When technology meets practice: how real-world use reshaped an XR-enhanced chronic pain programme across primary care sites

Extended reality (XR) interventions for chronic pain have shown promising results in controlled and early feasibility settings, but evidence on their transition into routine primary care remains limited. This real-world multicentre implementation case study examined REDOCVR, an XR-enhanced chronic pain programme, as it moved from pilot feasibility toward routine delivery across primary care centres in Catalonia, Spain, between February 2024 and May 2026. REDOCVR integrated augmented and virtual reality content into existing group-based chronic pain programmes led by psychologists and physiotherapists. Data sources included operational records, patient-reported outcomes from completed research groups (n = 103), two semi-structured professional discussion groups (n = 10), professional usability and workflow indicators (n = 11), and external scale-out material from one formative familiarisation site and one prospective readiness appraisal site. REDOCVR reached 225 participants across research and routine implementation groups. Real-world use showed that scalability was constrained mainly by workflow integration, device logistics, technical usability and organisational support, rather than by clinical content or patient acceptance. Professional feedback informed a planned unified application redesign and supported concentrating XR into four therapeutically selected sessions to reduce preparation time, simplify headset allocation and make technical support easier to plan. Patient-reported feasibility remained favourable, while clinical and medication-related outcomes showed favourable descriptive patterns but were interpreted only as contextual indicators. Moving XR-supported interventions from pilot to practice requires professional autonomy, workflow alignment, simplified technical architecture and institutional support for device management, training and maintenance.