Effect of Virtual Reality and Trans Auricular X-Vagus Nerve Stimulation for Anxiety and Depression in Chronic Shoulder Pain Patients

Exclusion Criteria

• •History of significant neurological or psychiatric conditions unrelated to chronic pain (e.g., epilepsy, psychosis, schizophrenia).
• •Skin lesions or piercing or extensive tattooing of the concha or Skin disease: infection, eczema or cancer of the ears or skin in region where VR headset or taVNS would sit
• •Presence of active implants (e.g. cochlear implant, implanted vagus nerve stimulator, cardiac pacemaker, implantable cardioverter defibrillator (ICD) deep brain stimulations or spinal cord stimulators, ventriculoperitoneal (VP) shunt).
• •Inability to tolerate VR (e.g., severe motion sickness, vertigo or balance issues, claustrophobia).
• •Fear of heights
• •Active infections, significant trauma, or other acute conditions affecting the shoulder.
• •Pregnancy and women trying actively to conceive
• •Pre-existing Persistent post-surgical pain-(\>6 months) from surgeries other than shoulder replacements
• •On- going alcohol and/ or drug problem
• •Widespread chronic pain conditions (fibromyalgia, complex regional pain syndrome)
• •Involvement in any clinical studies within the last 28 days prior to assessment
• •Other therapies such as other psychological interventions for A/D and pain in the shoulder are not allowed for the period of the study and follow up unless there is a psychiatric emergency. Participants may also not be involved in any trial on pain management or related to shoulders while participating in this VR/VNS trial.