Background & Aims

Virtual reality (VR) has successfully been tested as a non-pharmacological treatment for patients with acute and chronic pain [3]. Due to its immersive properties, VR is a particularly powerful tool to distract patients from pain. Beyond distraction there are many mechanisms through which VR can yield analgesic effects, depending on the content delivered via VR. Previously investigated approaches included the induction of positive affect, psychoeducation, guided relaxation and virtual embodiment. VR also offers the possibility of gamification likely leading to an increase in user motivation and therapy adherence. For these reasons, VR might be particularly well suited for the treatment of chronic non-specific low back pain (CLBP) [2]. In CLBP movement exercises are recommended as a first-line treatment, but adherence rates are often low. Therefore, we developed a VR therapy that combines gamified movement exercises (graded exposure) with full body illusions and tested its feasibility.

Methods

We recruited N = 20 patients with CLBP for the prospective and pre-registered trial (German Clinical Trials Register-ID: DRKS00031535). The VR therapy phase lasted three weeks and included two sessions per week, lasting 20-25 minutes per session (in VR). Before the start of the therapy phase there was a two-week period to assess baseline pain levels (daily measurements). The post-therapy phase lasted four weeks with a follow-up clinical assessment at the end.
During the sessions, patients wore a head-mounted-display (HMD) and were immersed into the virtual environment, where they embodied a virtual avatar and performed gamified movement exercises (graded exposure) . Required movements were demonstrated by a virtual hologram overlaying the embodied avatar. Patients’ movements were tracked, and they received continuous visual feedback about the accuracy of their movements in VR.
Primary outcome measures of the study were pain intensity ratings (NRS 0-10), adherence and side effects.

Results

Out of the 20 patients included, n = 18 (90 %) completed the study. We could demonstrate a significant pain reduction in the post-therapy phase compared with baseline pain levels. There were only few and minor side effects assessed with the Simulator Sickness Questionnaire (SSQ; [1]) with the most frequent relating to sweating, strained eyes and difficulties in focusing with the HMD.

Conclusions

We demonstrated the feasibility of the novel treatment approach. The initial results indicate that the analgesic effects are strong. The combination of gamified movement exercises (graded exposure) with continuous feedback in VR and body illusions might have several advantages over conventional treatments including an increased motivation and adherence and, ultimately, greater treatment success. However, a randomized controlled trial is needed to test this.

References

[1] Kennedy RS, Lane NE, Berbaum KS, Lilienthal MG. Simulator Sickness Questionnaire: An Enhanced Method for Quantifying Simulator Sickness. The International Journal of Aviation Psychology 1993;3:203–220.
[2] Tack C. Virtual reality and chronic low back pain. null 2019:1–9.
[3] Trost Z, France C, Anam M, Shum C. Virtual reality approaches to pain: toward a state of the science. PAIN 2021;162:325–331.

Presenting Author

Isabel Neumann

Poster Authors

Ivo Käthner

PhD

Department of Physiological Psychology, University of Bamberg, Bamberg, Germany

Lead Author

E-mail

Isabel Neumann

Department of Psychology I, University of Würzburg

Lead Author

E-mail

Stefan Lindner

Universitätsklinikum Würzburg

Lead Author

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Yevgeniya Nedilko

biomi gUG, Frankfurt, Germany

Lead Author

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Ralitsa Zhivova

biomi gUG, Frankfurt, Germany

Lead Author

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Michael Gödde

M.A.

videoreality GmbH, Frankfurt, Germany

Lead Author

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Heike Rittner

University Hospital Wuerzburg

Lead Author

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Topics

  • Treatment/Management: Pharmacology: Psychological and Rehabilitative Therapies

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