Main Findings
opioid dependence, low back pain, anxiety, chronic pain, pain, depression, disability, coronavirus disease 2019
CHRONIC PAIN, COMPLEX REGIONAL PAIN SYNDROME, CORONAVIRUS DISEASE 2019, COMPLICATIONS
We did not find an effect of 4 weeks of VR behavioral therapy-based pain management and education intervention on the physical and mental function of patients with nonspecific CLBP referred to a pain clinic. VR seemed to positively affect daily worst and least experienced pain. Opioid use in the VR group was halved. VR was associated with good treatment adherence and minimal and mild side effects.The limited benefit of VR may be explained by the application itself, patient expectations, a mismatch between the design and evaluation of the VR application, and the execution of the study during the coronavirus disease 2019 (COVID-19) pandemic. This was the first properly designed comparative pilot study wherein this VR application was evaluated for an effect on patient-reported health-related quality of life, mental and physical function, and pain and disability outcomes. Despite a rigorous design together with stakeholders, the application might not yet fully match the needs of patients with CLBP who failed initial physical and pharmacological therapy. The outcomes in the VR group may have been affected by the patient’s expectations for benefit of the VR treatment considering the follow-up treatment they were waitlisted for. Patients with CLBP with a high expectation of improvement are 2.4 times more likely to report improvement in functional limitations, pain intensity, and work participation.Patients in our study had on average 4 to 5 years CLBP with pain scores more than 4 at inclusion, and 40% used opioids. A longer duration of low back pain has been associated with a less favorable prognosis in a meta-analysis with an average baseline pain duration varying from 6 to 12 weeks in the trials.We enrolled patients during the COVID-19 pandemic. It is unknown how the COVID pandemic has impacted the results of this study. Both increased and decreased pain, anxiety, and depression have been described in chronic pain patients.An interesting observation in this study is the reduction in opioid use. This reduction was by patient choice and has not been shown in previous studies with behavioral therapy-based VR for CLBP. Confirmation of this observation in larger well-powered studies could have large implications for clinical practice, reducing the need for opioids significantly and thus reducing opioid dependence, including its complications, and health care costs.Garcia et alComparing our study findings with other VR studies in chronic pain has limited value due to other than CLBP patients included, for example, with complex regional pain syndrome,