Ask an answerable question (PICO)：
Neuropathic pain is defined as ‘pain caused by a lesion or disease of somatosensory nervous system.’ It is a common complication of patients with spinal cord injury. The nature of the pain includes electrical sensation, burning sensation, freezing sensation, etc. Clinically, drugs or percutaneous electrical stimulation were used to control pain, but the effect is limited. At present, that the use of virtual reality in amputation or stroke patients can relieve neuropathic pain, based on which the author wants to investigate whether virtual walking could also apply on spinal cord injury patients to relieve their neuropathic pain. Therefore, the clinical question has arisen: Whether using virtual reality can reduce neuropathic pain in spinal cord injury patients.
The Method and Analysis of Literature Review：
Systematic literature review used to search for articles published in the domestic and foreign countries using virtual reality to improve and treat neuropathic pain in patients with spinal cord injury. The participants are spinal cord injury patients with neuropathic pain. Intervention measures are various virtual reality applications, including various virtual walking/wheelchair sliding, augmented reality (AR), etc., and will be evaluated after treatment whether neuralgia has improved. Using keywords such as P: spinal cord injury, I: virtual reality, O: neuropathic pain, etc., and used Boolean logic to search in databases. Including PubMed, CINAHL, The Cochrane Library and Airiti Library. The language has limited to English. After searching for articles in the past five years, a total of 30 articles were found. After reviewing the title, abstract and full text, two articles were included, RCT and SR, respectively.
Critical Appraisal：
RCT and SR were appraised using the appraisal sheet of Oxford Center for EBM (Oxford center for EBM, 2011), and the results of the two levels of evidence were Level 2. RCT is based on six risk of bias (RoB), included randomized Allocation concealment, blinding of participants and personnel Incomplete outcome data assignment. Among them, there are two unclear risks, which have a limited impact on the quality of the research.
The systematic review was based on precise searching strategy, the criteria used to select articles for inclusion is appropriate, there are sufficient evidence to present the quality of research, and whether the results were integrated for evaluation. Because the included literature has a low average level and only one RCT, it has degraded to Level 2.
Results, Conclusions and Recommendations：
The short-term use of virtual walks can relieve pain because of the shift of attention; in the medium and long-term, it is because of the reorganization of the sensory cortex to reduce the pain. Based on the literature, the application of virtual walks can improve neuropathic pain in patients with spinal cord injury, and the combined use of transcutaneous electrical stimulation may help reduce neuropathic pain more effectively. The virtual reality masks become easy to obtain nowadays. It can used with mobile phones and allows patients to use at home for a lengthy period of time, achieving medium and long-term analgesic effects.
