Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Abstract

Digital therapeutics (DTx, mobile medical apps, software as a medical device) are rapidly emerging as clinically effective treatments for diverse chronic diseases. For example, the Food and Drug Administration (FDA) has recently authorized a prescription virtual reality (VR) app for treatment of moderate to severe low back pain. The FDA has also approved an adjunct digital therapy in conjunction with buprenorphine for opioid use disorder, further illustrating opportunities to integrate digital therapeutics with pharmacotherapies. There are ongoing needs to disseminate knowledge about advances in digital interventions among health care professionals, policymakers, and the public at large. This mini-review summarizes accumulating clinical evidence of digital interventions delivered via virtual reality and mobile apps to improve opioid-based analgesia. We identified relevant randomized controlled trials (RCTs) using Embase and PubMed databases which reported pain scores with a validated pain scale (e.g., visual analog scales, graphic rating scale, numeric rating scale) and use of a digital intervention in conjunction with opiates. Among identified RCTs, the majority of studies reported improved pain scores in the digital intervention group, as compared to “treatment as usual” group. Our work suggests that VR and mobile apps can be used as adjunct digital therapies for pain management. We discuss these findings in the context of how digital health technologies can transform patient-centered pharmacy care.

Digital health in pain assessment, diagnosis, and management: Overview and perspectives

“…Virtual reality has demonstrated significant pain reduction effects, as have cognitive-behavioural interventions using online modules, especially when therapist interventions are included ( 21 ). Digital therapeutics have been successfully used to complement treatment in opioid use disorder ( 22 ), including an app that assists patients decrease and manage their opioid use ( 23 ). A review of published research on the impact of digital interventions on opioid-based treatment programmes found 9 studies that met the criteria of RCTs.…”

“…The majority of this research focused on virtual reality apps. Eight of the 9 studies found a significant decrease in pain indicating a clear significant impact of digital health interventions in pain management or opioid use reduction ( 22 ).…”

“…VR is developing quickly as an effective form of digital therapeutic as the technology and content improves. The “SnowWorld” virtual reality video game that assisted burn patients with pain is an often-cited example ( 22 ), as is “SpiderWorld” ( 28 ). Recently, the Food and Drug Administration has approved an applied VR app called RelieVR for treating back pain ( 29 , 30 ).…”

“…In order for digital health interventions to be widely accepted and used in pain management, there is a need to demonstrate scalability, raise awareness among healthcare professionals, the public, policy makers (and legislators) and insurers ( 22 ). While Covid-19 provided some of this opportunity, the evidence-based efficacy of interventions beyond telehealth and app-based information sharing is necessary.…”

A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design

“…Most of the interventions described in these reviews are web-based interventions and often include some degree of clinician support. A variety of digital interventions have been designed to support people with chronic pain, including texting interventions [69], the use of smartphone-based chatbots [70,71], and more sophisticated technologies such as virtual reality [72,73]. However, to our knowledge, no published studies have described mHealth interventions developed specifically to support people with chronic pain to reduce their reliance on opioids.…”