RCT Comparing Skills-Based, Distraction, and Sham VR for Chronic Low Back Pain

Overview

This randomized controlled trial evaluated Skills-Based VR, Distraction VR, and Sham VR in 385 patients with chronic low back pain. Neither active VR intervention significantly outperformed Sham VR in reducing pain interference, though Distraction VR showed greater opioid use reduction. Baseline anxiety predicted better outcomes with Skills-Based VR.

Background

Chronic low back pain (cLBP) is a prevalent condition that severely impacts quality of life and often requires non-pharmacological management strategies to reduce reliance on opioids. Virtual reality (VR) therapies have emerged as promising home-based interventions, offering immersive experiences that may alleviate pain and improve function. This study aimed to compare the efficacy of Skills-Based VR (incorporating biofeedback and relaxation), Distraction VR (immersive 360-degree videos), and Sham VR (2D videos) on pain interference and related outcomes in cLBP patients.

Data Highlights

Key Findings

• Neither Skills-Based VR nor Distraction VR significantly improved PROMIS Pain Interference compared to Sham VR.
• Distraction VR led to a statistically significant greater reduction in daily opioid use compared to Sham VR (p=0.009).
• Baseline anxiety levels significantly predicted improvement in pain interference within the Skills-Based VR group (p=0.025), while depression symptoms did not.
• Adverse events were mostly mild and self-limited, with cybersickness being the most common.
• High adherence rates across all VR groups demonstrated the feasibility of home-based VR interventions for cLBP.

Clinical Implications

Home-based VR therapies for chronic low back pain are feasible and well-tolerated, but active VR interventions may not provide superior pain interference relief compared to sham controls. Distraction VR may offer benefits in reducing opioid consumption, suggesting a potential role in opioid-sparing strategies. Screening for baseline anxiety could help identify patients more likely to benefit from Skills-Based VR approaches.

Conclusion

While Skills-Based and Distraction VR did not outperform Sham VR in reducing pain interference, Distraction VR showed promise in reducing opioid use. Future research should focus on anxiety-moderated treatment effects and opioid reduction as primary outcomes to optimize VR interventions for chronic low back pain.

References

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2. Murray et al. 2012 -- Disability-adjusted life years (DALYs) for 291 diseases and injuries
3. Shmagel et al. 2018 -- Prescription Medication Use Among Community-Based U.S. Adults With Chronic Low Back Pain
4. Crofford 2010 -- Adverse effects of chronic opioid therapy for chronic musculoskeletal pain
5. Spiegel et al. 2024 -- What is medical extended reality? A taxonomy defining the current breadth and depth of an evolving field
6. Brea-Gómez et al. 2021 -- Virtual reality in the treatment of adults with chronic low back pain: a systematic review and meta-analysis