A new virtual reality physical activity intervention may be effective for people with chronic low back pain who avoid activity because of fear, helping them to become physically active once again, according to a new study presented this week at the Association of Academic Physiatrists Annual Meeting in Puerto Rico.
Low back pain (LBP) is a leading cause of pain and disability in the United States. It’s also one of the most common reasons that people seek medical care. While most acute LBP subsides within a few weeks, some people develop chronic back pain that only worsens when they avoid activity, often out of fear that moving will be too painful.
To help these patients overcome these barriers to physical activity, researchers at the University of Alabama-Birmingham Department of Physical Medicine and Rehabilitation, in partnership with Ohio University and University of Texas at Dallas conducted a study of an interactive virtual reality (VR) cognitive-behavioral intervention prototype that is designed to challenge the fearful avoidance pain beliefs and gradually promote physical activity in back pain patients with high levels of fear about movement.
“The mere fact that chronic low back pain contributes to annual costs of more than $300 billion, due in large part to lost wages and productivity raised many concerns for our group,” said Lucie E. Mitchell, DO, the study’s co-author. “Despite medical advances, both the incidence and costs associated with CLBP are on the rise. Narcotic prescriptions have increased 300 percent since the 1990s, and these provide little to no benefit in terms of pain relief or reduction in disability. Proliferating abuse and misuse of narcotic pain killers is a public health epidemic, and we need to intervene. Accordingly, there is a pressing need for innovative, low cost, and accessible interventions to prevent transition to CLBP that have the potential to reduce addiction and abuse.”
The study included 34 participants, including 17 females, with a mean age of 46.2 years. All had chronic low back pain and high maladaptive pain beliefs. Participants all completed a physician screening and daily monitoring of pain and interference, as well as standard measures of their current pain intensity, pain-related fear and disability before they began a three-day laboratory-based VR intervention protocol. They also completed the same screenings and measures after completing the protocol. The researchers used a median pre-intervention monitoring pain score of 6.4 to divide the participants into either a high or low pain intensity category.
Individuals with high pain intensity reported a significant decline in their average daily pain or pain interference scores over the course of the study, the researchers found. They also reported higher pain-related fear and disability compared to low pain intensity participants. Mean scores for both high and low pain intensity individuals were not significantly different. That suggested an above moderate treatment acceptability and overall positive interest in the VR intervention among the participants.
The study’s findings support that this virtual reality prototype may be particularly effective for reducing pain and pain interference among back pain patients with high levels of fear who report high pain intensity, as well as fear and disability, at the time of the intervention, according to the researchers.
“Our results demonstrate that significant reduction of pain and harm appraisals can be achieved using a virtual exposure platform. Additionally, the findings suggest that virtual exposure can reduce negative emotion to a greater extent than standard exposure. Finally, in comparison to standard exposure, virtual exposure can disrupt the association between pain-related fear and important outcome variables, such as pain intensity, mood and willingness to engage in challenging treatment,” said Dr. Mitchell. “Our long-term goal is to perform a multicenter, randomized clinical trial to examine the efficacy of a novel virtual reality gaming-graded exposure intervention for pain-related fear and disability in low back pain. We hope to be able to successfully develop accessible interventions to prevent transition to CLBP and, hopefully, to aid the reduction of our country’s opioid addiction and abuse.”