Virtual Reality for Pain in Acute Orthopedic Injuries

Mass General Brigham

Status: Completed

Conditions: Injuries; Injury Finger; Injury;Sports; Injury, Hand; Injury, Knee; Injury, Ankle; Injury Leg; Injury Arm; Injury Foot; Injury Wrist

Treatments: Device: RelieveVRx

Study type: Interventional

Funder types: Other

Identifiers

NCT05552430

2022P001500

Details and patient eligibility

About

The goal of this study is to pilot test a skills-based virtual reality (VR) for acute orthopedic injury. It will measure the feasibility, signals of improvement, exploratory pain mechanisms, and user experience of an established skills-based program (RelieveVRx) for acute orthopedic injury.

Full description

This study will use mixed-methods to investigate the feasibility of skills-based virtual reality (VR) for acute orthopedic injury in an open pilot with individual exit interviews (target N=10). Participants will be patients with acute orthopedic musculoskeletal injuries who are at risk for chronic pain and disability (PCS ≥ 20 and PASS-20 ≥ 40) and meet inclusionary/exclusionary criteria. Participants will be recruited through the MGH Orthopedics Department, flyers, and the Rally research platform. Participants will self-administer a skills-based virtual reality (VR) program at home over an 8-week period. Participants will attend two in-person study assessments to complete study assessments (surveys and an fNIRS imaging session). The primary outcome for the pilot will be a-priori Go/No-Go feasibility markers (feasibility, acceptability, fidelity, credibility, expectancy, satisfaction) of the VR program and data collection procedures to increase the success of subsequent trials. Exploratory measures include: multi-modal assessment of pain intensity, pain-specific coping (catastrophizing, self-efficacy, acceptance), disability, physical function, and emotional function (depression, anxiety, stress). The VR headset will collect usage data and daily smartphone surveys will track changes in pain during the 8-week intervention. Completers will have the opportunity to attend 30 min individual exit interviews to understand patients' perception of the VR and their experience with the study procedures to increase the success of larger trials.

Enrollment: 10 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Outpatient adults in the Level 1 Trauma Center
2. Age 18 or older
3. Able to meaningfully participate meaningfully (English fluency and literacy) and stable living situation
4. Acute musculoskeletal injury (e.g., fracture, dislocation, rupture) 1-2 months earlier (acute phase).
5. Pain Catastrophizing Scale ≥20 or Pain Anxiety Symptom Scale-20 ≥40
6. Has access to internet (Wi-Fi or wireless)
7. Willing to participate and comply with the requirements of the study protocol, including virtual reality program and questionnaire completion No psychotropics or stable for >6 weeks
8. Free of concurrent psychotropic medication for at least 2 weeks prior to initiation of treatment, OR stable on current psychotropic medication for a minimum of 6 weeks and willing to maintain a stable dose (i.e., no psychotropics or stable for >6 weeks)
9. Cleared by orthopedic surgeon for study participation

Exclusion criteria

1. Current or prior diagnosis of epilepsy, seizure disorder, dementia, migraines, or other neurological diseases that are contraindicated for VR
2. Medical condition predisposing to nausea or dizziness.
3. Hypersensitivity to flashing light or motion.
4. Vision or severe hearing impairment.
5. Injury to eyes, face, or neck that impedes comfortable use of virtual reality
6. Diagnosed with a medical illness expected to worsen in the next 3 months (e.g., malignancy)
7. Other serious injuries that occurred with the orthopedic injury or surgical complications (e.g., infection, need for repeat surgery)
8. Current or prior untreated mental illness, substance use disorder, or suicidal ideation
9. Self-reported pregnancy
10. Currently in litigation or under Workman's Comp
11. Practice of cognitive-behavioral therapy, yoga/meditation, or other mind body techniques once per week for 45 minutes or more within the last 3 months

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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10 participants in 1 patient group

Skills-Based VR

Experimental group

Description:

Participants will complete daily skills-based Virtual Reality (VR) sessions for 8 weeks (an average of 6 minutes per day) to determine the feasibility of at-home VR technology to aid the recovery of acute orthopedic musculoskeletal injuries. The VR device software is equipped with pain-specific treatment modules (e.g., Pain Education, Relaxation/Interoception, Mindful Escapes, and Pain Distraction Games) derived from evidence-based principles of cognitive behavioral therapy (CBT), mindfulness, and pain neuroscience education.

Treatment:

Device: RelieveVRx