Randomized-controlled trial of virtual reality for chronic low back pain to improve patient-reported outcomes and physical activity

项目总结 慢性下腰痛(CLBP)是一种普遍且代价高昂的疾病，它显著损害身体，情感， 和社会功能。尽管有压倒性的疾病负担，每四个成年人中就有一个报告经常回来 疼痛，现有的药物疗法在提供持久益处和改善与健康相关的能力方面是有限的 生活质量(HRQOL)。慢性下腰痛患者经常在其他药物治疗失败时转向阿片类药物 提供足够的止痛，但经常发现阿片类药物也无法提供有意义的止痛效果 或改善HRQOL。因此，cLBP在疼痛管理方面存在严重缺口；解决这一问题至关重要。 证据差距的一种方式，最大限度地为患者带来好处，同时最大限度地减少药物治疗的危害。 治疗性虚拟现实(VR)已经成为一种很有前途的循证治疗方式 肌肉骨骼疼痛，包括cLBP。VR用户戴着一副近景立体护目镜 屏幕创造了一种被运送到逼真的三维世界的感觉。通过刺激 在参与其他感官的同时，VR调节用户对伤害性刺激的处理。功能性 对大脑的磁共振成像(FMRI)显示，VR对感觉和岛叶的影响相似 皮质作为阿片类药物，和面对面的试验表明，VR的止痛效果与氢吗啡相似或更好。 然而，关于VR治疗慢性下腰痛的长期疗效和安全性的数据很少。到目前为止，虚拟现实技术一直受到限制 到短期临床试验。此外，除了单纯的分心外，关于VR模式的研究有限，例如 作为使用认知行为疗法(CBT)教授可输出技能的VR疗法，引导冥想，以及 基于生物反馈的呼吸练习。 为了解决这些差距，我们建议测量患者报告的结果(PRO)、生物统计结果和 360例非特异性慢性下腰痛患者随机分为3组，随访90天：(1)浸入式 基于技能的VR治疗；(2)沉浸式分心VR治疗；以及(3)使用2D视频的非沉浸式假VR 显示在VR耳机中。结果将为在cLBP中实施虚拟现实的最佳实践提供参考，并确定 患者水平的疗效预测指标。

PROJECT SUMMARY Chronic low back pain (cLBP) is a prevalent and costly condition that markedly impairs physical, emotional, and social function. Despite its overwhelming burden of illness, with one in four adults reporting frequent back pain, available drug therapies are limited in their ability to provide lasting benefits and improve health-related quality of life (HRQOL). Patients with cLBP frequently turn to opioids when other pharmacotherapies fail to provide adequate analgesia, yet often discover that opioids also fall short in delivering meaningful pain reduction or improving HRQOL. Hence, there is a critical gap in pain management in cLBP; it is vital to address this evidence gap in a way that maximizes benefits for patients while minimizing harms from medical therapy. Therapeutic virtual reality (VR) has emerged as a promising and evidence-based treatment modality for musculoskeletal pain, including cLBP. Users of VR wear a pair of goggles with a close-proximity stereoscopic screen that creates a sensation of being transported into lifelike, three-dimensional worlds. By stimulating the visual cortex while engaging other senses, VR modulates the user’s processing of nociceptive stimuli. Functional magnetic resonance imaging (fMRI) of the brain reveals that VR has similar effects on the sensory and insular cortex as opioids, and head-to-head trials show that VR achieves similar or greater analgesia as hydromorphone. However, there are few data regarding long-term efficacy and safety of VR in cLBP. To date, VR has been limited to short-term clinical trials. In addition, limited research exists on VR modalities beyond mere distraction, such as VR therapy that teaches exportable skills using cognitive behavioral therapy (CBT), guided meditation, and biofeedback-based breathing exercises. To address these gaps, we propose to measure patient-reported outcomes (PROs), biometric outcomes, and opioid use in 360 nonspecific cLBP patients randomized among 3 groups and followed for 90 days: (1) immersive skills-based VR therapy; (2) immersive distraction VR therapy; and (3) non-immersive sham VR using 2D videos displayed in a VR headset. The results will inform best practices for implementing VR in cLBP and identify patient-level predictors of efficacy.