheumatol. 2009, 5, 191–199.}