Botella et al., 2013Botella C. Garcia-Palacios A. Vizcaíno Y. Herrero R. Baños R.M. Belmonte M.A. Virtual Reality in the Treatment of Fibromyalgia: A Pilot Study., Spain, Cyberpsychology, Behavior, and Social NetworkingTo examine the effectiveness of a VR intervention in the treatment of fibromyalgia as an adjunct to Cognitive Behavioral Therapy (CBT)Design: Pre-test, post-test, 10 × 2-hour group CBT sessions in a VR environment and education on pain and healthy habits; facilitated by therapists over 7 weeks, 6-month follow-upParticipants: Adult patients with Fibromyalgia (FM), Female = 6; Male = 0; Age: 47-65 years Setting: rheumatology service within a public hospitalVR hardware: 2 personal computers, a large projection screen, 2 projectors onto a 4 × 1.5 screen with surround audio (no headset) VR software: engaging Media for Mental Health Applications worldMeasures: FM Impact Questionnaire, Chronic Pain Coping Inventory, Beck Depression Inventory II, Positive and Negative Affect Schedule, VR Satisfaction Scale Findings: Participants improved over a six month follow up period; some reduction in levels of depression; increase in positive affect; no increase in negative affect; no change in use of illness-focused coping strategies; high increase in wellness-coping strategies; experience of VR rated consistently highlyDarnall et al., 2020Darnall B.D. Krishnamurthy P. Tsuei J. Minor J.D. Self-administered skills-based virtual reality intervention for chronic pain: A randomized controlled pilot study., USA, JMIR Formative ResearchTo evaluate the feasibility and preliminary efficacy of a self-administered VR program for chronic painDesign: a parallel-group, randomized controlled trial (RCT), 21-day (3-week) intervention, 1 of 2 unblinded treatments (VR or audio narration), 4-8 treatment sessions (1-5 minutes)Participants: a web-based convenience sample of adults (n = 46 audio, n = 42 VR) aged 18-75 years with self-reported chronic low back pain or fibromyalgia Setting: community-basedVR hardware: Oculus Go VR headset preloaded with software VR software: software with 3 components, 1) skills rooted in pain CBT, 2) relaxation training and 3) mindfulnessMeasures: Defense and Veterans Pain Rating Scale, Average Pain Intensity, Pain Interference on Activity, Mood, Sleep, and Stress, Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, Patient Global Impression of Change, Satisfaction with treatment, Motion Sickness and Nausea Findings: Symptom improvement was found for each pain variable (all p < .001). Most VR participants reported no nausea or motion sickness (n = 19/25, 76%). Significant time × group effects were found in favor of the VR group for average pain intensity (p = .04), pain-related inference with activity (p = .005), sleep (p < .001), mood (p < .001), and stress (p = .003).Garcia et al., 2021Garcia L.M. Birckhead B.J. Krishnamurthy P. Sackman J. Mackey I.G. Louis R.G. Salmasi V. Maddox T. Darnall B.D. An 8-week self-administered at-home behavioral skills-based virtual reality program for chronic low back pain: Double-blind, randomized, placebo-controlled trial conducted during COVID-19., USA, Journal of Medical Internet ResearchTo assess if VR would evidence superior outcomes for all baseline to post-treatment comparisons in people with chronic low back pain compared to those assigned to a Sham VRDesign: double-blind, parallel-arm, single-cohort, remote, randomized placebo-controlled trial, one of two 56-day (1 session daily) treatment programs: 1) therapeutic VR or 2) Sham VRParticipants: community-based adult individuals with chronic low back pain for 6 months or more (n = 179), female: 76.5%, 137/179; Caucasian: 90.5%, 162/179, mean age: 51.5 years Setting: community-basedVR hardware: Pico G2 4K all-in-one head-mounted VR device (exhalation is measured by the microphone embedded in the hardware) VR software: EaseVRx - principles of CBT, mindfulness, and pain neuroscience education, and Sham VR an active control that utilizes non-immersive, 2D content)Measures: Defense and Veterans Pain Rating Scale, Pain Interference With Activity, Mood, Sleep, and Stress, Patient's Global Impression of Change, NIH Physical Function and Sleep Disturbance, Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, Chronic Pain Acceptance Questionnaire, Satisfaction with treatment, VR use, System Usability Scale, Motion Sickness and Nausea, Over-the-Counter Analgesic Medication Use, Opioid use Findings: For EaseVRx, large pre–post effect sizes ranged from 1.17 to 1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. Pain catastrophizing, pain self-efficacy, pain acceptance, prescription opioid use did not reach statistical significance for either group.Garrett et al., 2020Garrett B.M. Tao G. Taverner T. Cordingley E. Sun C. Patients perceptions of virtual reality therapy in the management of chronic cancer pain., Canada, HeliyonTo explore the experiences of individuals with cancer related chronic pain in using a daily VR-based self-administered home therapyDesign: qualitative inductive (constant-comparative) approach using two focus groups (approx. 60 minutes each)Participants: patients with cancer (aged >16) with chronic involved in an ongoing RCT of a VR intervention (n = 12), 30 min of activity per day for six days
Setting: at homeVR hardware: HTC Vive stereoscopic headset VR software: two interventions based on cognitive engagement and two based on mindfulness meditationMeasures: none – qualitative study Findings: Five major thematic categories emerged: (1) activities; (2) usability; (3) effects; (4) mode of action; and (5) technical aspects. Mixed results in the use of adjunctive VR therapy to manage chronic cancer pain. Future designs of VR interventions engage pain patients in the design process to ensure maximum efficacy of experiences to with individuals' preferencesGromala et al., 2015Gromala D. Tong X. Choo A. Karamnejad M. Shaw C.D. The virtual meditative walk: Virtual reality therapy for chronic pain management., Canada, Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing SystemsTo examine the effectiveness of a VR based Mindfulness Based Stress Reduction (MBSR) program to manage long-term painDesign: focus groups and participatory design sessions, followed by a single 12-minute experimental VR session with control group (audio only)Participants: Patients with chronic pain Female = 7; Male = 6; Age: 35-55
Setting: university hospital pain clinicVR hardware: Deepstream VR viewer and galvanic skin response (GSR) sensors VR software: Virtual Meditative Walk (forest environment)Measures: Numerical Rating Scale Findings: As slow movement of camera mimics act of walking, GSR sensors respond to arousal levels with changing weather immersive visuals and stereoscopic sounds. Responses suggest observing biofeedback data helps participants monitor management of perceived pain. VR appears effective in teaching MBSR to manage attention as therapeutic pain control intervention and more effective than MBSRIgna et al., 2014Igna R. Stefan S. Onac I. Ungur R.A. Szentagotai-Tatar A. Mindfulness-based cognitive-behavior therapy (MCBT) versus virtual reality (VR) enhanced CBT, versus treatment as usual for chronic back pain. A clinical trial.), Romania, Journal of Evidence-Based PsychotherapiesTo evaluate the effectiveness of a VR enhanced CBT intervention with MCBT usual care in reducing pain intensity and associated emotional and cognitive problems, improving quality of lifeDesign: clinical trial, 6 session intervention program, with 2 individual meetings per week, all participants received physiotherapy and pharmacotherapyParticipants: 68 adult patients with chronic pain (CBT = 18, MBCT = 25, control = 25), mean age of 47, most were female n = 36, Setting: unclearVR hardware: HTC Vive stereoscopic headset VR software: five minutes of exposure to the “SnowWorld” and afterwards debriefing about how shifting attention from pain decreases intensity of painMeasures: Visual Analogue Scale, McGill Pain Questionnaire, State-Trait Anxiety Inventory, Beck Depression Inventory, Profile of Mood States Short Version, Functional Assessment of Cancer Therapy Scale – General Version, General Attitudes and Beliefs Scale – short version, Pain Anxiety Symptoms Scale, Pain Catastrophizing Scale, Automatic Thoughts Questionnaire, Mindful Attention Awareness Scale, Chronic Pain Acceptance Questionnaire Findings: There were no significant differences between intervention groups and control group at post-treatment, except for the pain intensity scores but there were significant differences between pre-treatment and post treatment, for all three conditions, in mindfulness (t(62) = -3.365, p = .001) and pain catastrophizing (t(49) = 4.147, p = .000).Gromala et al., 2015Gromala D. Tong X. Choo A. Karamnejad M. Shaw C.D. The virtual meditative walk: Virtual reality therapy for chronic pain management., Canada, International Conference on Virtual, Augmented and Mixed RealityTo examine effectiveness of Virtual Meditative Walk VR system (based on MBSR) in managing chronic painDesign: Single 12-minute VR test sessions; control group continued usual clinic MBSR exerciseParticipants: Patients with chronic pain, Female = 4, Male = 3 (in VR group); Female = 3, Male = 3 (control group); Age: 35-55 Setting: established pain clinicVR hardware: stereoscopic display mounted on movable arm (gazing into device held at shoulder height) and GSR sensors VR software: prototype of Virtual Meditative Walk (foggy forest)Measures: Numerical Rating Scale Findings: VR and MBSR training with biofeedback appears significantly more effective than MBSR alone in reducing reported pain levels. Specific benefits of combination of VR and MBSR mediation identified as immersive sonic and visual signals about real time feedback to reinforce training.