Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital.
Harvard Medical School.
Clin J Pain. 2024 Sep 1;40(9):526-541. doi: 10.1097/AJP.0000000000001231.
Acute orthopedic traumatic musculoskeletal injuries are prevalent, costly, and often lead to persistent pain and functional limitations. Psychological risk factors (eg, pain catastrophizing and anxiety) exacerbate these outcomes but are often overlooked in acute orthopedic care. Addressing gaps in current treatment approaches, this mixed-methods pilot study explored the use of a therapeutic virtual reality (VR; RelieVRx ), integrating principles of mindfulness and cognitive-behavioral therapy, for pain self-management at home following orthopedic injury.
We enrolled 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, which included pain education, relaxation, mindfulness, games, and dynamic breathing biofeedback. Primary outcomes were a priori feasibility, appropriateness, acceptability, satisfaction, and safety. Secondary outcomes were pre-post measures of pain, physical function, sleep, depression, and hypothesized mechanisms (pain self-efficacy, mindfulness, and coping).
The VR and study procedures met or exceeded all benchmarks. We observed preliminary improvements in pain, physical functioning, sleep, depression, and mechanisms. Qualitative exit interviews confirmed high satisfaction with RelieVRx and yielded recommendations for promoting VR-based trials with orthopedic patients.
The results support a larger randomized clinical trial of RelieVRx versus a sham placebo control to replicate the findings and explore mechanisms. There is potential for self-guided VR to promote evidence-based pain management strategies and address the critical mental health care gap for patients following acute orthopedic injuries.
急性骨科创伤性肌肉骨骼损伤较为常见，费用高昂，且常导致持续性疼痛和功能受限。心理风险因素（如疼痛灾难化和焦虑）会使这些后果恶化，但在急性骨科护理中往往被忽视。为了弥补当前治疗方法的不足，这项混合方法的试点研究探讨了使用一种治疗性虚拟现实（RelieVRx），整合正念和认知行为疗法的原则，用于骨科损伤后在家中进行疼痛自我管理。
我们招募了来自马萨诸塞州综合医院布里格姆卫生保健系统一级创伤诊所的 10 名急性骨科损伤且疼痛灾难化或疼痛焦虑程度较高的成年人。参与者在家中完成了 8 周的每日 RelieVRx 疗程，其中包括疼痛教育、放松、正念、游戏和动态呼吸生物反馈。主要结果是预先设定的可行性、适当性、可接受性、满意度和安全性。次要结果是疼痛、身体功能、睡眠、抑郁和假设机制（疼痛自我效能、正念和应对）的前后测量。
VR 和研究程序均达到或超过所有基准。我们观察到疼痛、身体功能、睡眠、抑郁和机制方面的初步改善。定性退出访谈证实了对 RelieVRx 的高度满意度，并提出了促进基于 VR 的骨科患者试验的建议。
结果支持更大规模的随机临床试验，以复制 RelieVRx 与假安慰剂对照的结果并探索机制。自我引导的 VR 有可能促进基于证据的疼痛管理策略，并解决急性骨科损伤后患者心理健康护理的关键差距。
