Phantom limb pain (PLP) represents a significant challenge after amputation. This study investigated the use of phantom motor execution (PME) and phantom motor imagery (PMI) facilitated by extended reality (XR) for the treatment of PLP. Both treatments used XR, but PME involved overt execution of phantom movements, relying on the decoding of motor intent using machine learning to enable real-time control in XR. In contrast, PMI involved mental rehearsal of phantom movements guided by XR. The study hypothesized that PME would be superior to PMI. A multicenter, double-blind, randomized controlled trial was conducted in 9 outpatient clinics across 7 countries. Eighty-one participants with PLP were randomly assigned to PME or PMI training. The primary outcome was the change in PLP, measured by the Pain Rating Index, from baseline to treatment cessation. Secondary outcomes included various aspects related to PLP, such as the rate of clinically meaningful reduction in pain (CMRP; >50% pain decrease). No evidence was found for superiority of overt execution (PME) over imagery (PMI) using XR. PLP decreased by 64.5% and 68.2% in PME and PMI groups, respectively. Thirty-seven PME participants (71%) and 19 PMI participants (68%) experienced CMRP. Positive changes were recorded in all other outcomes, without group differences. Pain reduction for PME was larger than previously reported. Despite our initial hypothesis not being confirmed, PME and PMI, aided by XR, are likely to offer meaningful PLP relief to most patients. These findings merit consideration of these therapies as viable treatment options and alternatives to pharmacological treatments.

中文翻译：

---

扩展现实用于治疗幻肢痛：一项多中心、双盲、随机对照试验。


幻肢痛（PLP）是截肢后的一个重大挑战。本研究调查了使用扩展现实 (XR) 促进的幻象运动执行 (PME) 和幻象运动想象 (PMI) 来治疗 PLP。两种治疗均使用 XR，但 PME 涉及公开执行幻觉运动，依赖于使用机器学习对运动意图进行解码，以实现 XR 中的实时控制。相比之下，PMI 涉及 XR 引导下的幻象运动的心理演练。该研究假设 PME 优于 PMI。一项多中心、双盲、随机对照试验在 7 个国家的 9 个门诊诊所进行。 81 名 PLP 参与者被随机分配接受 PME 或 PMI 培训。主要结果是 PLP（通过疼痛评级指数测量）从基线到停止治疗的变化。次要结局包括与 PLP 相关的各个方面，例如具有临床意义的疼痛减轻率（CMRP；>50% 疼痛减轻）。没有发现证据表明使用 XR 的公开执行 (PME) 优于图像 (PMI)。 PME 和 PMI 组的 PLP 分别下降了 64.5% 和 68.2%。 37 名 PME 参与者 (71%) 和 19 名 PMI 参与者 (68%) 经历过 CMRP。所有其他结果均出现积极变化，没有组间差异。 PME 的疼痛减轻程度比之前报道的要大。尽管我们最初的假设尚未得到证实，但在 XR 的帮助下，PME 和 PMI 可能会为大多数患者提供有意义的 PLP 缓解。这些发现值得考虑将这些疗法作为可行的治疗选择和药物治疗的替代方案。