# Effectiveness and user experience of a virtual reality intervention in a cohort of patients with chronic musculoskeletal pain syndromes

## TL;DR

Virtual reality (VR) provides short- and mid-term pain and anxiety relief for chronic musculoskeletal pain patients, especially those with high anxiety and nociplastic pain.

## Contribution

Identified patient characteristics and psychological factors that predict positive VR outcomes in chronic pain management.

## Key findings

- VR reduced pain and anxiety in CMP patients with moderate short-term effects.
- Patients with high baseline anxiety showed greater pain reduction after VR.
- Machine learning identified a responsive cluster with nociplastic pain, alexithymia, and anxiety.

## Abstract

Chronic musculoskeletal pain (CMP) syndromes, including fibromyalgia, present diverse physical and psychological symptoms often resistant to pharmacological treatment. To retrospectively evaluate the effectiveness and user experience of Virtual Reality (VR) in reducing pain and anxiety in CMP patients and identify predictors of positive response. Data from 91 CMP patients in a 2-week interdisciplinary pain program were analyzed (78% met fibromyalgia criteria). Pain and anxiety were assessed using Numerical Rating Scales (NRS 0-10) before and after VR. Follow-up interviews were conducted after one month. An unsupervised machine learning model explored response patterns. VR led to a moderate but significant short-term reduction in anxiety and pain (median NRS −1.0, p < 0.001). A reduction of ≥3 NRS points occurred in 25% (anxiety) and 14% (pain). High baseline anxiety (NRS ≥ 7) correlated with greater pain reduction (median −2.0, p = 0.01). After one month, half of the patients reported sustained benefits. Catastrophizing and benzodiazepine use were linked to improved anxiety outcomes. Machine learning identified a most responsive cluster, characterized by patients with nociplastic pain, alexithymia, and anxiety. VR provided moderate short- and mid-term benefits for anxiety and pain in CMP patients, particularly in those with nociplastic pain and high baseline anxiety.

Chronic musculoskeletal pain (CMP), including conditions like fibromyalgia, is often difficult to manage with traditional medications alone. This study explores the potential of Virtual Reality (VR) as a tool to alleviate pain and anxiety in patients with CMP. We analyzed data from 91 patients who participated in a two-week interdisciplinary pain program and used VR as part of their treatment. During the program, comprehensive psychological and rheumatological assessments, as well as sleep analysis, were performed. Our findings indicate that VR provided moderate short-term relief, with nearly half of the participants reporting reduced anxiety and pain. Interestingly, patients with high levels of anxiety before the VR session experienced the most significant improvements. A follow-up survey conducted one month later showed that over half of the participants continued to perceive benefits from VR, particularly in reducing anxiety. A machine learning model helped identify specific patient characteristics that predicted a stronger response to VR, including those with nociplastic pain and psychological factors such as anxiety and alexithymia. While VR was well received by most participants, some experienced discomfort due to positioning or visual effects. This study highlights VR’s potential as a non-pharmacological option for managing chronic pain and anxiety, especially for patients with significant psychological distress. Future research should explore long-term effects and further personalize VR therapy for optimal outcomes.