JMIR Publications

ABSTRACT

Background:

Chronic pain management in public health services often struggles with limited engagement, emotional burden and long-term medication use. While extended reality (XR) has shown promise in specialized settings, evidence supporting its real-world implementation in routine primary care remains limited.

Objective:

This paper aims to assess the feasibility and usability of REDOCVR, an XR-supported psychoeducational program, and to examine exploratory clinical outcomes during its integration into group-based chronic pain services in public primary care centers (PCCs).

Methods:

A nonrandomized, hybrid type 2 implementation-effectiveness study was conducted across three PCCs in Catalonia, Spain. Adults with chronic pain (n=42) participated in 8 weekly group sessions led by psychologists and physiotherapists. The intervention embedded 15–20 minutes of co-designed immersive virtual reality (VR) and augmented reality (AR) content per session, targeting mindfulness, cognitive reframing, and motor activation. A supervised medication tapering protocol was included in later groups. Primary outcomes were implementation measures (adherence, tolerability, System Usability Scale [SUS], satisfaction). Secondary outcomes included patient-reported clinical measures (Warwick-Edinburgh Mental Well-being Scale [WEMWBS], Hospital Anxiety and Depression Scale [HADS], Central Sensitization Inventory [CSI], EQ-5D-5L) and medication changes, assessed at baseline, post-intervention, and 5-month follow-up.

Results:

A total of 42 participants were enrolled, with 36 (85.7%) completing the intervention and all assessments. Adherence was high, and no serious adverse events were reported. Patient-reported usability was strong (mean SUS score 81.4), while professional usability was moderate (mean SUS score 73.8). Significant improvements were observed in emotional well-being (WEMWBS; Cohen’s d = 0.86), anxiety (HADS-A; d = 0.66), and depression (HADS-D; d = 0.62) (all p < 0.001). Among participants in the tapering protocol (n = 22), mean medication use at 5 months decreased for benzodiazepines (–71.7%) and opioids (–41.8%).

Conclusions:

Integrating XR into established primary care group programs for chronic pain proved feasible and safe, and was acceptable to both patients and professionals. The intervention was associated with statistically significant improvements in emotional well-being and in symptoms of anxiety and depression, as well as reductions in the use of high-risk medications under a supervised tapering protocol. These exploratory findings highlight the potential of XR to strengthen routine nonpharmacological pain care and support progression to larger controlled trials to evaluate scalability and long-term effectiveness. Clinical Trial: ClinicalTrials.gov NCT06361706; http://clinicaltrials.gov/ct2/show/NCT06361706 and NCT06964360; http://clinicaltrials.gov/ct2/show/NCT06964360