Investigating Demographic Barriers Toward Virtual Reality Pain Efficacy in Clinical Trials: An Exploratory Mixed-Methods Study.

Chronic pain affects over 50 million Americans and is frequently managed with pharmacologic interventions, including opioids, which carry misuse risks. Virtual reality (VR) has emerged as a promising non-pharmacological therapy, yet questions persist about equitable access and whether VR could perpetuate existing health care disparities. This exploratory sequential mixed-methods study investigated barriers and facilitators to VR therapy use in diverse chronic pain populations and examined whether these challenges correlated with changes in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PROMIS-PI) scores. We recruited 31 participants from two National Institutes of Health-funded trials, utilizing purposive sampling to ensure a broad demographic range regarding race, ethnicity, gender, socioeconomic status, and geographic location. Participants completed one-on-one interviews regarding VR use, which were qualitatively coded and quantified to explore correlations with changes in PROMIS-PI from baseline to week 8. Six themes emerged from the qualitative analysis: apprehension and familiarity, usability and comfort, application and pain, experiences, personal connection, and community beliefs. Most participants reported at least temporary pain relief with VR, citing distraction-based or mindfulness content as beneficial; however, cost, technological literacy, and cultural familiarity were identified as key barriers. Spearman's $\rho$ and point-biserial tests showed no statistically significant relationships between thematic variables or demographics and PROMIS-PI changes. These findings suggest that VR therapy is broadly acceptable and beneficial across diverse patient groups, though cost and cultural apprehension may impede widespread, equitable adoption. Future research should focus on refining VR content for user comfort, expanding technological support, and developing strategies to overcome barriers to access to ensure the therapy's benefits are realized equitably.