The COVID-19 pandemic affected everyone in different ways. For people in rural America with chronic diseases, particularly those who experienced pain, the pandemic not only worsened pain but also triggered anxiety, depression, trouble sleeping, and substance use. This psychological distress was exacerbated by physical and social isolation, fear of seeking in-person visits, and a diminished ability to access clinical care during the pandemic. One way doctors and health systems reached out was through video visits, where patients and their providers communicated online via the Internet. However, video visits still had limits. Therefore, other techniques were used to support these visits.
Beyond video visits, there were home-based programs that patients could administer themselves to help manage their pain. These proven programs overcame staffing shortfalls, could be used over long distances to reach anyone in the world, and could be used at the time and place of the patients' choosing. In this study, two available, evidence-based, digital treatment programs that patients could use at home were compared. The goal was to determine if one approach was better than the other and whether certain patients responded better to one than the other.
The first program was an app that could run on any smartphone or computer. The program offered an 8-week, at-home curriculum to learn and practice new skills to help manage pain. The program ran on a standard screen on a phone or computer. The second program was also a proven 8-week program, but it used a technology called virtual reality (VR). VR involved wearing specialized goggles that created a sensation of being in a 3D world. Evidence showed that virtual worlds helped people learn and retain new skills to reduce pain.
The study recruited 300 people from rural communities in California, Louisiana, and Alabama and randomized them into either the 2D or 3D programs. Patients were then followed for 8 weeks, and their pain levels were measured. Signs of distress, including COVID-related anxiety, were also measured, along with medications used for pain, such as opioids, and the impact of pain on overall quality of life. To conduct the study, patients were asked to periodically complete short surveys online and permit the research team to collect information from their electronic health records. The study was developed in collaboration with patient partners from the American Chronic Pain Association (ACPA), who were part of the research team throughout the study's conduct, analysis, and reporting. The results helped patients, doctors, and health systems decide how best to administer home-based, patient-administered, digital treatment programs for pain and offered recommendations on how to select the right treatment for the right patient.
