S1900 Single Arm Feasibility Trial of a Virtual Reality-Directed Brain-Gut Behavioral Pain Treatment for Hospitalized Patients With Inflammatory Bowel Disease

Introduction: Hospitalized patients with inflammatory bowel disease (IBD) often receive inadequate pain treatment, given concerns for serious adverse effects from both opioid and non-opioid analgesics. Brain-gut behavioral therapies (BGBT) such as cognitive-behavioral therapy are effective for pain management but have not been fully examined as a pain treatment for hospitalized IBD patients. We examined the feasibility and acceptability of virtual reality (VR)-directed BGBT for hospitalized patients with IBD. Methods: We conducted a prospective single-arm study of a multicomponent inpatient VR-BGBT (comprised of education, distraction games, breathing exercises, meditation, and cognitive-behavioral therapy) for patients with IBD. We recruited adult hospitalized patients with IBD who self-reported IBD-related pain (severity ≥ 2, on a 0-10 scale). Our primary objective was intervention feasibility (the proportion of enrolled participants that received the VR-BGBT) and our secondary objective was intervention acceptability (evaluated using the Treatment Acceptability/Adherence Scale [TAAS] and qualitative interviews). We also explored changes in pain severity, perceived stress, pain catastrophizing, emotions, and IBD-related symptoms from baseline to post-treatment. Results: We enrolled 23 participants who were hospitalized with IBD and self-reported pain. We delivered the VR-BGBT to all 23 (100%) participants and 1 (4.4%) participant withdrew within 24 hours due to nausea, suggesting high tolerability of VR-BGBT. Participants rated the inpatient VR-BGBT treatment as acceptable (median TAAS 57, interquartile range [IQR] 52,62] on a 10-70 scale with higher scores indicating greater acceptability). Qualitative interviews revealed that VR-BGBT was easy to use, reduced the stress of hospitalization, distracted from acute pain, and promoted use of breathing exercises and meditation. Pre-to-post-treatment assessments demonstrated significant reductions in pain severity, perceived stress, daily pain catastrophizing, and bowel symptoms. Conclusion: VR-BGBT is feasible and acceptable as an inpatient treatment option for patients with IBD-related pain. Preliminary study findings, while confounded by concomitant effective treatment for inflammation, suggest that VR-BGBT may address pain-related distress and will inform future efficacy studies.