Background:
Within the VIREP (Virtual Reality for Chronic Backpain) - project, a Virtual Reality (VR) tool was developed  including elements of movement training, distraction and body awareness. This study aimed to investigate if (i) VR training causes any side effects, (ii) VR influences pain intensity, and (iii) how patients perceive the VR training. 

Methods:
As part of an inpatient multimodal pain management program, patients with chronic low back pain participated in seven training sessions.
Activities of daily living were practiced in an explorative, domestic VR environment.
Pain intensity was measured before, during and after each session, using a numeric rating scale (NRS; 0-10). VR training acceptance was measured with structured interviews.

Results:
23 patients (age 51 +/-12, 11 women) participated; five patients had to be excluded. No side effects were observed. Pain intensity improved slightly from the beginning to the end of the therapy program (5.2/10 vs. 4.9/10, p=0,083). In 54% of sessions, pain intensity remained unchanged before and after the sessions, in 35% of sessions pain reduced by at least two NRS points. In 16% of sessions that resulted in pain relief, patients claimed to be pain free after the treatment. A non-clinically significant pain increase of 1.3/10 was observed in 11% of sessions. Most patients (83%) enjoyed the VR activities. All patients perceived the treatment as pleasant.

Conclusion:
Findings suggest that the VR environment is a safe treatment method and was well accepted. A pain increase occurred in only a small percentage of training sessions.

VIRTUAL REALITY AS PART OF A MULTIMODAL THERAPY FOR INPATIENT CHRONIC LOW BACK PAIN PATIENTS