Got back pain? Can virtual reality provide real pain relief?

Chronic low back pain is among the leading causes of long-lasting pain, disability, and medical costs worldwide. There are many causes, including so-called wear-and-tear osteoarthritis, a degenerated disc, or compression of nerves in the lower back. In many cases, no cause can be found.

Sometimes, surgery can provide definitive relief, but most cases of low back pain don’t require surgery and won’t improve with it. Other treatment options, such as oral or injected medicines, physical therapy, or chiropractic care are helpful for some but not all. Unfortunately, this leaves millions in chronic pain seeking safe, reliably effective treatment. A new approach using virtual reality aims to fit the bill.

Virtual reality marketed as health care

Virtual reality (VR) devices allow users to enter simulated three-dimensional environments by wearing a headset that provides realistic visual effects and sound effects. Users can play tennis, battle enemies in a futuristic city, drive a race car, or become immersed in hundreds of other experiences.

For years, companies have been selling VR systems for entertainment, so the idea of using VR to treat health conditions may seem surprising. In November 2021, the FDA authorized AppliedVR to market its EaseVRx system, by prescription only, to treat adults with low back pain that has lasted at least three months.

Contrary to some media coverage and the maker’s website, the FDA did not endorse or approve the use of EaseVRx for treating chronic low back pain; it merely authorized marketing of the device.

How does this device work?

It’s not an overnight fix. Users wear a headset for 56 daily at-home sessions over the course of eight weeks. Each session takes two to 16 minutes a day. The program uses cognitive behavioral therapy (CBT) and other techniques to reduce pain and limit its impact on everyday activities. For example, users engage in

relaxation techniques, including deep breathing exercises (the program offers a “breathing amplifier” to allow users to be more aware of their breathing)
attention-shifting, to help focus less on pain
training to appreciate internal pain signals and modify one’s response to them
education about shifting perspective and encouraging self-compassion
pain distraction games
healthy movement training
education about pain and physical rehabilitation.

All of these techniques can be done during in-person sessions, and have been used for many years for a number of conditions. What is new about the EaseVRx system is that these techniques can be practiced at home using virtual reality.

Is it effective?

It’s hard to know how well this product will work for a range of people. A single, small study is summarized in the FDA press release as evidence of device effectiveness. It enrolled 179 adults with chronic low back pain who were randomly divided into two groups. One group used the EaseVRx three-dimensional virtual reality system and the CBT program described above. The other group (called Sham VR) used a two-dimensional video program about nature delivered through a headset during the daily sessions. Both groups were asked to fill out twice-weekly surveys with a 10-point pain scale.

After eight weeks of treatment:

At least 50% improvement in pain was reported by nearly half of the EaseVRx group and a quarter of the Sham VR group.
At least 30% reduction in pain was reported by 66% of the EaseVRx group and 41% of the Sham VR group.
Reduction in average pain intensity over the study period was greater in the EaseVRx group (43%) than in the Sham VR group (25%). Based on the 10-point pain scale, the EaseVRx group’s average pain level dropped from 5.1 to 2.9; the sham VR group dropped from 5.2 to 4.0.

In both groups, the reduction in pain lasted at least three months after completing the eight-week program. No serious side effects were noted.

What else is important to know about EaseVRx?

It’s encouraging to hear about a novel pain treatment that seems effective, safe, requires no medicine, and can be used on-demand at home. But we need to know much more about the use of virtual reality for low back pain, including:

Do the study findings apply to all chronic low back pain sufferers? Nearly 90% of potential study subjects were excluded because they met criteria for depression, a common issue for people suffering from back pain. Study subjects were mostly white, college-educated women who were technology-savvy. The results might be quite different if study participants had been more diverse and representative of the general population.
All study subjects could receive $6 for completing each of the surveys, which were sent twice a week. In addition, participants in both groups had the option of receiving virtual reality headsets (worth approximately $400) if they completed at least 16 surveys. How much did these offers affect survey results? Incentives can influence participant behavior.
Is the study data reliable? The study relied heavily on self-reporting. For example, the researchers could not confirm the type or cause of back pain or the use of medications.
How much of the benefit noted among EaseVRx users was due to CBT, rather than the 3-D virtual reality device? It’s impossible to know, since the Sham VR group received neither the VR program nor CBT.
How much will a back pain sufferer have to pay for this new VR device? My guess is that it’ll be expensive and, if not covered by insurance, may be too costly for many who most need it.
How long might the benefit of this VR program last, and how effective is retreatment?

The bottom line

It’s likely we’ll soon see ads promoting virtual reality as an innovative, safe, and effective approach that can provide tremendous relief for millions of back pain sufferers. Currently it’s impossible to say whether that’s true.

While I’m hopeful that virtual reality programs may be an effective new way to treat back pain and other causes of chronic pain, I’m not sold yet.