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

项目摘要 慢性腰痛（cLBP）是一种普遍且昂贵的病症，其显著损害身体、情感、 和社会功能。尽管有压倒性的疾病负担，四分之一的成年人报告说， 疼痛，可用的药物治疗在提供持久益处和改善健康相关的能力方面是有限的。 生活质量（HRQOL）。当其他药物治疗失败时，cLBP患者经常转向阿片类药物 提供足够的镇痛，但经常发现阿片类药物在提供有意义的疼痛减轻方面也不足 改善HRQOL。因此，在cLBP的疼痛管理方面存在关键差距;解决这一问题至关重要 证据差距，以最大限度地提高患者的利益，同时最大限度地减少药物治疗的危害。 治疗虚拟现实（VR）已经成为一种有前途的循证治疗方式， 肌肉骨骼疼痛，包括cLBP。VR的用户戴着一副眼镜， 屏幕，创造了一种被传送到栩栩如生的三维世界的感觉。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 大脑的磁共振成像（fMRI）显示，VR对感觉和岛叶有类似的影响。 皮质作为阿片类药物，头对头试验表明，VR达到类似或更大的镇痛氢吗啡酮。 然而，关于VR在cLBP中的长期疗效和安全性的数据很少。到目前为止， 短期临床试验。此外，除了纯粹的分心之外，对VR模式的研究有限，例如 作为VR疗法，使用认知行为疗法（CBT）教授可输出的技能，指导冥想， 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），生物特征结果， 360名非特异性cLBP患者随机分为3组，并随访90天：（1）沉浸式 基于技能的VR治疗;（2）沉浸式分散VR治疗;（3）使用2D视频的非沉浸式假VR 显示在VR头显中。研究结果将为在cLBP中实施VR提供最佳实践信息，并确定 患者水平的疗效预测因素。

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.