PROJECT SUMMARY
Chronic low back pain (cLBP) is a prevalent and costly condition that markedly impairs physical, emotional,
and social function. Despite its overwhelming burden of illness, with one in four adults reporting frequent back
pain, available drug therapies are limited in their ability to provide lasting benefits and improve health-related
quality of life (HRQOL). Patients with cLBP frequently turn to opioids when other pharmacotherapies fail to
provide adequate analgesia, yet often discover that opioids also fall short in delivering meaningful pain reduction
or improving HRQOL. Hence, there is a critical gap in pain management in cLBP; it is vital to address this
evidence gap in a way that maximizes benefits for patients while minimizing harms from medical therapy.
Therapeutic virtual reality (VR) has emerged as a promising and evidence-based treatment modality for
musculoskeletal pain, including cLBP. Users of VR wear a pair of goggles with a close-proximity stereoscopic
screen that creates a sensation of being transported into lifelike, three-dimensional worlds. By stimulating the
visual cortex while engaging other senses, VR modulates the user’s processing of nociceptive stimuli. Functional
magnetic resonance imaging (fMRI) of the brain reveals that VR has similar effects on the sensory and insular
cortex as opioids, and head-to-head trials show that VR achieves similar or greater analgesia as hydromorphone.
However, there are few data regarding long-term efficacy and safety of VR in cLBP. To date, VR has been limited
to short-term clinical trials. In addition, limited research exists on VR modalities beyond mere distraction, such
as VR therapy that teaches exportable skills using cognitive behavioral therapy (CBT), guided meditation, and
biofeedback-based breathing exercises.
To address these gaps, we propose to measure patient-reported outcomes (PROs), biometric outcomes, and
opioid use in 360 nonspecific cLBP patients randomized among 3 groups and followed for 90 days: (1) immersive
skills-based VR therapy; (2) immersive distraction VR therapy; and (3) non-immersive sham VR using 2D videos
displayed in a VR headset. The results will inform best practices for implementing VR in cLBP and identify
patient-level predictors of efficacy.