Combining Virtual Reality and Cognitive Behavioral Principles in Treating Long-term Pain: A Feasibility Study

Immersive virtual reality (VR) may enhance long‑term pain management when used alongside usual care. VR interventions based on cognitive and behavioral principles have potential to improve patient engagement, stress regulation, and coping. Investigate feasibility, usability and exploratory clinical impact of immersive virtual reality (VR) as an adjunct to usual care for patients with long-term pain. Of the 30 patients approached 28 were enrolled. Patients used immersive VR software grounded in Cognitive Activation Theory of Stress (CATS), cognitive behavioral therapy (CBT) and Acceptance and Commitment Therapy (ACT), delivered through Head Mounted Displays (HMDs). Usability and feasibility were assessed with System usability Scale (SUS) and clinician interviews. Patient-reported outcome measures included health-related quality of life (EQ-5D-5 L, EQ-VAS), PROMIS − 29 and the Patient Global Impression of Change (PGIC). Patients completed a median of 10 VR sessions over 8 weeks. Usability was high (average SUS 82), and no serious adverse events occurred. All patients completed the intervention; five were lost to follow-up, leaving 23 for analysis. On the PGIC, 34% reported improvement, 57% no change, and 8% worsening. Pain Interference approached statistical significant reduction (p = 0.05). Both EQ-VAS and EQ-index improved significantly (p = 0.02 and p = 0.03). Other domains showed small and non-significant changes (p > 0.05). Clinician interviews (n = 5) indicated the VR intervention was highly usable, aligned with therapeutic objectives, enhancing patient education and information retention. Immersive VR combined with usual care is feasible and safe for managing long-term pain. Controlled trials are needed to explore efficacy.