Trial reportJournal of medical Internet research2026
Skill-Based Virtual Reality Therapy in High-Impact Chronic Pain: 2-Year Follow-Up Results From a Secondary Analysis of a Randomized Controlled Trial.
Trial report in Journal of medical Internet research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHigh-impact chronic pain (HICP) involves substantial interference in functioning, affects 8.5% of the population, and leads to higher health care costs relative to low-impact chronic pain (LICP). Behavioral interventions such as virtual reality (VR) offer scalable and accessible treatment, but testing is needed to ensure durable effectiveness in HICP. We conducted a secondary analysis of the largest real-world dataset for a therapeutic skill-based VR vs a sham VR control to test treatment efficacy in HICP vs LICP. Relative to LICP, we found significantly larger (and clinically meaningful; ie, ≥2 points) pain interference and pain intensity reductions for HICP at end of treatment and 1 year posttreatment. End-of-treatment reduction in pain interference reclassified 70% (114/163) of participants with HICP as LICP, and this improvement held at 1 year posttreatment (104/155, 67%).
objectiveThis study examined the effectiveness of a 56-session skill-based VR therapy in HICP at 2 years posttreatment and compared the effects with those on LICP.
methodsWe conducted a secondary analysis of the skill-based VR sample (536/1067, 50.2%) at 2 years posttreatment from a randomized controlled trial involving an in-home chronic low back pain sample that was recruited and tested online and was diverse (female: 411/536, 77%; non-White individuals: 166/536, 31%; high school or lower educational level: 102/536, 19%; mean age 50.8 years) and had clinically severe pain at baseline (intensity=6.6; interference=6.2; 42% with severe or complete disability). Focusing on the skill-based VR participants (536/1067, 50.2%) and using a validated approach, we classified participants at baseline as either HICP (baseline Brief Pain Inventory pain interference score>7) or LICP (baseline Brief Pain Inventory pain interference score<7). Clinical effectiveness was examined using a general linear model at 2 years posttreatment relative to baseline with the primary outcomes of pain interference and pain intensity.
resultsParticipants with HICP (192/536, 35.8%) reported superior reductions in pain interference, pain intensity, sleep disturbance, and physical disability (P<.001 in all cases) at 2 years posttreatment compared to participants with LICP (344/536, 64.2%). Participants with HICP had clinically meaningful (≥2-point) reductions in pain interference (mean 3.1, 95% CI 2.66-3.54; effect size=1.12) and pain intensity (mean 2.6, 95% CI 2.18-3.02; effect size=1.01) at 2 years posttreatment. Importantly, reduced pain interference scores at 2 years posttreatment reclassified 71.1% (106/149) of the participants with HICP as LICP. No serious adverse events or side effects were reported.
conclusionsPatients with HICP experience severe pain that drives high health care use. The skill-based VR therapy demonstrated durable reductions in pain and related outcomes 2 years posttreatment, with the largest benefits observed in the HICP subgroup. These results suggest that a skill-based, VR-delivered therapy produces durable effects in patients with HICP, a population that is frequently overmedicalized and undertreated with behavioral interventions. These findings suggest that home-based VR-delivered therapy offers a scalable treatment option for this underserved population.
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