Integrating Extended Reality Into Primary Care Chronic Pain Programs: A Real-World Feasibility Study of the REDOCVR Intervention.

Abstract

Background: Chronic pain management in public health services often struggles with limited engagement, emotional burden, and medication use. XR shows promise in specialized settings, but evidence for codesign and integration into primary care remains limited.

Objective: This study aimed to examine the feasibility, usability, and real-world implementation of REDOCVR, an XR-supported psychoeducational program, and to explore preliminary clinical outcomes during its integration into chronic pain groups in public primary care centers.

Methods: This was a nonrandomized, hybrid type 2 phased implementation study conducted in 3 primary care centers in Catalonia, Spain. The intervention built on existing multidisciplinary psychoeducational chronic pain groups led by psychologists and physiotherapists. In collaboration with patients, XR modules were codesigned and incorporated to enhance mindfulness, cognitive reframing, and motor activation activities already established in routine care. Eight weekly sessions included 15-20 minutes of this content, with a supervised medication tapering protocol included in later groups. Primary outcomes were implementation measures (adherence, tolerability, System Usability Scale, and satisfaction). Secondary outcomes included patient-reported clinical measures (Warwick-Edinburgh Mental Well-being Scale [WEMWBS], Hospital Anxiety and Depression Scale [HADS], Central Sensitization Inventory, and EQ-5D-5L) and medication changes, assessed at baseline, post-intervention, and 5-month follow-up.

Results: In total, 42 participants were enrolled, and 36 (85.7%) completed the intervention and all assessments. Adherence was high, and no serious adverse events occurred, with minimal cybersickness reported (5.6%). Patient usability was strong (mean 81.4, 95% CI 75.6-87.1), and overall satisfaction was high (mean 82.4, 95% CI 78.5-86.4). Professional usability was moderate (mean 59.1, 95% CI 51.6-66.5). Statistically significant improvements were observed in emotional well-being (Warwick-Edinburgh Mental Well-being Scale mean change 4.8, 95% CI 2.9-6.7; Cohen d=0.86), anxiety (HADS-A -2.5, 95% CI -3.8 to -1.2; Cohen d=0.66), and depression (HADS-D -1.6, 95% CI -2.5 to -0.7; Cohen d=0.62) (all P<.001). Mobility improved significantly (median change -1.0, 95% CI -1.0 to 0.0, P=.09), while Pain/Discomfort showed a nonsignificant trend (P=.08). Among tapering participants (n=22), mean use of benzodiazepines decreased by 71.7% and opioids by 41.8% at 5 months.

Conclusions: This study suggests that an XR-enhanced psychoeducational program can be incorporated into group-based chronic pain care within the public primary health care system. Exploratory improvements in emotional well-being, anxiety, depression, and reduced use of high-risk medications during supervised tapering indicate potential benefits, although causal inferences cannot be drawn given the feasibility design. These findings provide practical insights to inform refinement and progression to larger controlled studies evaluating scalability and long-term effects in routine primary care.