Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is 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 aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity &gt;4 over the past month and chronic pain duration &gt;6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (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 data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P&lt;.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P&lt;.001), mood (P&lt;.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that 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.</jats:p> </jats:sec>

Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study

“…Virtual reality (VR) is a newly emerging and promising intervention tool for chronic pain treatment to both distract individuals from their pain and facilitate otherwise painful or feared movements [1,2]. For adults exhibiting a variety of chronic pain conditions-including spine, shoulder, abdominal, hip, musculoskeletal, and neuropathic pain-research has demonstrated the efficacy of VR tools, finding significant reductions in subjective reports of pain both during and after VR sessions [3][4][5][6][7]. VR treatments have also been shown to significantly reduce pain, prompt physiological reactions of relaxation, improve physical functioning, and improve social role functioning for adults with chronic low back pain [8,9].…”

Effectiveness of virtual technologies in relieving pain in patients with rheumatoid arthritis

“…В указанном аспекте сам факт наличия болевых ощущений значим для тяжести депрессивных настроений и выраженности тревоги и беспокойства [36], что ухудшает результаты медикаментозной терапии, приверженность к лечению, доверие к лечащему врачу. Применение виртуальных методов воздействия по ме-Южно-Российский журнал терапевтической практики South Russian Journal of Therapeutic Practice 2021;2(1):83-89 тодике вовлечённой отвлечённости позволяет реализовывать три различных механизма: отвлечение, нейромодуляцию и терапию с постепенным воздействием, -что в настоящее время рассматривается как возможная комплементарная немедикаментозная терапия различных болевых синдромов [37,38]. В нашем исследовании также подтверждена дополнительная анальгетическая возможность использования виртуальных воздействий с применением VR-технологий в лечении больных с ревматоидным артритом.…”

Immersive Education for Chronic Condition Self-Management

“…Such skills may be acquired and rehearsed in interactive VR scenarios, and made effective through the implementation of gamification, task progression, feedback and reward schemes. One example of a simple implementation of skills training in VR for chronic pain is relaxation training for stress management (Darnall et al, 2020). Here, training to self-induce a relaxed state can be made easier by overlaying relaxing audio-visual contexts and breath detection and feedback techniques (Darnall et al, 2020).…”

“…One example of a simple implementation of skills training in VR for chronic pain is relaxation training for stress management (Darnall et al, 2020). Here, training to self-induce a relaxed state can be made easier by overlaying relaxing audio-visual contexts and breath detection and feedback techniques (Darnall et al, 2020). Notably, such interventions may have implications beyond improving perceived capacity to manage stress.…”

“…Immersive VR has been used as a medium for chronic condition interventions such as exposure therapy for phobias and post-traumatic stress, kinesthetic training for chronic neck pain, and physical rehabilitation (Gohari et al, 2019). Whilst immersive VR has been used to deliver information about the science and psychology of pain, as well as in teaching relaxation and mindfulness skills to people with chronic pain (Louw et al, 2019;Darnall et al, 2020), its application in delivering self-management programs is not yet common. Developing such interventions using this new platform is likely complex, and consideration is needed regarding how to assimilate: (1) The unique tools afforded by immersive technologies, (2) The education and training needs of people with chronic conditions, and (3) The key theoretical models that describe the underpinnings of learning and behavior change.…”