From randomized controlled trial to real world clinical evidence: effectiveness and engagement of in-home virtual reality pain treatment for chronic pain in older adults.

Chronic lower back pain prevalence is greatest among older adults. Older adults (65+) often have multiple comorbidities and are more likely to have high-impact chronic pain that significantly impacts daily activities and function. Owing to greater pain burden, older adults are prime candidates for low-risk, in-home pain treatment. The goal of the present study was two-fold: (1) to examine clinical effectiveness of an FDA-Authorized Skills-Based Virtual Reality delivered therapy for chronic lower back pain in adults (18-64) and older adults (65+) by conducting a secondary analysis of a randomized controlled trial (N = 505), and (2) to examine engagement rates with the Skills-Based Virtual Reality delivered therapy in adults and older adults in the randomized controlled trial sample, and a separate real-world clinical sample (N = 2460). The clinical effectiveness analysis found that adults and older adults with chronic lower back pain showed statistically equivalent and clinically meaningful reductions in pain intensity and pain interference that were durable to 12-months post-treatment along with parallel improvements in sleep, depression, and physical disability. Adult and older adult high-impact chronic pain patients showed greater pain reductions than lower impact chronic pain patients with the majority shifting to lower impact chronic pain status at end-of-treatment that was maintained at 12-months post-treatment. VR program engagement analysis showed that older adults evidenced higher engagement in VR relative to adults in both the randomized controlled trial and real-world clinical sample. Together these results challenge common misperceptions about older adults and suggest that this Skills-Based VR therapy is an accessible solution for chronic lower back pain in older adults that leads to strong clinical outcomes and high VR program engagement. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT05263037.