{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T19:35:59Z","timestamp":1780342559783,"version":"3.54.1"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":38,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["UH3AR076573"],"award-info":[{"award-number":["UH3AR076573"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001881"],"award-info":[{"award-number":["UL1TR001881"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Marc and Sheri Rapaport Fund for Digital Health Science and Precision Health at Cedars-Sinai"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"DOI":"10.1038\/s41746-026-02437-4","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T07:23:00Z","timestamp":1771226580000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Randomized-controlled trial of skills-based vr vs. distraction vr vs. sham VR for chronic low back pain"],"prefix":"10.1038","volume":"9","author":[{"given":"Brennan M. R.","family":"Spiegel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel A.","family":"Eberlein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Persky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariko L.","family":"Ishimori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swamy","family":"Venuturupalli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Tu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi","family":"Alhatem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary A.","family":"Vijjeswarapu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Krut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Norris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Yung","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mourad","family":"Tighiouart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Vrahas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer","family":"Liran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itai","family":"Danovitch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinh","family":"Vuong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Fouladian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"2437_CR1","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1007\/s00586-017-5432-9","volume":"27","author":"EL Hurwitz","year":"2018","unstructured":"Hurwitz, E. L., Randhawa, K., Yu, H., C\u00f4t\u00e9, P. & Haldeman, S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur. Spine J. 27, 796\u2013801 (2018).","journal-title":"Eur. Spine J."},{"key":"2437_CR2","doi-asserted-by":"publisher","first-page":"2197","DOI":"10.1016\/S0140-6736(12)61689-4","volume":"380","author":"CJ Murray","year":"2012","unstructured":"Murray, C. J. et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet (Lond., Engl.) 380, 2197\u20132223 (2012).","journal-title":"Lancet (Lond., Engl.)"},{"key":"2437_CR3","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1016\/j.jpain.2018.04.004","volume":"19","author":"A Shmagel","year":"2018","unstructured":"Shmagel, A., Ngo, L., Ensrud, K. & Foley, R. Prescription Medication Use Among Community-Based U.S. Adults With Chronic Low Back Pain: A Cross-Sectional Population Based Study. J. Pain. : Off. J. Am. Pain. Soc. 19, 1104\u20131112 (2018).","journal-title":"J. Pain. : Off. J. Am. Pain. Soc."},{"key":"2437_CR4","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1038\/nrrheum.2010.24","volume":"6","author":"LJ Crofford","year":"2010","unstructured":"Crofford, L. J. Adverse effects of chronic opioid therapy for chronic musculoskeletal pain. Nat. Rev. Rheumatol. 6, 191 (2010).","journal-title":"Nat. Rev. Rheumatol."},{"key":"2437_CR5","unstructured":"Medical Extended Reality Program: Research on Medical Extended Reality-Based Medical Devices, https:\/\/www.fda.gov\/medical-devices\/medical-device-regulatory-science-research-programs-conducted-osel\/medical-extended-reality-program-research-medical-extended-reality-based-medical-devices."},{"key":"2437_CR6","first-page":"4","volume":"1","author":"BMR Spiegel","year":"2024","unstructured":"Spiegel, B. M. R. et al. What is medical extended reality? A taxonomy defining the current breadth and depth of an evolving field. J. Med Ext. Real. 1, 4\u201312 (2024).","journal-title":"J. Med Ext. Real."},{"key":"2437_CR7","first-page":"e51124","volume":"15","author":"D Mistry","year":"2023","unstructured":"Mistry, D., Brock, C. A. & Lindsey, T. The present and future of virtual reality in medical education: a narrative review. Cureus 15, e51124 (2023).","journal-title":"Cureus"},{"key":"2437_CR8","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1111\/papr.12885","volume":"20","author":"MM Ahern","year":"2020","unstructured":"Ahern, M. M. et al. The effectiveness of virtual reality in patients with spinal pain: a systematic review and meta-analysis. Pain. Pr. 20, 656\u2013675 (2020).","journal-title":"Pain. Pr."},{"key":"2437_CR9","doi-asserted-by":"publisher","first-page":"11806","DOI":"10.3390\/ijerph182211806","volume":"18","author":"B Brea-G\u00f3mez","year":"2021","unstructured":"Brea-G\u00f3mez, B. et al. Virtual reality in the treatment of adults with chronic low back pain: a systematic review and meta-analysis of randomized clinical trials. Int J. Environ. Res Public Health 18, 11806 (2021).","journal-title":"Int J. Environ. Res Public Health"},{"key":"2437_CR10","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.2196\/medinform.7271","volume":"5","author":"B Garrett","year":"2017","unstructured":"Garrett, B., Taverner, T. & McDade, P. Virtual reality as an adjunct home therapy in chronic pain management: an exploratory study. JMIR Med. Inform. 5, e11 (2017).","journal-title":"JMIR Med. Inform."},{"key":"2437_CR11","doi-asserted-by":"publisher","first-page":"e34402","DOI":"10.2196\/34402","volume":"10","author":"L Goudman","year":"2022","unstructured":"Goudman, L. et al. Virtual reality applications in chronic pain management: systematic review and meta-analysis. JMIR Serious Games 10, e34402 (2022).","journal-title":"JMIR Serious Games"},{"key":"2437_CR12","doi-asserted-by":"publisher","first-page":"4071","DOI":"10.3390\/ijerph19074071","volume":"19","author":"S Grassini","year":"2022","unstructured":"Grassini, S. Virtual reality assisted non-pharmacological treatments in chronic pain management: a systematic review and quantitative meta-analysis. Int J. Environ. Res Public Health 19, 4071 (2022).","journal-title":"Int J. Environ. Res Public Health"},{"key":"2437_CR13","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000001110","author":"TD Groenveld","year":"2023","unstructured":"Groenveld, T. D. et al. Effect Of A Behavioural Therapy-Based Virtual Reality Application On Quality Of Life In Chronic Low Back Pain. Clin. J. Pain. https:\/\/doi.org\/10.1097\/AJP.0000000000001110 (2023).","journal-title":"Clin. J. Pain."},{"key":"2437_CR14","doi-asserted-by":"publisher","first-page":"e38256","DOI":"10.2196\/38256","volume":"25","author":"Q Guo","year":"2023","unstructured":"Guo, Q. et al. Virtual reality intervention for patients with neck pain: systematic review and meta-analysis of randomized controlled trials. J. Med Internet Res 25, e38256 (2023).","journal-title":"J. Med Internet Res"},{"key":"2437_CR15","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1016\/j.jval.2021.04.1285","volume":"25","author":"Q Huang","year":"2022","unstructured":"Huang, Q., Lin, J., Han, R., Peng, C. & Huang, A. Using virtual reality exposure therapy in pain management: A systematic review and meta-analysis of randomized controlled trials. Value Health 25, 288\u2013301 (2022).","journal-title":"Value Health"},{"key":"2437_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/g4h.2022.0088","volume":"12","author":"P Kantha","year":"2023","unstructured":"Kantha, P., Lin, J.-J. & Hsu, W.-L. The effects of interactive virtual reality in patients with chronic musculoskeletal disorders: a systematic review and meta-analysis. Games Health J. 12, 1\u201312 (2023).","journal-title":"Games Health J."},{"key":"2437_CR17","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1097\/j.pain.0000000000002883","volume":"164","author":"EJ Lier","year":"2023","unstructured":"Lier, E. J., de Vries, M., Steggink, E. M., Ten Broek, R. P. G. & van Goor, H. Effect modifiers of virtual reality in pain management: a systematic review and meta-regression analysis. Pain 164, 1658\u20131665 (2023).","journal-title":"Pain"},{"key":"2437_CR18","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.2147\/JPR.S200498","volume":"12","author":"B Mallari","year":"2019","unstructured":"Mallari, B., Spaeth, E. K., Goh, H. & Boyd, B. S. Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. J. Pain. Res 12, 2053\u20132085 (2019).","journal-title":"J. Pain. Res"},{"key":"2437_CR19","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1089\/cyber.2014.0207","volume":"17","author":"BK Wiederhold","year":"2014","unstructured":"Wiederhold, B. K., Gao, K., Sulea, C. & Wiederhold, M. D. Virtual reality as a distraction technique in chronic pain patients. Cyberpsychology, Behav. Soc. Netw. 17, 346\u2013352 (2014).","journal-title":"Cyberpsychology, Behav. Soc. Netw."},{"key":"2437_CR20","doi-asserted-by":"crossref","unstructured":"Maddox, T. et al. In-home virtual reality program for chronic low back pain: durability of a randomized, placebo-controlled clinical trial to 18 months post-treatment. Reg Anesth Pain Med, rapm-2022-104093 (2022).","DOI":"10.1136\/rapm-2022-104093"},{"key":"2437_CR21","unstructured":"Device Classification under Section 513(F)(2)(De Novo), https:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfRL\/rl.cfm?lid=764583&lpcd=QRA."},{"key":"2437_CR22","doi-asserted-by":"publisher","first-page":"e26292","DOI":"10.2196\/26292","volume":"23","author":"LM Garcia","year":"2021","unstructured":"Garcia, L. M. et al. An 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality Program for Chronic Low Back Pain: Double-Blind, Randomized, Placebo-Controlled Trial Conducted During COVID-19. J. Med Internet Res 23, e26292 (2021).","journal-title":"J. Med Internet Res"},{"key":"2437_CR23","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.mcpdig.2023.09.003","volume":"1","author":"T Maddox","year":"2023","unstructured":"Maddox, T. et al. In-Home Virtual Reality Program for Chronic Lower Back Pain: A Randomized Sham-Controlled Effectiveness Trial in a Clinically Severe and Diverse Sample. Mayo Clin. Proc. Digit Health 1, 563\u2013573 (2023).","journal-title":"Mayo Clin. Proc. Digit Health"},{"key":"2437_CR24","doi-asserted-by":"publisher","first-page":"e30260","DOI":"10.2196\/30260","volume":"24","author":"JA Hoag","year":"2022","unstructured":"Hoag, J. A., Karst, J., Bingen, K., Palou-Torres, A. & Yan, K. Distracting Through Procedural Pain and Distress Using Virtual Reality and Guided Imagery in Pediatric, Adolescent, and Young Adult Patients: Randomized Controlled Trial. J. Med Internet Res 24, e30260 (2022).","journal-title":"J. Med Internet Res"},{"key":"2437_CR25","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1016\/j.jpain.2011.08.010","volume":"12","author":"DH Bradshaw","year":"2011","unstructured":"Bradshaw, D. H., Donaldson, G. W., Jacobson, R. C., Nakamura, Y. & Chapman, C. R. Individual differences in the effects of music engagement on responses to painful stimulation. J. Pain. : Off. J. Am. Pain. Soc. 12, 1262\u20131273 (2011).","journal-title":"J. Pain. : Off. J. Am. Pain. Soc."},{"key":"2437_CR26","doi-asserted-by":"publisher","first-page":"2433","DOI":"10.1001\/archinte.163.20.2433","volume":"163","author":"MJ Bair","year":"2003","unstructured":"Bair, M. J., Robinson, R. L., Katon, W. & Kroenke, K. Depression and pain comorbidity: a literature review. Arch. Intern Med 163, 2433\u20132445 (2003).","journal-title":"Arch. Intern Med"},{"key":"2437_CR27","doi-asserted-by":"publisher","first-page":"204","DOI":"10.4103\/0253-7176.106012","volume":"34","author":"L Leung","year":"2012","unstructured":"Leung, L. Pain catastrophizing: an updated review. Indian J. Psychol. Med 34, 204\u2013217 (2012).","journal-title":"Indian J. Psychol. Med"},{"key":"2437_CR28","doi-asserted-by":"publisher","unstructured":"Lee, K. E., Ryu, H. & Chang, S. J. The Effect of Pain Catastrophizing on Depression among Older Korean Adults with Chronic Pain: The Mediating Role of Chronic Pain Interference and Sleep Quality. Int J Environ Res Public Health 17, https:\/\/doi.org\/10.3390\/ijerph17238716 (2020).","DOI":"10.3390\/ijerph17238716"},{"key":"2437_CR29","doi-asserted-by":"publisher","first-page":"e23859","DOI":"10.1097\/MD.0000000000023859","volume":"100","author":"K Taguchi","year":"2021","unstructured":"Taguchi, K. et al. Integrated cognitive behavioral therapy for chronic pain: An open-labeled prospective single-arm trial. Med. (Baltim.) 100, e23859 (2021).","journal-title":"Med. (Baltim.)"},{"key":"2437_CR30","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1037\/a0035747","volume":"69","author":"DM Ehde","year":"2014","unstructured":"Ehde, D. M., Dillworth, T. M. & Turner, J. A. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am. Psychol. 69, 153\u2013166 (2014).","journal-title":"Am. Psychol."},{"key":"2437_CR31","doi-asserted-by":"publisher","first-page":"e050545","DOI":"10.1136\/bmjopen-2021-050545","volume":"11","author":"B Birckhead","year":"2021","unstructured":"Birckhead, B. et al. Home-based virtual reality for chronic pain: protocol for an NIH-supported randomised-controlled trial. BMJ Open 11, e050545 (2021).","journal-title":"BMJ Open"},{"key":"2437_CR32","doi-asserted-by":"publisher","first-page":"S61","DOI":"10.1093\/pm\/pnac175","volume":"24","author":"CM Greco","year":"2023","unstructured":"Greco, C. M. et al. Biobehavioral assessments in BACPAC: recommendations, rationale, and methods. Pain. Med 24, S61\u2013S70 (2023).","journal-title":"Pain. Med"},{"key":"2437_CR33","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","volume":"42","author":"PA Harris","year":"2009","unstructured":"Harris, P. A. et al. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inf. 42, 377\u2013381 (2009).","journal-title":"J. Biomed. Inf."},{"key":"2437_CR34","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-024-02166-y","author":"L Ross","year":"2024","unstructured":"Ross, L. et al. Bridging the Gap: Culturally Responsive Strategies for NIH Trial Recruitment. J. Racial Ethn. Health Disparities https:\/\/doi.org\/10.1007\/s40615-024-02166-y (2024).","journal-title":"J. Racial Ethn. Health Disparities"},{"key":"2437_CR35","doi-asserted-by":"crossref","unstructured":"Wickham, H. in ggplot2: Elegant Graphics for Data Analysis 189-201 (Springer International Publishing, 2016).","DOI":"10.1007\/978-3-319-24277-4_9"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02437-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02437-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02437-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:21:58Z","timestamp":1774534918000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02437-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,16]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["2437"],"URL":"https:\/\/doi.org\/10.1038\/s41746-026-02437-4","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,16]]},"assertion":[{"value":"27 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no conflicts of interest to declare. AppliedVR, the manufacturer of RelieVRx, participated in the Cedars-Sinai Accelerator in partnership with Techstars in 2016; however, none of the authors are employed by AppliedVR, hold equity in the company, receive royalties from the company, or benefit financially from the Cedars-Sinai Accelerator. One author (B.S.) serves on the Editorial Board of npj Digital Medicine but had no involvement in the review, handling, or decision-making related to this manuscript.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"248"}}