Acute musculoskeletal injuries, such as bone fractures and joint dislocations, are common and may result in chronic pain and functional limitations. Previous studies have documented that certain psychological risk factors (such as pain catastrophizing and anxiety) are associated with worse outcomes among individuals with acute orthopedic injuries. However, acute orthopedic care often overlooks these psychological components of rehabilitation.
While cognitive behavioral therapy and mind-body approaches have shown promise in terms of decreasing depression and pain catastrophizing and increasing physical functioning after an orthopedic injury, access to these approaches remains poor due to the stigma surrounding mental health treatment, reluctance to address psychosocial issues in the orthopedic setting, lack of trained providers, and inadequate health insurance coverage. In a recent study, Ryan Mace, PhD, a psychologist at the Center for Health Outcomes and Interdisciplinary Research (CHOIR) at Mass General, and colleagues have examined the use of virtual reality (VR) in patients with acute orthopedic injury.
Virtual Reality (VR) is a computer-generated simulation that creates an immersive, three-dimensional environment users can interact with using specialized equipment (typically a headset). Because VR is an immersive experience, it can help distract the user from painful stimuli; however, VR can also incorporate behavioral pain management strategies and skills training (e.g., education, diaphragmatic breathing, relaxation training, cognition and emotion regulation). In this pilot study, Mace and colleagues explore the use of the skills-based VR program RelieveVRx (approved by the FDA for the management of low back pain) in a group of individuals with acute musculoskeletal injuries.
The research team recruited 10 adults with acute orthopedic injuries and elevated pain catastrophizing or pain anxiety from Level 1 Trauma Clinics within the Mass General Brigham health care system. Participants completed daily RelieVRx sessions at home for 8 weeks.The RelievRX intervention incorporates pain education, relaxation exercises, mindfulness techniques, games, and dynamic breathing biofeedback.
In this pilot study, the researchers observed improvements in pain, physical functioning, sleep, and depressive symptoms. Qualitative exit interviews demonstrated high satisfaction with RelieVRx among participants and yielded recommendations for supporting additional VR-based clinical trials with orthopedic patients.
While this pilot study was small, the results are promising and suggest that skills-based VR may be a useful tool for addressing pain management and improving outcomes in patients after an acute musculoskeletal injury. The authors note the immense potential for therapeutic VR to radically shift our approach to preventing chronic pain and disability, providing an effective, low-risk non-pharmacological intervention for acute orthopedic injury. Skills-based VR could be easily administered in the clinic or at home, adapted to other pain conditions, and personalized using digital therapeutics. Future larger randomized clinical trials of RelieVRx versus a sham placebo control are needed to replicate the findings and to better understand mechanisms of action.
Mace RA, Brewer JR, Cohen JE, Ly TV, Weaver MJ, Borsook D. Virtual Reality for Subacute Pain After Orthopedic Traumatic Musculoskeletal Injuries: A Mixed Methods Pilot Study. Clin J Pain. 2024 Sep 1; 40(9):526-541.
