Remote cognitive behavioral therapy utilizing an in-home virtual reality toolkit (Vx Therapy) reduces pain, anxiety, and depression in patients with chronic cervical and lumbar spondylytic pain: A potential alternative to opioids in multimodal pain management

Matthew J McGirt; Christopher M Holland; S Harrison Farber; Scott L Zuckerman; Michael S Spertus; Nicholas Theodore; Deborah Pfortmiller; Gerry Stanley

doi:10.1016/j.xnsj.2023.100287

Remote cognitive behavioral therapy utilizing an in-home virtual reality toolkit (Vx Therapy) reduces pain, anxiety, and depression in patients with chronic cervical and lumbar spondylytic pain: A potential alternative to opioids in multimodal pain management

N Am Spine Soc J. 2023 Oct 19:16:100287. doi: 10.1016/j.xnsj.2023.100287. eCollection 2023 Dec.

Authors

Matthew J McGirt¹, Christopher M Holland¹, S Harrison Farber², Scott L Zuckerman³, Michael S Spertus⁴, Nicholas Theodore⁵, Deborah Pfortmiller¹, Gerry Stanley⁶

Affiliations

¹ Carolina Neurosurgery & Spine Associates, Atrium-Wake Forest University, 225 Baldwin Ave, Charlotte, NC 28205, USA.
² Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd. Phoenix, AZ 85013, USA.
³ Department of Neurosurgery, Vanderbilt University, 1211 Medical Center, Nashville, TN 37232, USA.
⁴ Whole Health in Pain Medicine, Miami Veterans Affairs Healthcare System, 1201 NW 16th St., Miami, FL 33125, USA.
⁵ Department of Neurosurgery, Johns Hopkins University, 1800 Orleans St., Baltimore, MD 21287, USA.
⁶ Harvard Med Tech, 6280 S. Valley View Blvd., Las Vegas, NV 89118, USA.

Abstract

Background context: Virtual reality (VR) reduces pain through visual and auditory distraction without narcotic-related side effects or dependency. Cognitive behavioral therapy (CBT) improves pain-related disability and quality of life, but patient access remains a challenge. We hypothesized that in-home weekly CBT coordinated with daily use of a proprietary VR toolkit will reduce pain, anxiety, and depression for patients with non-operative chronic cervical and lumbar spondylitic pain with and without radiculopathy.

Methods: A total of 145 patients with chronic spondylitic pain (63 cervical, 46 noradicular lumbar, 36 radicular lumbar) were enrolled into a guided 14-week VR+CBT program (Vx Therapy) consisting of weekly encounters with a trained therapist and 50 modules. Pain/anxiety severity scores and time to pain recurrence were recorded prospectively by patients. PROMIS measures of overall daily pain intensity, behavior, interference, anxiety, and depression were recorded at baseline and conclusion of the program.

Results: A total of 52% of the 145 patients were male. The average (SD) age of the cohort was 51 (10.7) years (range: 24-76 years). Mean score for all PROMIS domains were significantly improved after 14 weeks of Vx Therapy (pain intensity 36±24 vs. 28±21, interference 39±25 vs. 24±21, behavior 35±21 vs. 25±16, anxiety 51±28 vs. 41±26, depression 58±32 vs. 48±32) for the entire cohort and each diagnosis group. Virtual reality acutely reduced pain on average by 33% (4.5±2.5 vs. 6.7±2.2, p<.05) across all 14 weeks, lasting a mean 2.8 hours after use. Duration of pain relief increased by the final vs. first month (4.5 hours vs. 2.5 hours, p<.05). Virtual reality acutely reduced anxiety on average by 46% (3.5±3 vs. 6.4±2, p<.05) across all 14 weeks lasting a mean 2.7 hours after use. The effect was similar for all 3 groups.

Conclusions: Fourteen weeks of a remote CBT guided in-home VR toolkit provided effective and sustained pain, anxiety, and depression relief in patients with chronic degenerative neck/back pain with and without radiculopathy. The non-invasive, non-pharmacological nature of Vx Therapy makes it an ideal option for pain management in the post-opioid epidemic era.

Keywords: Back pain; CBT, Spondylytic pain; Chronic pain; Cognitive behavioral therapy; Neck pain; Virtual reality therapy.