Virtual Reality for the Treatment of Chronic Low Back Pain

Not Applicable

Withdrawn

Interventions: Device: HTC Vive with Lumen Program
Device: HTC Vive with Karuna Virtual Reality Program

Brief Summary: Chronic low back pain is highly prevalent in US adults and is a major cause of missed work days and disability. While several treatment options exist, chronic opioids are commonly used for these conditions even though there are limited data supporting efficacy, and clear evidence of harm associated with chronic opioid administration.

Virtual reality has been proposed as a treatment option that may lead to decreased pain and improved physical functioning, while avoiding the harms associated with medication management. This study is intended to obtain preliminary safety and efficacy data to guide the design of a larger clinical trial.

Detailed Description: This is a pilot study to evaluate the safety and efficacy of the Kauruna Virtual Reality program for the treatment of chronic low back pain. This study is intended to document the safety and efficacy of the use of virtual reality for the treatment of chronic low back pain. The primary outcome measure will be physical functioning as measured by the PROMIS 6. Secondary outcome measures include patient-reported pain intensity, adverse side effects, disability as measured by the Oswestry Low back disability questionnaire, and mental functioning as assessed using the PHQ-9 and GAD-7. Finally, impact on opioid use in patients on chronic opioids will be assessed by documentation of daily opioid dose in oral morphine equivalents.

Forty adult patients with chronic low back pain who are receiving care through the Penn Pain Medicine Center are eligible to participate in the study. The study will consist of a screening visit, followed by randomization into 1 of 2 study groups. Both study groups will participate in two 20-minute virtual reality sessions a week for 8 weeks. Study group 1 will participate in 20 minutes of mindfulness mediation. Study Group 2 will undergo initial sessions focused on graded motor imagery, followed by sessions focused on graded exposure. Patient-reported outcomes data will be obtained at baseline, then weekly during the 8-week study period, then 4 weeks following completion of the study sessions.

Recruitment & Eligibility

Inclusion Criteria

Age over 18
Able to speak and read English
A history of chronic low back pain for at least 6 months
No changes to medications within 30 days of randomization
Able to provide outcomes data through the electronic patient-reported outcome data collection system

Exclusion Criteria

Age less than 18 years.
Pregnant women
Cognitive impairment that limits ability to participate in the study, including the provision of outcome data through the electronic patient-reported outcome data collection system.
Unable to stand for at least 15 minutes
Employees or students of the University of Pennsylvania

Arm && Interventions

Group	Intervention	Description
Mindfulness Mediation	HTC Vive with Lumen Program	Subjects will undergo virtual reality in a non-embodied (no first person bodily experience) program called Lumen, which was developed by Stanford University's Virtual Human Interaction Lab.
Graded Motor Imagery	HTC Vive with Karuna Virtual Reality Program	The subjects will engage in 2 therapeutic modules intended to help them practice increasing range of motion safely, and using small movements of the lower back.

Primary Outcome Measures

Name	Time	Method
Physical Functioning measured by PROMIS 6 (Patient Reported Outcome Measurement Information System)	12 weeks	Physical functioning reported on a scale 1 (unable to do) to 5 (without any difficulty)

Secondary Outcome Measures

Name	Time	Method
Mental Functioning measured by GAD-7 (Generalized Anxiety Disorder)	12 weeks	Mental functioning reported on a scale 0 (not at all) to 3 (nearly every day)
Disability measured by the Oswestry Low Back Disability Questionnaire	12 weeks	Disability reported on a scale 0 (can complete task) to 5 (can't complete tasks)
Patient-Reported Pain Intensity	12 weeks	Pain reported on a scale 0 (no pain) to 10 (worst pain possible)
Mental Functioning measured by PHQ-9 (Patient Health Questionnaire)	12 weeks	Mental functioning reported on a scale 0 (not at all) to 3 (nearly every day)
Adverse Events	12 weeks	Any symptom, sign, illness or experience that develops or worsens in severity during the course of the study will be documented

Locations (1): Penn Pain Medicine Center
🇺🇸
Philadelphia, Pennsylvania, United States