Home-based virtual reality (VR) demonstrated high user satisfaction and clinically meaningful symptom reduction in people with chronic low back pain (during the COVID-19 pandemic) and may represent an effective on-demand, nonpharmacologic treatment option for this condition, according to research published in the Journal of Medical Internet Research.

Evidence from numerous research studies suggests that virtual reality (VR) can be effective in managing acute pain, including pain resulting from medical procedures and burn wound care. Literature on the subject, though, is limited.

To expand on the current evidence base, researchers sought to conduct a placebo-controlled, randomized controlled community-based trial (ClinicalTrials.gov identifier NCT04415177) of people with chronic low back pain to evaluate outcomes associated with therapeutic VR treatment.


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A total of 188 participants were enrolled and randomly assigned 1:1 to a treatment group. The EaseVRx group participated in a 56-day VR pain relief skills program, while the control group (Sham VR) received VR content that utilized nonimmersive 2D images in the VR headset. Nine participants withdrew after randomization, leaving a final cohort of 179 participants (EaseVRx, n=89; Sham VR, n=90), 91% of whom completed the Day 56 assessment.

Participants were 77% women and 91% White, most had at least some college education (92%), and they primarily resided in highly urban or metropolitan areas (76.54%). Mean participant age was 51.5 (±13.1) years. Mean back pain intensity score was 5 out of 10, and the sample duration of back pain was 5 years or longer.

Investigators observed a significant treatment effect across multiple domains. The EaseVRx group demonstrated lower pain intensity compared with the Sham VR group, with a decrease in average pain intensity over time noted in both groups. Pain intensity was reduced by an average of 42.8% and 25.1% for the treatment and control groups, respectively.

The EaseVRx group also had lower activity interference and a higher decrease in pain interference with activity over time. Positive outcomes for the EaseVRx groups were also noted in the realms of pain interference with mood, sleep, and stress.

Participants in the EaseVRx group completed a mean of 43.3 sessions (vs 48.1 sessions in the Sham VR group). Although both groups demonstrated improvement in pain coping symptoms, including catastrophizing, self-efficacy, and acceptance, no improvements reached statistical significance.

Neither group demonstrated significant changes in morphine milligram equivalent dose between baseline and the conclusion of treatment. However, the EaseVRx group showed a substantial decrease in the use of over-the-counter analgesic medication. Those in the EaseVRx group were also more likely to recommend VR treatment to others and reported higher treatment satisfaction.

Study limitations include the collection of self-reported data, an inability to confirm pain diagnoses or analgesic prescription information, and a potential lack of generalizability to people who are not White, college-educated, Internet-savvy women.

“Therapeutic VR had high rates for engagement and user satisfaction,” the researchers wrote. “Additional studies are needed to determine effects in demographically diverse populations and in other pain conditions….Additional research is needed to characterize mechanisms of treatment effects and durability of effects.”

“Home -based VR appears to provide effective and on-demand nonpharmacologic treatment for chronic low back pain,” they concluded.

Disclosure: Several study authors declared affiliations with AppliedVR. Please see the original reference for a full list of authors’ disclosures.

Reference

Darnall B, Garcia L, Birckhead B, et al. Double-blind, randomized placebo-controlled trial of 8-week self-administered at-home behavioral skills-based virtual reality (VR) for chronic low back pain (during COVID-19). Published online January 13, 2021. J Med Internet Res. doi:10.2196/26292