PijnVRij: A qualitative study into the lived experiences of patients with non-specific chronic low-back pain using Virtual Reality

Merlijn Smits, Harry van Goor

Department of Surgery, Radboudumc, Nijmegen, the Netherlands

Introduction

21,2% of the Dutch population is suffering from chronic low-back pain. Chronic pain often negatively affects quality of life, mobility, and activities of daily living of these patients. Current chronic pain treatment, mostly via NSAIDs, is often inadequate [1]. Psychological interventions for treating chronic pain, including acceptance and commitment therapy (ACT), mindfulness-based interventions, hypnotherapy and eye movement and desensitization and reprocessing (EMDR) therapies are increasingly applied to help patients dealing with their pain [2-4]. The VR application Reducept combines these psychological interventions into a serious game to enable people to deal with their pain on a daily basis.

Methods

Twenty adult patients suffering from chronic non-specific low-back pain not attributable to a recognisable, known specific pathology used VR daily at home for a period of four weeks. Patients were interviewed twice, either personally or by phone. The first interview intended to understand how patients experienced their chronic pain in daily life. The second interview was held directly after four weeks and aimed to understand how patients experienced VR in relation to their pain and activities of daily living. Interview data were systematically analysed by way of thematic content analysis [5].

Results and discussion

Three males and 17 female participants with an average age of 51 (SD13) used VR at home. The interviews resulted in a set of themes important in the context of chronic pain in daily life and VR: experience of pain, ability to execute daily activities, accepting pain, and understanding pain. At the start, most patients experienced pain as heavy pain attacks in the lower back. They already had a long history in medical therapy and pain-relieving medication. Use of VR allowed half of the patients to temporarily lower pain experiences and most could find relaxation via VR during the day. Four indicated better sleep quality after using VR. One participant lowered medication intake, another called of surgery. Lessons learned in VR could be applied by five in real life. Chronic pain negatively affected daily activities with regards to patients’ ability to work and their social lives. VR did not affect ability to work or the number of social contacts, but VR improved ability of relatives to empathize with the patient as it increased their knowledge on pain. Most patients had difficulties to accept or understand their pain. VR improved pain acceptance for five, and knowledge on pain for ten patients. Design recommendations were identified for meeting better lived experiences of patients.

Conclusions

Qualitative research into lived experiences of patients provides insight in what type of patients might be suitable for using VR and how VR can be designed to optimally contribute to the needs of patients.

References

[1] Bala, M., et al., Epidemiology of chronic pain in the Netherlands. 2011, Kleijnen Systematic Reviews Ltd York, United Kingdom.

[2] Niknejad, B., et al., Association between psychological interventions and chronic pain outcomes in older adults: a systematic review and meta-analysis. JAMA internal medicine, 2018. 178(6): p. 830-839.

[3] Hilton, L., et al., Mindfulness meditation for chronic pain: systematic review and meta-analysis. Annals of Behavioral Medicine, 2017. 51(2): p. 199-213.

[4] Tesarz, J., et al., Effects of eye movement desensitization and reprocessing (EMDR) treatment in chronic pain patients: A systematic review. Pain Medicine, 2014. 15(2): p. 247-263.

[5] Braun, V. and V. Clarke, Using thematic analysis in psychology. Qualitative research in psychology, 2006. 3(2): p. 77-101