Objectives: The primary objective of this evaluation is to determine the impact of virtual reality (VR) distraction on acute and chronic pain in Veterans within the Veterans Affairs Health Care System (VA). A secondary objective is to determine the impact of VR on the experience of stress and anxiety in Veterans utilizing VR for the indication of pain. A third objective is to develop an understanding of the Veteran experience of using VR in a healthcare setting.Methods: This prospective, pretest-posttest mixed methods assessment was performed at a VA medical center from August 30, 2019 to November 23, 2020. VR experiences lasted between 10 and 30 min utilizing an immersive head-mounted display with multiple, autonomously chosen virtual environments. Qualitative data was collected concurrently to provide context to quantitative measures which included pain scores and stress/anxiety levels. Data from 79 participants was included in this analysis. Data included pre- and post-VR session Defense and Veterans Pain Rating Scale and stress/anxiety levels.Results: Results for the cohort demonstrated a statistically significant decrease in pain intensity (p <0 .001) with an average 12% decrease in pain levels and an 92% reduction in anxiety for those in concurrent pain.Conclusion: VR as a non-pharmacological adjunct or alternative modality, appears to be a viable option for improving pain management and reducing anxiety in Veteran populations across various age ranges, and levels of acuity and chronicity. VR was found to be an effective distraction from pain, a pleasurable experience for the majority, and opened the door to other non-pharmacological modalities in a Veteran population.

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BACKGROUND Prescription opioid misuse risk is disproportionate among Veterans; military Veterans wounded in combat misuse prescription opioids at an even higher rate (46.2%). Opioid misuse, use disorders, and overdoses are costly in terms of morbidity, mortality, and humanitarian and economic burden. Opioid misuse costs the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) more than $1.13 billion annually. Adjusted annual healthcare costs for diagnosed opioid abuse patients are higher than those for patients without diagnosed abuse, and prevalence of diagnosed opioid abuse is almost 7 times higher for those in the Veteran's Administration than in commercial health plans, translating to a significant economic burden for this population. OBJECTIVE The overarching purpose of this single-arm prospective pilot study was to explore whether deploying a mobile application (CPMRx) to track postoperative pain and medication use is feasible in a VA Medical Center. In support of this goal, we had four complementary specific aims: (1) to determine the technological and logistical feasibility of the mobile application, (2) to assess acceptability of the mobile application to participants, (3) to measure demand for and engagement with the mobile application, and (4) to explore potential utility of the mobile application to patients and providers. METHODS Participants (n = 10) were Veterans undergoing total knee arthroplasty within the Veterans Health Administration. CPMRx uses scientifically validated tools to help clinicians understand how a patient can use the least amount of medication while getting the most benefit. The suite of software includes a mobile application for patients, which includes a behavioral health intervention, and a clinical decision support tool for healthcare providers, which provides feedback about pain and medication use trends. Veterans self-managed their pain while using the CPMRx mobile app during their at-home recovery following surgery. RESULTS Overall, quantitative measures of acceptability were high. The average rating for the amount of time required to use the application was 4.9 and the average rating for ease of use was 4.4. Open-ended questions also revealed that most participants found ease of use to be high. Demand and engagement were high as well, with a mean number of mobile application entries of 34.1 during the postoperative period. There were no reported technological or logistical issues with the mobile application. Participants took an average of 25.13 opioid tablets to manage their postoperative pain. CONCLUSIONS Results of this study revealed that use of a mobile application for pain and medication management during postoperative recovery was both feasible and acceptable in older Veterans undergoing total knee arthroplasty within the Veterans Health Administration. The wide variation in opioid consumption across participants revealed the potential utility of the mobile application to provide actionable insights to clinicians if adopted more widely.

Pathway to Excellence® standards promote virtual reality innovation at the Charles George VA Medical Center