Virtual Reality Neuro Feedback (VRNF) Pre-Implementation Site Visit

Keywords

Chronic pain, virtual reality, neurofeedback, patient-centered outcomes

Types of Research

Pre-implementation study; community-engaged research; patient-centered outcomes research

Summary

This is a single site, qualitative study in which we will conduct interviews and focus groups with care team members (i.e., primary care providers, nurses, behavioral health providers), clinic staff, clinic leadership, and patients to identify barriers and facilitators to VRNF implementation, guided by PRISM/RE-AIM domains likely to influence implementation (e.g. implementation & sustainability infrastructure, external environment). These interviews and surveys will focus on workflow impacts, resource constraints, and perceptions of reach, effectiveness, adoption, and sustainability.

Significance

The significance of this project is to adapt the usage of VRNF based on patient feedback, EEG signals in response to VRNF, and assessed optimal dosage. Upon doing so, we will explore the accessibility and feasibility of VRNF among outpatient settings. Furthermore, we will gain an understanding of how VRNF affects patients' mood, pain, and anxiety management.

Impact

Primary care environments are well-positioned to deliver VRNF due to their role as the first point of contact for patients and the ongoing relationships providers establish. However, successfully integrating VRNF into these settings involves addressing several challenges, including provider training, patient engagement, and logistical issues. In rural primary care, additional complexities arise from provider shortages17 and limited access to multidisciplinary pain management approaches.18 Given the scarcity of healthcare resources and potential transportation barriers in these areas, 18,19 VRNF presents a vital non-pharmacologic intervention tailored to the needs of chronic pain patients.

Implications for Reducing Health Disparities

Chronic pain affects 50 million people in the United States, leading to significant public health challenges, including reduced quality of life, disability, and lost workforce productivity.1-3 These issues cost the healthcare system over $100 billion annually, primarily due to pain management and opioid use disorders.4 In rural communities, where access to comprehensive pain management services is limited, patients face additional barriers that can exacerbate their condition and further reduce quality of life.5,6 Primary care physicians manage approximately 52% of chronic pain cases. 7,8 

There is an urgent need for innovative pain management approaches that reduce opioid dependence, improve patient outcomes and address the broader public health impact of chronic pain in underserved, rural areas.5,12,13

References

 

  1. Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. Aug 2015;16(8):769-80. doi:10.1016/j.jpain.2015.05.002
  2. Rikard SM. Chronic pain among adults—United States, 2019–2021. MMWR Morbidity and Mortality Weekly Report. 2023;72
  3. Kawai K, Kawai AT, Wollan P, Yawn BP. Adverse impacts of chronic pain on health-related quality of life, work productivity, depression and anxiety in a community-based study. Fam Pract. Nov 16 2017;34(6):656-661. doi:10.1093/fampra/cmx034
  4. Alford DP, Krebs EE, Chen IA, Nicolaidis C, Bair MJ, Liebschutz J. Update in pain medicine. J Gen Intern Med. Nov 2010;25(11):1222-6. doi:10.1007/s11606-010-1452-4
  5. Rafferty AP, Luo H, Egan KL, Bell RA, Gaskins Little NR, Imai S. Rural, Suburban, and Urban Differences in Chronic Pain and Coping Among Adults in North Carolina: 2018 Behavioral Risk Factor Surveillance System. Prev Chronic Dis. Feb 18 2021;18:E13. doi:10.5888/pcd18.200352
  6. Asante D, McLachlan CS, Pickles D, Isaac V. Understanding unmet care needs of rural older adults with chronic health conditions: A qualitative study. International journal of environmental research and public health. 2023;20(4):3298.
  7. Breuer B, Cruciani R, Portenoy R. Pain Management by Primary Care Physicians, Pain Physicians, Chiropractors, and Acupuncturists: A National Survey. Southern medical journal. 08/01 2010;103:738-47. doi:10.1097/SMJ.0b013e3181e74ede
  8. Dubois MY, Follett KA. Pain medicine: the case for an independent medical specialty and training programs. Academic Medicine. 2014;89(6):863-868.
  9. Punwasi R, de Kleijn L, Rijkels-Otters JBM, Veen M, Chiarotto A, Koes B. General practitioners' attitudes towards opioids for non-cancer pain: a qualitative systematic review. BMJ Open. Feb 1 2022;12(2):e054945. doi:10.1136/bmjopen-2021-054945
  10. Eichmeyer S, Zhang J. Primary care providers’ influence on opioid use and its adverse consequences. Journal of Public Economics. 2023/01/01/ 2023;217:104784. doi:https://doi.org/10.1016/j.jpubeco.2022.104784
  11.  Bell LV, Fitzgerald SF, Flusk D, Poulin PA, Rash JA. Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America prior to the emergence of COVID-19: A systematic review of qualitative research. Can J Pain. 2023;7(1):2156331. doi:10.1080/24740527.2022.2156331
  12. Eaton LH, Langford DJ, Meins AR, Rue T, Tauben DJ, Doorenbos AZ. Use of Self-management Interventions for Chronic Pain Management: A Comparison between Rural and Nonrural Residents. Pain Manag Nurs. Feb 2018;19(1):8-13. doi:10.1016/j.pmn.2017.09.004
  13. Heyward J, Jones CM, Compton WM, et al. Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers. JAMA Netw Open. Oct 5 2018;1(6):e183044. doi:10.1001/jamanetworkopen.2018.3044
  14. Rolbiecki AJ, Froeliger B, Smith J, et al. Virtual reality and neurofeedback as a supportive approach to managing cancer symptoms for patients receiving treatment: A brief report of a feasibility trial. Palliative and Supportive Care. 2024:1-7. doi:10.1017/S1478951524000385
  15. Orakpo N, Vieux U, Castro-Nuñez C. Case Report: Virtual Reality Neurofeedback Therapy as a Novel Modality for Sustained Analgesia in Centralized Pain Syndromes. Case Report. Frontiers in Psychiatry. 2021;12
  16. Rolbiecki AJ, Craig K, Megan P, Smith J, Ghosh P, Mehr DR. Virtual Reality and Neurofeedback for Management of Cancer Symptoms: A Feasibility Pilot. Am J Hosp Palliat Care. Mar 2023;40(3):291-298. doi:10.1177/10499091221109900
  17. Schaefer SL, Dualeh SHA, Kunnath N, Scott JW, Ibrahim AM. Higher Rates Of Emergency Surgery, Serious Complications, And Readmissions In Primary Care Shortage Areas, 2015–19: Study examines rates of emergency surgery, serious complications, and readmissions in primary care shortage areas. Health Affairs. 2024;43(3):363-371.
  18. Dave P. Reducing Disparities in Pain Management in Primary Care. Asian Journal of Hospital Pharmacy. 2024:28-33.
  19. Nguyen LH, Dawson JE, Brooks M, Khan JS, Telusca N. Disparities in pain management. Anesthesiology Clinics. 2023;41(2):471-488. 

 

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