Why VR could be the new dawn of pain, anxiety management – MedCity News

CDC data shows that more than 20% of Americans have chronic pain, with 36% of themhaving high-impact chronic pain.

The discomfort of this pain is arguably exacerbated by the rising prevalence of mental health conditions across the country, which is becoming an increasingly sizable burden on Americans wellbeing. In fact, the percentage of U.S. adults who received mental health treatment rose from 19.2% in 2019 to 21.6% in 2021, according to CDC research released earlier this month.

Experts think virtual reality (VR) can help address both of these public health issues.

The history of VR in healthcare began in 1996 at the University of Washington Harborview Burn Center, where Hunter Hoffman and David Patterson developed a novel technique of using immersive VR for pain management. They were seeking to help burn victims go through debridement, an incredibly painful process in which damaged tissue and foreign objects are removed from burn wounds. Typically, patients receive opioids to help manage their pain throughout these procedures, but Hoffman and Patterson recognized that opioids were only mildly effective and often had terrible side effects.

When the human body experiences pain, a signal goes from the point of injury and lights up brain receptors. Hoffman and Petersons research argued that if the neural pathway is flooded with alternate signals, you can get patients to feel less pain. They measured their tests with both subjective patient-reported outcomes as well as MRIdata, finding that VR was more effective at pain management during debridement than opioids.

They demonstrated that VR could outperform opioids proving the power of a pixel over a molecule, said Matthew Stoudt, co-founder and CEO of AppliedVR. That launched hundreds of studies, all validating that same insight.

AppliedVR, founded in 2015 and based in Van Nuys, California, develops VR solutions designed for low-friction adoption in healthcare. To Stoudt, the reason why Hoffman and Petersons findings havent revolutionized pain management is because technology has long been a limiting factor when it comes to hospitals adoption of VR. At the time of their research, VR technology cost $50,000, weighed 50 pounds and was tethered to 50 machines, so like a lot of innovation in this world, it sat squandering in the laboratory, he said.

Stoudt believes that the healthcare industry is sitting on an entirely new class of medicine, that can greatly improve providers approach to pain management once VR headsets and other portable VR devices are developed and deployed at scale. However, patients are sometimes wary of adopting new technology or straying from the longstanding care methods they have been conditioned to trust, he pointed out. His company is focused on delivering what could potentially seem like a complicated and intimidating device into patients homes in a way that is easy to use, engaging and efficacious.

The first condition that AppliedVR is looking to solve is chronic lower back pain. The company partnered with Beth Darnall, a pain psychologist and director of the Stanford Pain Relief Innovations Lab, to co-develop its eight-week chronic lower back pain management program. This physician-prescribed, self-administered solution allows patients to manage their chronic lower back pain without opioids from the comfort of their own home. AppliedVRs system for chronic lower back pain has received breakthrough device designation and de novo approval from the Food and Drug Administration.

AppliedVR has tested its VR devices at health systems such as Mayo Clinic, Cleveland Clinic, UPMC, Geisinger and Cedars-Sinai.

Cedars-Sinai stands out as a health system that is especially supportive of VR adoption. The health system has been using VR in its hospitals for nearly a decade and has treated around 3,500 patients with the technology, according to Dr. Brennan Spiegel, a Cedars-Sinai physician and medical VR researcher. And he thinks more health systems should do the same.

We treat the human body like a machine when people come into a hospital, and in Western medicine in general, and that works pretty well to an extent, he said. But we know that the mind and the body are connected. That is not voodoo science. The fact that the brain and the body communicate is actually well-established neuroscience.

Dr. Spiegel argues that if you can put the brain into a position of comfort, that relaxation will have downstream effects on the rest of the body. This can help reduce heart rate, blood pressure and stress hormone levels, he claimed. This not only helps patients have a more positive experience during their hospital stay, but it can also yield clinical benefits, such as lowering pain scores and reducing the need for pain medications.

Pain medications may reduce the physical experience of pain, but they dont do anything to manage the emotional experience of being in a hospital, or anxiety that comes along with that, Dr. Spiegel said. Hospitals are a very unnatural environment that nobody literally no body was designed to be in.

At Cedars-Sinai, VR use aims to reduce both pain and anxiety scores. When I spoke with Dr. Spiegel, he was in Cedars-Sinais surgical intensive care unit, where VR is deployed every day. Clinicians wheel around a four-wheeled mobile cart that carries VR equipment that can be easily transported and set up from room to room. The cart houses headsets made by HP, which can measure patients biometrics such as heart rate, heart rate variability and pupillometry. These metrics help clinicians assess the physiologic impact of the VR on the patients body.

The health system has created its own VR software, called Nature VR, that allows patients to enter various natural environments so they can reduce anxiety and/or pain through meditation, paced breathing exercises or relaxation of their own accord.

Patients are typically treated with the VR headsets for about 15 minutes. Their baseline pain and anxiety scores are measured both before and after treatment so that clinicians can see whether the patient had a positive response. Most of the time, they do. When that is the case, the headset will stay at the patients bedside so they can then use it throughout the rest of their hospital stay.

In addition to this inpatient program, Cedars-Sinai also had outpatient VR programs in which patients take headsets home to manage things like pain, anxiety or irritable bowel syndrome.

Dr. Spiegel had treated a patient with a VR headset minutes before our call. He said that patient was appreciative of the treatment, notingthat it allowed him to get away from the less-than-comfortable environment he was in and enter a calm, relaxed space.

Having the option to momentarily escape the hospital environment can do a lot to improve the inpatient experience. Solomon Rogers, the director of global innovation at Magnopus, is another strong supporter of this thesis.

Rogers company is atechnology studio based in Los Angeles and London that has created VR projects for numerous films and television shows. Now, its exploring applications in the healthcare space. One of Magnopus biggest healthcare partners, Childrens Hospital Los Angeles, piloted its VR technology in 2019 to help pediatric patients escape reality for a short while.

There was a patient who was bedridden, who couldnt move from their back, he said. We enabled virtual reality technology to bring in an experience in which that patient could become an astronaut. Without needing to sit up and move, they were able to climb around the space station and be free of the bounds of the bed, all while being able to look down back on Earth.

Not only does momentarily freeing pediatric hospital patients from their reality improve their mental wellbeing, it has also been shown to marginally improve the speed of their rehabilitation, according to Rogers.

Magnopus has also deployed VR technology to alleviate anxiety in pediatric patients parents. Through a partnership with the Great Ormond Street Hospital for Children in London, Magnopus developed technology to lower families anxiety before a childs hospital stay through the use of 360-degree hospital VR tours. Immersing the patient and their family into the world of the hospital before they ever enter the building helps them enter their stay with less unknowns, and therefore more comfort, according to Rogers.

Its well-known that hospitals use VR for surgical training, but there are so many other ways it can be applied in healthcare, he said.

Photo: LightFieldStudios, Getty Images

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Why VR could be the new dawn of pain, anxiety management - MedCity News