Background & Aims
Virtual Reality (VR) has gained support as a non-pharmacological intervention for acute and chronic pain. Concurrently, there is growing attention to systematic inequities in pain burden, characterized by poorer pain treatment and outcomes for individuals from racially and economically marginalized backgrounds. These disparities are echoed by a broader literature that describes a “digital divide” referring to reduced access to health technology (including increasingly popular digital health applications) within historically disadvantaged communities. Despite this potential racial and economic technological inequity, there has not been systematic analysis of sociodemographic and socioeconomic inclusivity in existing VR pain research. Accordingly, this study sought to examine sociodemographic and socioeconomic data collected by US-based studies of immersive VR adult pain intervention. Findings can highlight trends in VR pain research relevant to clinical care and empirical inquiry.
Methods
The present study examined a total of 36 US-based studies of adult pain interventions using immersive VR. Studies were identified as part of a systematic review (PROSPERO #CRD42022307153) supported by the Mayday Fund and a CIHR Planning Grant to codify key outcomes in VR pain literature. Current analysis focused on US-based studies due to specificity of cultural context. Two reviewers separately examined the studies collected in the larger review for the following criteria: 1) Demographic characteristics [i.e., race/ethnicity, language (gender and age distributions have been reported elsewhere)] and 2) Socioeconomic characteristics [i.e., level of education, family income/work status, insurance status]. Additional variables examined included geographic location of research (i.e., urban/rural setting), compensation for participation, and previous experience with technology or VR, as these variables were conceptualized as relevant to VR access and usability.
Results
Of 36 studies, 22 (n=967) reported race; 661(68%) participants identified as White/Caucasian, 217(22%) as Black/African American, 32(3%) as Asian/Pacific Islander, 7(1%) as American Indian, 40(4%) as Other, and 5(1%) as Multiracial. In the 5 studies reporting ethnicity, 59(20%) participants were Hispanic. All 12 studies reporting language required English fluency. Ten of 36 studies reported education, with 377(78%) of 483 participants endorsing some college. Six studies reported participant income, with close to equal distribution across income categories. All participants in the 4 reporting studies had insurance. Five studies reported work status, with 46% of participants currently employed. Of 11 studies reporting on incentive, 6 included compensation. Seven studies reported on prior technology/VR use; of these, 2 required access to internet. Of 23 studies reporting geographic location, 11 were in an urban area, 8 were mixed urban-suburban; 1 study was rural and 1 suburban.
Conclusions
Our analysis concludes that published studies of US-based adult VR pain intervention do not consistently report (or possibly collect) key sociodemographic and socioeconomic variables needed to ascertain equitable access. While most consistently reported, race/ethnicity was missing in over a third of examined studies. White participants emerged as the clear majority in studies reporting race. This is concerning in light of recognized disparities in pain burden and technology access, and recent efforts toward greater inclusion, diversity, and equity in pain research. Associations between VR pain intervention access/utilization and central socioeconomic factors (e.g., income, education) were almost entirely obscured by lack of data reporting. Given recognition of existing inequities, rapid pace of digital technology, and theoretical promise of greater access facilitated by virtual technologies, reporting and analysis of this information is critical in contemporary VR pain research.
References
1. Trost, Z., France, C., Anam, M. & Shum, C. Virtual reality approaches to pain: toward a state of the science. PAIN 162, 325–331 (2021).
2.Hood, A. M. et al. Racism exposure and trauma accumulation perpetuate pain inequities—advocating for change (RESTORATIVE): A conceptual model. Am. Psychol. 78, 143–159 (2023).
3.Dy, M. et al. Virtual Reality for Chronic Pain Management Among Historically Marginalized Populations: Systematic Review of Usability Studies. J. Med. Internet Res. 25, e40044 (2023).
4.Yao, R. et al. Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review. J. Med. Internet Res. 24, e34144 (2022).
5.Palermo, T. M. et al. Promoting Inclusion, Diversity, and Equity in Pain Science. Pain Med. Off. J. Am. Acad. Pain Med. 24, 105–109 (2023).
Presenting Author
Zina Trost
Poster Authors
Berit Zuch
Neuroscience, BS
Texas A&M University
Lead Author
Topics
- Access to Care