Feasibility and Efficacy of Commercial-Off-the-Shelf Virtual Reality Applications for Managing Chronic Pain and Enhancing Well-Being Among Older Adults in the Community: Mixed Methods Pilot Study

Abstract

Background: Older adults may experience chronic pain as they age, which can affect their physical and psychological well-being. Virtual reality (VR) is emerging as a novel and nonpharmacological intervention that offers pain relief and mood enhancement through immersive experiences. However, the feasibility and effectiveness of using nonlocalized and commercial VR applications for chronic pain relief and mood enhancement among community-dwelling older adults remain underexplored.

Objective: The main objectives of this study were to (1) evaluate the feasibility of using commercial-off-the-shelf VR applications for managing chronic pain among older adults, (2) assess the efficacy of VR in alleviating chronic pain, and (3) examine its impact on the well-being of older adults in a community setting.

Methods: The study was a single-arm mixed methods pilot study. It was divided into two stages, including preparation and implementation. A total of 13 older adults (8 with chronic pain and 5 without) were recruited to participate in a 3-week VR intervention. Participants engaged in VR sessions that followed a step-by-step adaptation process. Each session included 360-degree relaxation videos and VR-based boxing exercises via Les Mills BODYCOMBAT, lasting 15 minutes. Pain intensity, pain self-efficacy, well-being, and mood were measured pre- and post-intervention using the Numeric Pain Rating Scale (NPRS), a pain self-efficacy question, the World Health Organization-Five Well-Being Index (WHO-5), and the Mood Assessment Scale (Mood). VR feasibility was evaluated based on completion rates, adverse outcomes, and qualitative feedback from semistructured interviews.

Results: Of the 13 participants recruited, 11 completed the intervention (84.6% completion rate). The mean age was 79.2 (SD 9.2) years. The study found a statistically significant 16.32% improvement in the mean mood score, with a mean increase of 2.64 (SD 1.45) points and a large effect size (P<.001; Cohen d=1.82). The median pain self-efficacy score decreased from 3.0 (IQR 1.5-3.0) to 1.0 (IQR 1.0-2.0) (z=-2.236; P=.03). However, no significant changes were observed in pain intensity or overall well-being. The study demonstrated the high feasibility of commercial-off-the-shelf VR technology for older adults. Minor adverse effects were reported, including back pain and headset discomfort. In addition, 90.9% of participants enjoyed the VR experience, and all were willing to join future sessions.

Conclusions: The pilot study demonstrated that commercial-off-the-shelf VR applications can effectively enhance mood and pain self-efficacy. Additional procedures, such as prebriefing, real-time interpretation, and a gradual adaptation process, were essential to overcoming barriers such as language, cultural nuances, and the digital literacy of older adults. Despite the lack of significant changes in pain intensity or overall well-being, the psychological benefits suggest that VR could be a valuable adjunct tool in chronic pain management. Future research should focus on larger sample sizes, longer intervention durations, randomized controlled trials, and the development of localized commercial VR applications to further explore their efficacy.

Keywords: NPRS; VR; WHO-5; World Health Organization-Five Well-Being Index; commercial VR; feasibility; mood; non-localized; off-the-shelf; older adults; pain; pain self-efficacy; pilot study; virtual reality; well-being.

Figure 1.. Guiding the participant to use the controllers.

Figure 2.. Individual briefing of the scenes to be seen.

Figure 3.. Participant engaging in Les Mills BODYCOMBAT, a 5-minute virtual reality boxing exercise.

Figure 4.. Scene from the Les Mills BODYCOMBAT game session.

Figure 5.. Flow diagram of participant progress throughout the intervention.