ORIGINAL RESEARCH article
Front. Pain Res.
Sec. Geriatric Pain
This article is part of the Research TopicBeyond Pills and Potions: The Role of Technology in Managing Later-Life PainView all articles
From Randomized Controlled Trial to Real World Clinical Evidence: Effectiveness and Engagement of In-Home Virtual Reality Pain Treatment for Chronic Pain in Older Adults
Provisionally accepted
- 1AppliedVR, Van Nuys, United States
- 2Scripps Center for Integrative Medicine, La Jolla, United States
- 3Stanford University School of Medicine, Stanford, United States
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Chronic lower back pain prevalence is greatest among older adults. Older adults (65+) often have multiple comorbidities and are more likely to have high-impact chronic pain that significantly impacts daily activities and function. Owing to greater pain burden, older adults are prime candidates for low-risk, in-home pain treatment. The goal of the present study was two-fold: (1) to examine clinical effectiveness of an FDA-Authorized Skills-Based Virtual Reality delivered therapy for chronic lower back pain in adults (18 – 64) and older adults (65+) by conducting a secondary analysis of a randomized controlled trial (N = 505), and (2) to examine engagement rates with the Skills-Based Virtual Reality delivered therapy in adults and older adults in the randomized controlled trial sample, and a separate real-world clinical sample (N = 2460). The clinical effectiveness analysis found that adults and older adults with chronic lower back pain showed statistically equivalent and clinically meaningful reductions in pain intensity and pain interference that were durable to 12-months post-treatment along with parallel improvements in sleep, depression, and physical disability. Adult and older adult high-impact chronic pain patients showed greater pain reductions than lower impact chronic pain patients with the majority shifting to lower impact chronic pain status at end-of-treatment that was maintained at 12-months post-treatment. VR program engagement analysis showed that older adults evidenced higher engagement in VR relative to adults in both the randomized controlled trial and real-world clinical sample. Together these results challenge common misperceptions about older adults and suggest that this Skills-Based VR therapy is an accessible solution for chronic lower back pain in older adults that leads to strong clinical outcomes and high VR program engagement.
Keywords: virtual reality, Chronic lower back pain, immersive therapeutic, Cognitive behavioral therapy (CBT), VR
Received: 27 Aug 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Maddox, Sackman, Judge, Maddox, Bonakdar and Darnall. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Todd Maddox, tmaddox@appliedvr.io
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