How Zina Trost is Using Virtual Reality to Ease Pain from Spinal Cord Injuries

While virtual reality (VR) is commonly associated with gaming and entertainment, Dr. Zina Trost, associate professor in the Department of Psychological and Brain Sciences at Texas A&M University, reimagined it to help relieve patients suffering from neuropathic pain caused by spinal cord injuries.  

Trost is a clinical health and rehabilitation expert, whose research focuses on the study of pain and physical injury, specifically how people tend to cope with these challenges and ways that support their recovery.  

An aspect of this research investigates how virtual reality can help people through rehabilitation and recovery. Trost was first introduced to the idea of using VR at the University of Washington Medical Center during her residency where she observed the center’s use of VR for pain management, particularly in children undergoing burn debridement. The center hospital utilized a VR experience called “Snow World,” which immersed children into a different environment to distract them from their pain. 

That experience inspired Trost to begin incorporating VR into her own research and case studies. Today, she leads and is part of 11 ongoing virtual reality projects funded by the Congressionally Designated Medical Resarch Program, the VA, Australian government, and TAMU, including her current Randomized Clinical Trials of a virtual walking experience. Her work challenges the ways in which people view the technology and how it can also be used to aid in pain relief and recovery.  

Trost’s research uses VR in several innovative ways. She studies how we can use VR to change the way people perceive their own physical abilities. By creating an immersive and interactive environment, she helps show patients that the movements and therapies required of them are much more doable than they might believe. 

“For example, if I have someone with a high-level spinal cord injury and I need them to practice a movement of pinching together their two fingers, a task which is critical to function but repetitive, boring, and challenging, I look at ways in which I can use VR to motivate them into making the movement,” Trost said. “By gamifying the experience and using the visual elements offered by VR, we can motivate participants through their recovery process.” 

One of the major uses of VR is to use the brain's susceptibility to visual feedback. Much like mirror therapy used for phantom limb pain, where the mirror tricks the brain into seeing a limb that is no longer there to help with pain relief, VR uses a similar logic. By creating an illusion, VR can trick the brain into perceiving a body part as fully functional, which in turn helps relieve pain. 

Trost’s research also explores the way in which we can use VR to evoke emotional responses in individuals recovering from opioid overdoses. Similarly, by transporting them into new realities, she — together with colleague Dr. Brian Albanese — aims to inspire hope in those who might suffer from suicidal thoughts. 

Neuropathic pain following spinal cord injury differs from typical pain; it isn’t caused by external catalysts like stubbing your toe. Instead, it arises from the brain sending signals that create a burning, stabbing and shooting electric pain. The intensity of the pain can be so extreme that many individuals have been known to go to extreme lengths to find relief—with some even severing their spinal cord above the original injury in hopes of reducing their suffering.  

“We believe neuropathic pain from spinal cord injuries is similar to phantom limb pain,” said Trost. “The brain is sending out signals to move a body part that is no longer responsive, and when the brain gets no feedback, it results in the brain getting frustrated, causing it to act out in dysfunctional ways.” 

In the past, it was reported that there was no cure for this pain; it was shown to be minimally responsive to any type of medication, therapy or hypnosis. That changed when research started showing the use of VR as a source of neuropathic pain relief. 

Two trials that Trost is conducting are virtual walking experiences for people with spinal cord injuries, a way to relieve the participants of the neuropathic pain caused by their injuries. While the two studies share similar goals and have similar procedures, they involve distinct groups of participants: one group has complete spinal cord injuries, meaning no sensation or motor control below their injury; the other group has incomplete spinal cord injuries with some motor or sensory function remaining.  

“My goal through the study is to try and provide some sort of relief to this pain caused by their injuries — a pain that 60% to 80% of those with spinal cord injuries experience,” said Trost.  

The virtual walking therapy study created by Trost utilizes the visual feedback that the body is fully functional. The participant is placed into an illusion created by VR, in which they are in a standing position and able to walk through a virtual environment with the goal of collecting game coins. In the simulation, participants are able to personalize their avatars, including their clothing, shoes and skin color.  

With the participants wearing a VR headset, they can see their legs moving, their shadows walking beside them and their arms swinging with their movement. This illusion convinces the brain that the participants' body is standing and walking, helping to calm the neural confusion and reduce neuropathic pain. 

“Research suggests that this illusion of walking can affect SCI neuropathic pain similarly to the way mirror therapy affects limb pain ” said Trost. “My colleagues and I collaborated with people who have spinal cord injuries, to make the virtual experience more realistic and authentic.”  

The study results have so far been promising. Participants have reported a noticeable relief from their chronic pain and even MRI results taken before the experience compared to those from after, were able to see a substantial positive increase in the level of GABA in the brain. Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the central nervous system and is substantially lower in people with neuropathic pain following SCI. 

During the studies, the team recruits participants with a C5 spinal cord injury and below from across the United States and Canada. Each participant experiences 20 5–10-minute VR sessions during a two-week period. They complete questionnaires before and after they finish the intervention, and, if possible, complete MRI imaging. Research funds cover their travel costs and a $450 stipend. 

“Initially we had planned to travel to people’s homes to deliver the VR treatment. But after COVID-19 hit, we started sending headsets directly to participants,” she said. “With guidance from our team via Zoom, participants can do the same thing at home, and we monitor their experience remotely.”  

Working with VR brings about both opportunities and challenges. So far, most of the research done with VR in pain management has focused on acute pain, meaning pain of limited duration, while Trost’s work targets chronic pain. 

“What we don’t yet fully know is how to use VR to help those with chronic pain, which is pain that will not go away, and is a significant risk factor for suicide,” she said. “There are still so many unknowns in the area of VR and chronic pain research, and my goal is to try and reduce some of that uncertainty.” 

Trost hopes that her research will make a meaningful contribution to the lives of people with chronic pain, and that someday VR pain management will become accessible to everyone. 

“I want to give people with chronic pain hope,” said Trost. “That one day in the future, there will be a way for people to manage their pain and experience real relief.” 

View the full photo gallery to get an inside look at Trost's research lab and team.