Chronic lower back pain (CLBP) is a widespread problem, affecting 25-45 percent of adults at some time in their life, and disabling 25 percent of adults in any one year. Psychological factors contribute to both the exacerbation and recovery process. Relaxation therapy is an empirically validated cognitive-behavioral technique that is frequently used for CLBP. Pharmacological agents such as opioid analgesics have proven effective, however, the risk of physical and psychological dependence is a problem, particularly for persons at higher risk for dependence. Nonpharmacological treatments provide an alternative or adjunct to treatment without posing these threats and can therefore benefit the broader population affected by CLBP. This study is designed to test an innovative nonpharmacological treatment approach that incorporates relaxation therapy with virtual reality to create a virtual relaxation environment for persons with CLBP. Virtual reality (VR) environments combine computer graphics with sensory input devices including tracking devices, visual head mount displays, and directional audio designed to immerse the user into the environment. Previous research has demonstrated that immersive VR is effective at distracting patients from painful medical procedures. In this controlled study, 20 adults with CLBP will be randomly assigned to the virtual relaxation treatment condition or wait list control. The relaxation environment will incorporate a breathing and guided progressive muscle relaxation exercise lasting approximately 20 minutes. Participants will complete 5 therapy sessions. Physiological measures of muscle tension and self-report measures of pain, relaxation, and medication intake will be compared at pre- and post-treatment and three month follow-up. The primary objective of this study is to develop and test the feasibility of the virtual relaxation environment for reducing pain and medication use among persons with CLBP. The long term objective is to test a comprehensive, computerbased, cognitive-behavioral treatment package for CLBP. Potential exists to extend such a package to address a broad range of psychological and health issues.
