Ab0142 Virtual Reality-Based Intervention to Reduce Chronic Pain in Persons With Rheumatoid Arthritis: Mixed Methods Pilot Study

Background: Despite advances in pharmacologic treatment, approximately 20% of individuals with rheumatoid arthritis (RA) suffer from persistent pain, despite disease remission and the absence of damage and despite chronic use of painkillers, including opioids. Effective alternatives such as pain education and cognitive behavior therapy are time consuming and require professional supervision. Innovative treatments are needed that allow self-administration and on-demand treatment. The Virtual Reality (VR) training program Reducept incorporates pain education, relaxation and mindfulness, acceptance and commitment therapy with gaming elements aimed at gaining control over chronic pain. Objectives: This study aims to (1) examine the feasibility of implementing a study protocol that uses VR Reducept for the treatment of persistent pain, and (2) to determine the acceptability of using VR for pain management in an outpatient RA-population. Methods: A convergent, mixed methods design was used. First, 6 healthy volunteers were enrolled to examine the feasibility and possible side effects of a single hospital-based VR session. This was repeated in a group of 21 RA-patients (16 female, 5 male) with chronic pain despite stable low disease activity. The Oculus Go VR-headset was used in combination with Reducept (Figure 1). Pain intensity (NRS) was assessed before and after each VR application. Side-effects were assessed with the Virtual Reality Sickness Questionnaire (VRSQ). User experience was assessed using a combination of scale-based items and semi-close-ended/open-ended questions. Patients' perspective on the VR working mechanisms was explored with in-depth interviews after VR use. Secondly, a 8 week longitudinal study was conducted in 7 RA-patients to examine the feasibility of implementing a study protocol for 3x weekly VR Reducept self-administration at home. Outcome variables were usability, satisfaction with use, effects on pain intensity (NRS), arthritis self-efficacy scale (ASES), quality of life (SF-36) and side effects (VRSQ). Results: VR Reducept had good usability and tolerability. In single use, the most prevalent side-effects were general discomfort, fatigue and eyestrain. However, in most cases these symptoms were already present before use and did not worsen. 13 out of 21 (62%) patients experienced small improvements in pain. Mean NRS pain intensity before VR was 5.29 (±1.84) and after VR 4.57 (±2.06)(Figure 2). Overall, participants had a positive attitude towards VR. Patients perceived the following working mechanisms: relaxation, focus shifting/distraction, being involved, raised awareness and more control over the pain. In repeated home use, sufficient data was available for 5 of the 7 patients; 1 patient did not use VR at all and 1 patient dropped out after the first session due to virtual reality sickness. With repeated use, severity of reported side effects was mostly none or slight. Individual pain intensity scores appeared to fluctuate strongly over time. After 8 weeks, 4 out of 5 patients experienced overall small improvements in pain compared to baseline and 1 patient remained unchanged. Mean NRS pain was 5.2 (±0.98) at baseline and 4.4 (±0.8) at 8 weeks. There was no change in quality of life or in arthritis self-efficacy. Conclusion: This study provides promising indications for the feasibility and acceptability of implementing a study protocol for testing the effectiveness of VR Reducept for the treatment of persistent pain in RA-patients with stable low disease activity. REFERENCES: [1] de Vries FS, van Dongen RTM, Bertens D. Pain education and pain management skills in virtual reality in the treatment of chronic low back pain: A multiple baseline single-case experimental design. Behav Res Ther. 2023 Mar;162:104257. doi: 10.1016/j.brat.2023.104257. Epub 2023 Jan 18. PMID: 36731183. Acknowledgements: NIL. Disclosure of Interests: Anna de Jong: None declared, Femke de Greef: None declared, Tessa Hippert: None declared, Demy Gerritsen: None declared, Mirjam Hegeman: None declared, Peter ten Klooster: None declared, Christina Bode: None declared, Harald E. Vonkeman AbbVie, Novartis, Pfizer, UCB, Johnson and Johnson, Galapagos, Boehringer Ingelheim.