Feasibility and safety of pain neuroscience education and graded exposure using non-immersive virtual reality on pain and psychosocial factors in adults with chronic low back pain: preliminary effects of a randomised controlled pilot trial

Abstract Pain neuroscience education combined with graded exposure using virtual reality (PNE + GE-VR) may reduce pain intensity and maladaptive psychosocial factors in adults with chronic low back pain (CLBP). The main objective was to examine the feasibility and safety of a single session of PNE + GE-VR and to investigate the preliminary immediate effects on pain intensity compared with a control group (CG). As secondary objective, the preliminary immediate effects on other pain outcomes and psychosocial factors were analysed. A randomised controlled pilot trial was conducted. Participants were adults with CLBP who regularly attended therapeutic swimming as part of their usual activities. The PNE + GE-VR group received a 90-minute session of PNE plus GE using non-immersive VR (Nintendo Switch ® ). The CG did not receive intervention. Both groups continued their usual therapeutic swimming sessions. ANCOVA was conducted. Fifty-four participants were allocated to PNE + GE-VR group ( n = 33) or CG ( n = 21). The intervention was feasible and safe. Regarding preliminary clinical efficacy, adjusted between-group differences favouring PNE + GE-VR group were observed for pain interference, knowledge of pain neurophysiology, kinesiophobia, and pain catastrophizing. For secondary outcomes, no relevant between-group differences were identified. A single session of PNE + GE-VR was feasible and safe, and may be an adjunctive promising approach for CLBP, with potential immediate benefits on pain and psychosocial factors. Future research should focus on adequately powered efficacy trials to confirm these findings. Trial registration number ID: NCT06410027. Date: 2024-04-19. Available at: https://clinicaltrials.gov/search?cond=NCT06410027 .