Virtual Reality for the Treatment of Chronic Back Pain: Feasibility of a Novel Intervention Combining Movement Exercises and Body Illusions (Preprint)

BACKGROUND Virtual reality (VR) is an effective non-pharmacological method to reduce acute and chronic pain. For the treatment of non-specific chronic low back pain (CLBP), it offers benefits over traditional treatment options, such as the possibility of gamified movement exercises with real-time performance feedback and virtual embodiment. OBJECTIVE In the current feasibility study, we implemented a novel immersive VR intervention that combined all these elements. METHODS Patients with CLBP took (N = 20) part in the prospective and pre-registered trial over nine weeks. The VR therapy phase lasted three weeks with two VR sessions per week. Before the start of the therapy phase, there was a two-week baseline phase and the post-therapy phase lasted four weeks. During the sessions, patients wore a head-mounted display. In VR, they embodied a virtual avatar and performed gamified movement exercises (graded exposure). Meanwhile, they received real-time feedback on performance. Primary outcome measures were pain intensity ratings, adherence and side effects. Secondary outcomes included back- and task-specific functioning and questionnaires to assess fear avoidance beliefs. RESULTS Adherence was high (n =18, respective 90 % completed the study), and participants indicated lower pain in the post-therapy phase compared with baseline levels (P = .004, d = 0.82). There were only few and minor side effects. Task- and back-specific functioning was improved, i.e. performing daily-life activities (BPS: P = .018, ????2g = .04; RDQ: P = .018, ????2g = .08), and movement restrictions decreased (P < .001). CONCLUSIONS We demonstrated the feasibility and analgesic effects of a novel intervention combining gamified movement exercises with real-time feedback in VR and body illusions. A randomized controlled trial is needed to test the specificity of the effects. CLINICALTRIAL German Clinical Trials Register (ID DRKS00031535)