Differential treatment response to virtual reality in high-impact chronic pain: secondary analysis of a randomized trial.

High-impact chronic pain (HICP) affects 8.5% of the population and is associated with higher healthcare utilization and costs. Sparse data exist on pain treatment response differences between HICP vs. lower-impact chronic pain (LICP). We conducted a secondary analysis of a randomized controlled trial in a diverse community sample (N = 1067) with chronic low back pain who were demographically diverse (female: 77%; non-Caucasian: 32%; high school or less education: 19%; mean age: 50.8) and clinically severe (baseline pain intensity = 6.6, baseline pain interference = 6.2, and 42% severe/completely disabled). We compared HICP vs. LICP treatment responses for an 8-week Skills-Based Virtual Reality program at end-of-treatment and at 12-months for pain intensity and pain interference (multi-primary outcomes). MMRM analysis (multiplicity corrected) revealed significantly larger reductions (and clinically meaningful reductions) for HICP than LICP for both primary outcomes at both post-treatment time points. End-of-treatment reduction in pain interference among HICP reclassified 70% of them as LICP, and this improvement held at 12-months (67%). Significantly larger reductions were found for HICP vs LICP for the secondary outcomes Sleep Disturbance and the Oswestry Disability Index, but not for Depression. No differences were found for HICP vs. LICP for device engagement or usability scores.Trial registration: ClinicalTrials.govNCT05263037 .