Exploring Virtual Reality Mindfulness Training for Veterans with SCI and Chronic Pain.

1 Background and Significance: An estimated 70% of individuals with SCI struggle with chronic pain, which 2 negatively impacts quality of life, satisfaction, and social participation. Virtual care and the use of innovative 3 technologies like virtual reality provide engaging and effective ways to expand access to care and improve health 4 and well-being. However, as virtual care expands, research involving the use of virtual modalities in the SCI 5 population lags behind other populations. Additionally, most virtual evidence-based behavioral interventions for 6 chronic pain are designed for nondisabled populations, creating potential accessibility barriers in program 7 procedure and content fit that likely impact intervention acceptability in individuals with SCI. One tool used to 8 combat chronic pain is mindfulness, which is the practice of being aware of the present moment in a sustained, 9 accepting, and nonjudgmental way. Mindfulness can reduce anxiety and depression, which are associated with 10 greater pain intensity. Low mindfulness is linked to pain catastrophizing, which increases avoidance of activities 11 that may provoke pain, thereby decreasing overall function and participation (ie, pain interference). Pain 12 interference moderates the impact of pain on quality of life and social participation, whereas using mindfulness 13 to increase pain acceptance results in better function, social participation and quality of life. The VA 14 Compassionate Awareness Learning Module (VA CALM) teaches Veterans the powerful skill of mindfulness. VA 15 CALM delivers content in a weekly group setting, providing an optimal solution for Veterans with SCI and chronic 16 pain. The group structure benefits self-efficacy and social participation by providing a space to normalize 17 experiences and promote connectedness, which is particularly important for individuals who have limited 18 community mobility and interactions with SCI peers. However, given the complexities of neurological injury, 19 individuals with SCI have alterations in sensation, motor control and proprioception. Although mindfulness has 20 demonstrated major benefits, mindfulness activities are often designed for “neurologically normative” populations 21 without consideration/accommodation for those with neurologic alterations, resulting in low acceptability and 22 content mismatch. Mindfulness and VR are 2 solutions gaining traction in chronic pain research, but there is 23 limited research leveraging these combined approaches in the SCI population and further research is necessary. 24 Evidence demonstrates that VR improves embodiment among patients with neuropathic pain. Embodiment, an 25 essential element of mindfulness, is the concept of awareness and attention to the body in relation to situation 26 and environment. VR modalities provide engaging, low-cost solutions that are customizable, which is ideal for 27 the accessibility needs of the SCI population. Research Plan: Aim 1: Conduct formative evaluation of the VA 28 CALM program to develop accommodations to improve accessibility for Veterans with SCI. VA CALM will be 29 delivered to 10 Veterans with SCI to assess for needed modifications to adapt the program for SCI. A steering 30 committee of 10 members (including clinicians, researchers, and Veterans with SCI) will meet during content 31 redesign meetings to determine appropriate accommodations. Aim 2: Explore the feasibility and acceptability of 32 delivering VA CALM over a virtual reality platform for Veterans with SCI. This will be achieved by delivering 2 33 modified modules via VR to Veterans with SCI assess the feasibility and acceptability of using VR to deliver this 34 program. Veterans will complete quantitative surveys and qualitative focus groups to provide detailed information 35 about feasibility and acceptability of both the modified program and the use of VR for program delivery in the 36 SCI population. Career Plan: Dr. Touchett will Project Number: 1IK1RX004813-01A2 | Fiscal Year: 2025 | NIH Institute/Center: Veterans Affairs (VA) | Principal Investigator: Hilary Touchett | Institution: MICHAEL E DEBAKEY VA MEDICAL CENTER, HOUSTON, TX | Activity Code: IK1 | Study Section: Career Development Program - Panel II[RRD9] View on NIH RePORTER: https://reporter.nih.gov/project-details/10999541