Whether playing simulated dodgeball or fishing, individuals who participate in immersive video games get distracted from chronic back pain and make specific movements that ease their discomfort and allow them to engage in more active lives, according to preliminary findings by a VCU physical therapy researcher. James Thomas, Ph.D., professor and director of the Motor Control Lab, presented the early results, based on five years of data collection, during the International Association for the Study of Pain’s  2024 World Congress  this summer in Amsterdam.

More specifically, the promising results showed a 31% decrease in pain and a 30% reduction in disability among participants, according to Thomas, a leading researcher in the field of virtual reality (VR) and chronic pain. Funded by a $3.5 million grant from the National Institutes of Health, the study explores the use of immersive VR games as an intervention that encourages movement in individuals suffering from chronic back pain.

“We've developed a suite of VR games specifically designed to get people with chronic back pain to engage in trunk movement, which they often try to avoid due to fear,” said Thomas, who has been studying this approach for more than a decade and published more than 20 papers on related research. “The underlying thought is that if you can get people to move, over time, they will implicitly learn they can move again.”

Chronic back pain is a pervasive and debilitating condition, affecting an estimated one in three Americans. What’s more, 90% of all back pain lacks any identifiable cause. Traditional treatments often fall short, and can lead patients on a seemingly never-ending search for symptom relief and a better quality of life. 

After practicing for 15 years, Thomas wanted to better understand why some patients with back pain improved and others did not –  even when they have the same signs and symptoms. He returned to school to earn his doctorate in kinesiology at Ohio University, where Thomas focused on neuroscience and how patient fears map to movement.

His passion and research has led to an  innovative approach that harnesses the power of VR to distract users and gradually expose them to movements they would typically avoid. “The beauty of this VR intervention is that it allows us to create a safe, controlled environment where people can slowly build up their tolerance for movement,” he said. “By making it a game, we’re able to encourage participation and track progress in a way that’s engaging and empowering for the user.”

The clinical trial at the center of it all, which concluded data collection in late 2023, involved a large dataset of over six terabytes of information. Thomas and his team are now working on analyzing the full results and preparing manuscripts for publication. Additional next steps include securing funding to expand the research and develop a home-based version of the VR system. The goal is to make the tech more accessible to individuals –  particularly those in rural or underserved areas.

The current suite includes three different games: dodgeball, fishing and stacking boxes – all activities that require different mixes of movements like bending, reaching and turning. As users play and demonstrate mastery of basic skills, the program can increase the range of motion required to succeed at the task. 

Thomas uses a self-developed algorithm to ensure that tasks scale to each user’s body size. For example, the game will throw a ball at the right trajectory and angle for that user to make the desired movement expected during conventional physical therapy sessions.

First tested within the laboratory with dedicated headsets and full-body sensors, the current suite of games is designed to work with VR headsets on any platform, making it easy for individuals to do what are essentially conventional PT exercises at home. PT practitioners can track participants remotely and modify the games as needed. 

Additional cognitive games, such as memory matching, also hold promise as interventions for patients with progressive movement disorders such as Parkinson’s disease. A research group in Italy currently is using the VCU team’s software in a separate pilot study.

“This technology has the potential to revolutionize the way we approach chronic back pain management,” Thomas said. “By giving people the tools to take an active role in their recovery, we can help them regain their quality of life and reduce the burden on the health care system. It’s an exciting time, and we’re just scratching the surface of what's possible.” To that end, Dr. Thomas is getting ready to launch SOVA XR, a startup that will make these novel VR interventions available to the public, which will expand the impact on management of chronic low back pain.