One hundred sixty-eight patients with chronic low back pain were randomized to receive either an 8-week, in-home behavioral skills–based VR program (n=84) or a sham VR program (n=84). The primary outcome was pain intensity. Secondary outcomes included pain interference (overall and by subdomains: activity, sleep, mood, stress), responder rates (≥30% reduction in pain intensity or interference), and treatment durability over time. Outcomes were assessed at the end of treatment and at 6, 18, and 24 months post-treatment. Overall, the results of the study revealed that participants in the skills-based VR group experienced significantly greater and more durable reductions in both pain intensity and interference compared to the sham group, with effects maintained at 24 months. These findings suggest that an at-home VR behavioral intervention can offer long-term pain relief in chronic low back pain patients.