Design of Immersive Virtual Reality Systems and Their Application in Zoster-Associated Pain Following Pulsed...

Herpes zoster-associated neuropathic pain (ZAP) is a complication of herpes zoster that encompasses the acute, subacute, and chronic phases of the disease. ZAP is characterized by severe and persistent pain, which substantially compromises patients' quality of life. Given the well-recognized limitations of currently available pharmacological and interventional therapies, there is a pressing need to identify additional effective and safe treatment modalities. The present study therefore aims to evaluate the rehabilitative efficacy of pulsed radiofrequency (PRF) neuromodulation combined with a proprietary immersive virtual reality (IVR) system in patients with zoster-associated pain (ZAP), and to compare its effects with those of PRF combined with relaxation VR therapy. This trial is designed as a single-center, parallel-group, randomized controlled trial. A total of 80 patients with postherpetic neuralgia will be enrolled and randomly assigned in a 1:1 ratio to either the experimental group or the control group using a simple randomization procedure. The primary outcome measure will be pain intensity, assessed using the Numerical Rating Scale (NRS). Secondary outcomes will include the Pittsburgh Sleep Quality Index (PSQI), the Hospital Anxiety and Depression Scale (HADS), and the Short Form 12 Health Survey (SF 12). Outcomes will be assessed at five time points: at baseline (admission), immediately after completion of PRF, at discharge, and at 1 month and 2 months post-discharge. Statistical analyses will be performed using generalized estimating equations (GEE). The primary endpoint of this study was defined as the difference in pain intensity (NRS score) between the two groups at the 2-month follow-up. The entire study will be designed and conducted in strict accordance with the SPIRIT guidelines, and all adverse events will be systematically documented throughout the study. To the best of our knowledge, this randomized controlled trial is the first to investigate the combination of PRF neuromodulation and immersive virtual reality (IVR) for the management of ZAP. Should the anticipated efficacy be confirmed, the findings of this study will provide a promising rehabilitative strategy and contribute to improving clinical outcomes for patients with this refractory pain condition.