JMIR Publications

ABSTRACT

Background:

Chronic pain management is optimized with a multidisciplinary biopsychosocial treatment approach. However, patients have limited access to comprehensive care that includes behavioral medicine for chronic pain. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapeutic with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations.

Objective:

The primary goal of this study was to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based cognitive behavioral treatment for chronic pain. The secondary goal was to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary goal was to conduct a randomized controlled trial to compare the VR treatment to an audio-only treatment; this comparison isolated the immersive effects of the skills-based VR program, thereby informing potential mechanisms of effect.

Methods:

We conducted a randomized controlled trial involving an online convenience sample of adults (N=97) 18-65 years of age with self-reported chronic non-malignant chronic low back pain or fibromyalgia with an average pain intensity > 4 over the past month, and chronic pain duration > 6 months. Enrolled participants were randomly assigned to one of two treatment groups: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) Audio: an audio-only version of the 21-day VR program. The analytic dataset included participants who completed at least one of eight surveys administered during the intervention period: VR (n=39) and Audio (n=35).

Results:

The VR group launched a total of 1047 sessions vs. 946 sessions for Audio group. The majority of VR participants (76%) reported no nausea or motion sickness. High satisfaction ratings were reported for both groups (84% for VR and 72% for Audio). For VR efficacy, we observed a significant declining trend in for each pain variable over time (all P<.001) with results strengthening after two weeks. Comparing VR to Audio, we found significant time x group effects for average pain intensity (P= .036), and pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003), with significant reductions in pain catastrophizing and pain self-efficacy for both groups. Overall, results suggest that immersive VR yields superior treatment effects relative to audio only content.

Conclusions:

High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability for at-home skills-based VR for chronic pain. Significant reduction in pain outcomes over the course of the 21-day treatment both within VR group and compared to an audio-only version suggests VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.