JMIR Publications

ABSTRACT

Background:

High-impact chronic pain (HICP) involves substantial interference in functioning, affects 8.5% of the population, and is associated with higher healthcare costs relative to lower-impact chronic pain (LICP). Asynchronous behavioral options such as virtual reality (VR) can offer scalable and accessible treatment but testing is needed to ensure durable effectiveness in HICP. We recently conducted a secondary analysis of the largest real-world dataset for therapeutic Skills-Based VR vs Sham VR to test treatment efficacy in HICP vs. LICP. Relative to LICP, we found significantly larger (and clinically meaningful; i.e., 2+ point) pain interference and pain intensity reductions for HICP at end-of-treatment and 1-year post-treatment. End-of-treatment reduction in pain interference reclassified 70% of HICP participants as LICP, and this improvement held at 1-year post-treatment (67%).

Objective:

To examine long-term effectiveness of Skills-Based VR in HICP at 2-years post-treatment and to compare effects with LICP.

Methods:

We conducted a secondary analysis of a randomized controlled trial involving a chronic low back pain sample (N=1067) that was diverse (female: 77%; non-Caucasian: 32%; high school or less education: 19%; mean age: 50.8) and clinically severe at baseline (pain intensity = 6.6, pain interference = 6.2, and 42% severe/completely disabled) to 2-years post-treatment. Using a validated classification approach, Skills-Based VR participants were classified at baseline as either HICP (> 7 Brief Pain Inventory pain interference) or LICP (< 7). Clinical effectiveness was examined using the general linear model at 2-years post-treatment relative to baseline.

Results:

HICP participants reported superior reductions in pain interference, pain intensity, sleep disturbance and physical disability (p-value range: 0.0002 - 0.0001) at 2-years post-treatment compared to LICP. HICP had clinically meaningful (2+ point) reductions in pain interference (3.1±2.7) and pain intensity (2.6±2.6) at 2-years post-treatment. Importantly, reduced pain interference scores at 2-years post-treatment reclassified 71% of the HICP participants (N=106) as LICP.

Conclusions:

A Skills-Based VR therapy was associated with long-term clinically meaningful benefits to 2-years post-treatment, with the greatest benefits observed for HICP. These results suggest that the home-based Skills-Based VR-delivered therapy may be a scalable and durably effective treatment option for patients with high-impact chronic pain. Clinical Trial: ClinicalTrials.gov NCT05263037