It is reported that there are about 50 million chronic pain patients in the United States (by definition, chronic pain refers to pain that lasts more than three months), and severe cases can even cause patients to have mobility difficulties. Unlike acute pain caused by tissue damage, chronic pain is not only a symptom, but also a separate disease. Traditional treatment is to inject or take opioid pain medications, but in practice the drugs are not as effective as they are and do not completely relieve pain. For some patients with severe conditions, they may take medicine more than once a day, which means that the United States faces a problem of overdose, and at the same time, long-term overdose will weaken the treatment effect of the disease.
As a result, medical scientists are turning their attention to non-pharmacological therapies and believe that it will replace any existing drugs as a frontier and central technology for chronic pain treatment. For example, VR technology is becoming a potential pain relief solution, while doctors hope to reduce deaths from drug overdoses, and on the other hand, the US medical system is beginning to restrict the use of painkillers, which also brings business opportunities for VR therapy. According to statistics, the value of VR in the medical field has reached one billion dollars, and it is expected to grow exponentially in the next few years. This technology is used in a variety of medical scenarios, such as alleviating anxiety and depression, helping stroke patients recover, visualizing preoperative planning, and more. And in November 21, the US FDA certified the first VR product for the treatment of chronic pain.
Previously, in order to replace drug therapy, people have tried various interventions, in addition to emerging VR therapy, physical therapy/fitness, massage, acupuncture, functional recovery training, psychotherapy, rehabilitation training, mindfulness practice, mind-body practice, etc. In contrast, will VR be more effective as an alternative to drugs? Can VR really grab patients' attention and make them forget about pain? If you want to know the answers to these questions, you may learn more from the following real cases.
Case 1:
In 2015, Brennan Spiegel, a gastroenterologist and researcher at Cedar-Sinai Medical Center, launched an academic medical program using VR therapy and received a $1 million grant from an investment banker on the Cedar-Sinai Board of Directors. In November '21, a patient named Julia Monterroso participated in the program.
Monterroso, who is 55 years old, had been suffering from pain in her lower abdomen for a year and a half before joining the medical plan. Later, in September '21, she underwent surgery for a herniated disc in her lower back, after which the pain in her lower abdomen worsened and she had to stop working as a cleaner. However, after a series of tests, doctors did not detect the cause of Monterroso's abdominal pain. Therefore, pain relief can only be achieved through adjuvant therapy.
The VR solution used by Spiegel is based on PC VR, and the software developed by psychiatrist Omer Liran features real-time adjustments to content based on patient feedback. Liran said that the reason why she chose to develop it herself is because the cost of outsourcing development is expensive and the cycle is long, and it is difficult for public welfare projects to bear such time and capital investment.
Before starting treatment, Liran and Spiegel need to collect biometric data from patients beforehand, such as scanning hearts, glasses, cognitive load, brain power, and more. After entering VR, the cognitive load of patients increases significantly, and for VR novices, entering the virtual world for the first time is a magical experience, and the immersive scene is quite credible. Monterroso said: "In VR, I saw the virtual woods, and I thought of my dead son and burst into tears.
Spiegel notes that such strong reactions are common, and that patients are self-healing in VR. Monterroso also said that he had previously tried to relax through breathing exercises, and now found that VR relaxed better and pain was relieved.
In addition to the woods, Monterroso also experienced virtual environments such as beaches and mountains in VR, and according to monitoring data, these scenes slowed her cognitive load and heart rate, and her body gradually relaxed. Spiegel said: Usually, people's pupils are dilated when they are stressed, and because the beach and mountain scenes are soothing enough to reduce Monterroso's pressure, her pupils are shrunk when she experiences it.
Monterroso then experienced another VR environment dedicated to treating chronic bowel symptoms, this time Monterroso will play a doctor in the virtual world, manually interacting with the robot Maia in the virtual clinic and patients, such as using a stethoscope to check the condition, listening to digestive tract sounds and so on. The purpose of this is to help patients learn about the condition by participating in the diagnosis and treatment of the condition.
In this experience, Maia, a virtual robot, explains how the brain and gut work together and uses images to illustrate this process. For example, when the brain feels stress, it will turn purple red, and the yellow line from the brain to the intestine will become a flame effect. At the same time, there will be a fast-beating heart and fast-moving intestines, at which time the body's oxygen will enter the brain and move away from the intestine, causing intestinal discomfort.
The effects of the VR treatment were immersive enough that Monterroso didn't even notice the people around him until he left VR.
With this VR treatment, Monterroso also seems to have found the cause of the pain in his lower abdomen. She was very sad at one point because of the death of her son, which caused her considerable stress.
Spiegel said: There is only one life and you can't exist in both realities at the same time. In VR, you can enter an immersive scene anytime, anywhere, and simulate a virtual reality by visually tricking the brain. Not only that, but the human body reacts to virtual reality, such as Monterroso's physical pain is relieved in VR.
Case 2:
On August 8, 2016, Robert Jester, a retired high school biology teacher, accidentally fell off a ladder while cleaning his chimney and broke his spinal cord. Because of the ruptured spinal cord, Jester not only couldn't walk, but he also felt his legs tingling, as if he had been scalded by boiling water or stabbed with a knife.
The pain lasted for a year, and he bit off his molars because of the pain, and even planned suicide. He had tried taking medicine, but the medication made him feel depressed and he still couldn't enjoy life normally.
By chance, Jester discovered a VR medical company called AppliedVR, which uses VR to treat anxiety and acute pain in children, so Jester decided to give it a try. During the VR session, Jester experienced a virtual farm and flew in a plane flown by the Wright brothers, and VR made him so focused that he forgot about physical pain.
In this way, Jester began to use VR more and more frequently, while reducing the amount of drugs he used. Finally, after two months of treatment, the use of painkillers was completely stopped. Jester said: "Whenever there is pain in my body, I immediately use VR therapy, AppliedVR is very interesting, I can breathe to interact with the tree in VR. For example, when Jester's breathing is slow and steady, the virtual tree in VR will sprout and grow. Jeter adds that this allows me to focus in a minute.
Through these cases, we can see that VR is effective in pain treatment, but the question that arises is, will patients continue to have pain after discontinuing VR? If it only works when using VR, will patients need to use VR for a long time in the future, and will this also affect their real life? At present, VR does not seem to have caused obvious side effects to the human body, but with the improvement of VR experience and content quality, whether people will become dependent in the future is also a question worth considering.
However, Jester found that even after a year without using VR, the training he received in VR was still working, and whenever pain appeared, he could close his eyes and fantasize about the scene in VR and gradually adjust himself. Experts believe that this is also the goal pursued by VR in the future, that is, to have a long-lasting, realistic effect on the condition, not just to be effective when used.
Case 3:
Another patient involved in the VR therapy project was Misty Williams, a 38-year-old who worked in the back kitchen of a restaurant. Her cause was a pain attack caused by sickle cell disease, and at one point a strong anesthetic (Dilaudid, a morphine drug) was used to relieve the pain. But because the anesthetic is too powerful, she can't use it while cooking, otherwise it may delay her work.
Later, Misty began being hospitalized for VR treatment, and it turned out that VR worked better than Dilaudid. Even if you use VR after a break from work, it will not affect the subsequent work.
Case 4:
Carol Dhainin, 50, has had 28 surgeries for a dislocated kneecap and has struggled with chronic pain for the past 15 years. Later, she was diagnosed with fibromyalgia. In order to relieve her physical pain, she took a variety of painkillers every day, and even if she took the medicine every few hours, the medicine was less effective. She also tried physical recovery, but after the treatment she felt very tired and slept for almost 10 consecutive days.
Carol isn't convinced that VR can relieve pain, and despite having tried various approaches, she's still skeptical about the new technology. Of course, when the drug no longer works, some patients will have to try VR as a new therapy.
The principle of VR pain relief
According to gating theory, Clifford Woolf, a professor of neurobiology at Harvard Medical School, believes that the brain has some control over pain, such as when a person runs out of a burning house, even if it twists the ankle, it is difficult to feel, because the brain focuses on escaping the fire and ignores the pain signal, and does not recover pain until it escapes safely. On the other hand, medical scientists have found through experiments that central nervous system disorders are also related to pain, such as amplifying the body's pain perception because of greater sensitivity to pain. In addition, when the nervous system is out of control, even if the body is not injured, it can release a false pain signal.
Meanwhile, Northwestern University's Pain Lab found that when pain persists, activity in the brain shifts from sensory and motor centers to areas associated with emotion (amygdala, hippocampus). Therefore, it is inferred that chronic pain is part of psychology, and when people are in pain, negative emotions dominate. Simply put, pain relief is more like recovery training for the brain and nerves, and in theory, even without drugs, non-drug interventions such as psychotherapy and VR are enough to be effective.
From a medical point of view, there are six tips for treating chronic pain, and VR can provide most of them:
1, understand pain: pain itself is a disease, not only a symptom of other diseases, it may even be caused by special nerve cells out of control;
2. Exercise helps to relieve it: in many cases, exercise can reduce the discomfort of chronic pain patients and even improve pain tolerance;
3. Find and control the source of pain: relax from the level of thought, untie the "heart knot" that causes physical pain, such as writing a diary to release stress;
4. Through psychological treatment, change the way the brain processes pain;
5. Use alternative words to describe pain indirectly and euphemistically;
6. Find a doctor to prescribe the right medicine.
From these 6 tips, it can be seen that psychological factors may affect chronic pain symptoms, so psychotherapy is also relatively common. Immersive VR is beginning to bear fruit in the field of psychotherapy, and more and more people are using this technology to meditate and relax. Researchers also hope to use the advantages of VR in psychotherapy to relieve physical pain.
At the same time, medical scientists pointed out that physical diseases are not necessarily directly related to pain, even some patients with herniated lumbar discs have no pain for a while, and arthritis patients who have been treated with joint replacement will still feel pain after surgery. This is because the cause of pain is usually complex, so usually only superficial treatment with drugs can be used. Rather than pinpointing the cause of pain, medical personnel are more inclined to look for a clinically effective treatment, such as VR, which has shown some pain relief.
As a non-drug therapy, VR is expected to break through the limitations of existing therapies and avoid addiction and death caused by overdose. In the eyes of medical scientists, VR visual experience also acts as a digital psychedelic effect, where people may produce strong psychological/emotional changes and learn to improve their state of mind through this technology. In addition, through the visual explanation of the virtual robot Maia in VR, Monterroso learned how to heal himself more intuitively, and the effect was better than that dictated by doctors.
Early VR therapy
As early as 1990, Hunter Hoffman, a cognitive psychologist at the University of Washington, tried to use VR to relieve the pain of burn patients. We know that burns themselves are a very painful thing, but the subsequent dressing change process is equally painful.
To ease patients' pain, Hoffman developed a VR solution called SnowWorld, which simply involves patients throwing snowballs at penguins in a virtual winter scene to forget about real suffering. Through brain supplement scans, Hoffman found that VR treatment could be close to that of intravenous drugs.
Compared with drugs and surgery, VR therapy has far fewer side effects. In the 90s, the price of using VR was usually just experiencing some nausea and vertigo. In modern times, doctors are still trying to use VR to relieve pain, such as using VR to distract pregnant women during childbirth. Today's VR greatly reduces the sense of vertigo, not only the experience is better, but the cost and volume are also significantly lower than before.
Hoffman predicts that the development of VR technology will have a downstream impact that will drive the rapid development of VR therapy into standard pain treatment options.
Contemporary VR solutions
AppliedVR states that matching the user's breathing speed with VR vision is intended to provide users with real-time feedback on changes that have taken place in their bodies. This therapy is effective enough to go far beyond the oral narratives used in traditional cognitive-behavioral therapy. In other words, directly reflecting the patient's body data visually in VR is faster and more intuitive than directly showing them data and charts, and the patient can also adjust the physical state in time according to the feedback of VR without interrupting the treatment.
To better treat patients like Jester, AppliedVR has also redesigned a VR solution specifically for chronic pain: RelieVRx. RelieVRx not only includes a variety of quiet and beautiful scenes, but also uses games to distract patients and soothe the nervous system. The entire course lasted 8 weeks, and patients needed to use VR once a day for an average of 7 minutes each time. Unlike VR games, RelieVRx does not support a lot of interaction, only tracks the user's head movement, the advantage is that it is easy to get started, put on the headset and can quickly experience, even without reading the manual.
Todd Maddox, vice president of research and development at AppliedVR, said: "VR allows the brain to learn through experience, which is the first step to changing long-term patient behavior.
In terms of data, AppliedVR's research report showed that with RelieVRx, the number of chronic low back pain symptoms decreased by nearly 43% on average, and the effect was better than that of non-VR therapy (the control group decreased by an average of 25%). In addition, it was also found that most people can still get sustained results within three months after VR treatment, and some people can still get sustained results for six months.
In addition to AppliedVR, a company called Karuna Labs is also integrating VR with healthcare. The company's approach is a hybrid model that blends VR therapy with telemedicine video. Patients can be paired with a rehabilitation coach, who calls the patient weekly to guide pain relief exercises. At other times, patients need to be in VR for three months of self-contact.
In Karuna's VR classes, patients move their bodies based on visual guidance, while VR headsets and joysticks track the patient's posture, triggering interaction with the VR forehead. It also includes sports games such as archery simulations that can be used to restore back or shoulder exercises, or fun vacuum cleaner games to help patients with daily recovery exercises. In the interesting interaction and visual experience of VR, patients are more likely to forget about physical pain and have more motivation to exercise, thereby promoting motor nerve recovery in the body.
The patient's performance in VR will be recorded as data and sent remotely to the coach.
Lincoln Nguyen, founder of Karuna Labs, said that when a patient is transported to another world in VR, his brain will stop associating routine movements with pain, and the patient's movements that cannot be done in real life can be done in VR. In other words, VR can use vision to trick the human brain and thus control the body to move.
Mirror therapy, invented in 1990, is also a way to trick the brain into reducing pain. This therapy is often used to treat "phantom limb pain", where people who have lost their hand or leg still feel the pain of a missing limb. Through a mirror, the patient's remaining hand or leg can be visually replicated to look like it has a complete limb, and the patient's pain is usually relieved.
To further deceive the brain, Karuna applies the core principles of mirror therapy to VR, where patients trust that they are healthy and feel no pain. For patients who have lost their hands or legs, VR can simulate the missing body part or even the movements of that part. Sounds a bit like a feeling of visual hypnosis. In this virtual environment, it is easier for patients to follow instructions to perform complex movements.
Karuna will also increase the exercise services of avatars in VR, so that patients think they are getting the same exercise in reality, further boosting confidence.
The puzzle of VR healthcare
In fact, the application of VR in the field of psychotherapy and physical therapy is still in its infancy, and there is no perfect commercialization and commercialization model, and even some products have only recently begun to enter the FDA approval process. Even for AppliedVR, the current main economic source is to rely on scientific research grants, and the application scenarios are mainly government-funded research projects, which are provided free of charge to patients participating in the project.
One of the big challenges with VR in treatment scenarios is that hospitals have not fully embraced this emerging technology. Even at Cedar-Sinai Medical Center, doctors in its emergency room have not yet adopted the VR solution developed by Spiegel. On the one hand, considering the cost of VR, treatment with VR may be more time-consuming than drug therapy. In addition, the price and user experience of VR therapy may not be suitable for every patient.
To advance VR healthcare solutions, a solid business model is key. So, who pays for VR therapy? When patients cannot afford this treatment, does the insurance company support reimbursement? In this regard, an insurance company pointed out that VR solutions need to be FDA certified before insurance can reimburse them. In addition, there is a need to verify the efficacy of VR therapy in clinical trials, the economic model, and whether it can achieve better results with less expenditure.
However, even though RelieVRx is FDA certified, it is still not reimbursed by insurance companies. Therefore, in response to the problem of business model, Karuna is planning to cooperate with welfare agencies and insurance companies to incorporate VR therapy into workers' compensation, veterans' benefits and other programs.
Nguyen pointed out that VR is still an emerging technology in the medical scene, and the current healthcare system is slowly accepting VR treatment options, and most patients do not yet understand the effects of VR treatment. Perhaps only by conducting more and more tests and attracting more patients to try VR can VR medical treatment be further implemented.
Reference source: nytimes