Learning Motivational Interviewing in VR: A Feasibility Study Using Self-Reported Measures.

Chronic low back pain (cLBP) impacts approximately one-third of adults globally. With increasing efforts to curb opioid prescribing, effective, accessible nonpharmacological, behavioral treatments for cLBP are called for nationally by the U.S. Centers for Disease Control and Prevention (CDC) and U.S. Centers for Medicare and Medicaid Services (CMS). Pain education and cognitive behavior therapy (CBT) are recommended as first-line treatments given their low risk but barriers impede broad implementation. These include barriers to access because of the multisession, therapist-led nature of CBT, variability in effectiveness due in part to variation in the quality of therapists, and the inconsistent durability of effect up to 12 months after treatment. Digital devices, such as immersive virtual reality (VR), can deliver therapeutic content in a consistent, quality-controlled manner in the home, potentially addressing these shortcomings. A critically important additional advantage of VR over other digital technologies (e.g., smartphone mobile applications) is that the immersive nature of VR content broadly engages multiple centers in the brain in synchrony and can target pain processing brain regions known to be involved in cLBP that are responsive to treatments, such as CBT. Thus, therapeutic programs can be delivered in VR that combine pain education, CBT, diaphragmatic breathing, biofeedback, and mindfulness, which collectively help patients develop coping skills to address cLBP. The ease of use and the potential for repetition in VR allow these pain-coping skills to become habits that are long lasting and durable, all with a low-risk device accessible in-home. Several VR-based chronic pain programs have been developed that show promise (see Refs. and for reviews), and one, a proprietary skills-based VR program for cLBP (called RelieVRx), is FDA authorized. Despite the promise of VR as an immersive therapeutic for chronic pain, questions remain as to whether sociodemographic variabilities could impact patient engagement and contribute to the heterogeneity of treatment effectiveness. Several studies have found heterogeneity in the effectiveness of digital therapeutics as a function of age, gender, race/ethnicity, and socioeconomic status (SES), with patients who are older, females, non-White, or of low SES being disadvantaged. Critically, key factors identified to address these inequities are broad availability (e.g., no Wi-Fi necessary) and ease of use (e.g., minimal time commitment, in-home administration, and simple navigation). New digital health technologies should specifically evaluate these factors within the context of key sociodemographic factors, which is the goal of this report.