{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:48:03Z","timestamp":1782841683220,"version":"3.54.5"},"reference-count":39,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High-impact chronic pain (HICP) involves substantial interference in functioning, affects 8.5% of the population, and leads to higher health care costs relative to low-impact chronic pain (LICP). Behavioral interventions such as virtual reality (VR) offer scalable and accessible treatment, but testing is needed to ensure durable effectiveness in HICP. We conducted a secondary analysis of the largest real-world dataset for a therapeutic skill-based VR vs a sham VR control to test treatment efficacy in HICP vs LICP. Relative to LICP, we found significantly larger (and clinically meaningful; ie, \u22652 points) pain interference and pain intensity reductions for HICP at end of treatment and 1 year posttreatment. End-of-treatment reduction in pain interference reclassified 70% (114\/163) of participants with HICP as LICP, and this improvement held at 1 year posttreatment (104\/155, 67%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study examined the effectiveness of a 56-session skill-based VR therapy in HICP at 2 years posttreatment and compared the effects with those on LICP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of the skill-based VR sample (536\/1067, 50.2%) at 2 years posttreatment from a randomized controlled trial involving an in-home chronic low back pain sample that was recruited and tested online and was diverse (female: 411\/536, 77%; non-White individuals: 166\/536, 31%; high school or lower educational level: 102\/536, 19%; mean age 50.8 years) and had clinically severe pain at baseline (intensity=6.6; interference=6.2; 42% with severe or complete disability). Focusing on the skill-based VR participants (536\/1067, 50.2%) and using a validated approach, we classified participants at baseline as either HICP (baseline Brief Pain Inventory pain interference score&gt;7) or LICP (baseline Brief Pain Inventory pain interference score&lt;7). Clinical effectiveness was examined using a general linear model at 2 years posttreatment relative to baseline with the primary outcomes of pain interference and pain intensity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants with HICP (192\/536, 35.8%) reported superior reductions in pain interference, pain intensity, sleep disturbance, and physical disability (P&lt;.001 in all cases) at 2 years posttreatment compared to participants with LICP (344\/536, 64.2%). Participants with HICP had clinically meaningful (\u22652-point) reductions in pain interference (mean 3.1, 95% CI 2.66-3.54; effect size=1.12) and pain intensity (mean 2.6, 95% CI 2.18-3.02; effect size=1.01) at 2 years posttreatment. Importantly, reduced pain interference scores at 2 years posttreatment reclassified 71.1% (106\/149) of the participants with HICP as LICP. No serious adverse events or side effects were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with HICP experience severe pain that drives high health care use. The skill-based VR therapy demonstrated durable reductions in pain and related outcomes 2 years posttreatment, with the largest benefits observed in the HICP subgroup. These results suggest that a skill-based, VR-delivered therapy produces durable effects in patients with HICP, a population that is frequently overmedicalized and undertreated with behavioral interventions. These findings suggest that home-based VR-delivered therapy offers a scalable treatment option for this underserved population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/90688","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T21:45:06Z","timestamp":1776980706000},"page":"e90688","source":"Crossref","is-referenced-by-count":0,"title":["Skill-Based Virtual Reality Therapy in High-Impact Chronic Pain: 2-Year Follow-Up Results From a Secondary Analysis of a Randomized Controlled Trial"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1265-4960","authenticated-orcid":false,"given":"Todd","family":"Maddox","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8564-6211","authenticated-orcid":false,"given":"Josh","family":"Sackman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1533-3265","authenticated-orcid":false,"given":"Robert","family":"Bonakdar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6899-2825","authenticated-orcid":false,"given":"Roselani","family":"Maddox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3590-511X","authenticated-orcid":false,"given":"Beth D","family":"Darnall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.3344\/kjp.22357"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6736a2"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2018.07.006"},{"key":"ref4","unstructured":"VaegterHBBruunKDBye-M\u00f8llerLHigh-impact chronic painInternational Association for the Study of 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