Wearing virtual reality goggles is not just trendy among video gamers, but has found popularity with researchers interested in exploring how the technology can help people living with chronic pain. When combined with cognitive behavioral therapy, virtual reality or VR has been shown to decrease pain intensity.
VR has been used for decades to help people overcome phobias and anxiety disorders. One of its first applications was developed in the mid-90s to distract burn victims from the agonizing pain of changing their wound dressings. A virtual environment, called SnowWorld, was developed by cognitive psychologist Hunter Hoffman to ease the pain from severe burns.
More recently, VR research has focused on both acute and chronic pain, and tested in people with post-traumatic stress disorder, idiopathic facial pain, cancer pain, complex regional pain syndrome and other conditions like irritable bowel syndrome.
[Read: Tips for Living Better With Joint Pain]
What Is Virtual Reality?
VR has come a long way since it was first developed in the 1960s by the U.S. Air Force. Once thought of as a sci-fi gimmick with static and monotonous visuals, today’s VR features high-definition images using dynamic light to give each scene a sense of beginning and end. Many VR technologies use dramatic and immersive sound, and many systems monitor breathing so they can guide users through deep-breathing exercises. Patients wear headsets for 10 to 20 minutes once a day that transport them into 3D worlds — scenes vary from swimming with dolphins and ocean exploration to watching Cirque du Soleil or touring exotic destinations. In some cases, VR is used as a way to exercise and increase fitness.
Mainstream use of VR in entertainment and teaching has led to its increased popularity. Sleeker and low-cost versions have revolutionized VR technology and made them more accessible to the public. Oculus Quest 2 from Meta Platforms Inc. (formerly Facebook) is one of the more popular headsets because it’s light, well built, easy to use and more affordable than previous versions.
Innovation Expansion
Several hundred hospitals across the country are assessing the use of VR, including well-known medical centers like Hospital for Special Surgery in New York and Boston’s Children Hospital. Cedars-Sinai Medical Center has been on the cutting edge of using VR to treat people with chronic pain. The VR program, led by gastroenterologist Dr. Brennan Spiegel, professor of medicine and public health at Cedars-Sinai, has treated more than 3,000 patients.
Spiegel has spearheaded several VR studies since 2015. One study followed 100 patients suffering from pain due to a variety of causes. The team at Cedars-Sinai found that the group that experienced VR technology reported a 24% drop in pain scores. The other 50 patients who watched a standard, 2D nature video with relaxing scenes on a nearby screen experienced only a 13.2% reduction in pain.
“Virtual reality has been shown to reduce pain when used within the hospital in a variety of studies,” says Spiegel, who is also director of health services research at Cedars-Sinai and author of the book, “How Immersive Therapeutics Will Revolutionize Medicine.” “We have also developed a digital pain reduction kit, including virtual reality, used at home to help patients improve quality of life and reduce their need for pain medications.”
[READ: Pain and OTC Medications: Which Is Best?]
Understanding VR for Pain Management
Despite all the excitement around VR and its promise for managing pain and potentially reducing the need for opioids, the exact mode behind how VR impacts pain remains unknown. Some experts speculate that VR creates a non-medicated form of analgesia by changing the activity of the body’s pain modulation system, whiles others postulate that VR serves as a “pain distraction” by reducing the perception of pain by absorbing and diverting attention away from the pain.
Andrea Stevenson Won believes in the potential of VR technology, but she also recognizes the need for more studies. Won is director of the virtual embodiment lab at Cornell University in Ithaca, New York, where she’s an assistant professor of communications with the College of Agriculture and Life Sciences. She became interested in virtual reality and how it could be used as a treatment option for chronic pain issues and has led studies examining the use of VR to ease the pain in adults and children with complex regional pain syndrome, or CRPS, and patients with cerebral palsy and peripheral idiopathic facial pain.
“In the past, there were very few labs that were working in VR because it was so expensive and technically challenging, but once consumer equipment became available, many more researchers started envisioning new potential applications for virtual reality,” says Won. “There’s huge potential for VR as a therapeutic option, but we don’t want this to be oversold and people to get excited about VR treatments before they are proven effective.”
Researchers are also looking into the potential side effects of VR, such as whether it could be addictive. “We have not seen abuse among our patients who are using it for therapeutic purposes, and in fact, what we have observed is that people don’t love using VR after 20 to 30 minutes,” Spiegel says.
The most common side effect for some patients, according to Spiegel, is “cybersickness,” the feeling of dizziness and nausea when the patient is wearing a VR headset. Patients also have experienced side effects such as blurred vision, eye strain and headache. He says less than 5% of patients experience these effects, but they usually disappear when the headset comes off and often decrease with subsequent use and treatment sessions.
[Read: Best TMJ Exercises for Jaw Pain Relief.]
Future of VR and Medicine
The explosion of interest in VR technology seems endless. In November 2021, the Food and Drug Administration approved the first VR technology — called EaseVRx — for the treatment of adult patients with diagnosed chronic lower back pain. EaseVRx uses the principles of cognitive behavioral therapy techniques for the purpose of reduction of pain and pain interference.
As one of a few approved “digiceuticals,” aka digital therapeutics, the device is intended for at-home self-use and consists of a VR headset, controller and a “breathing amplifier” attached to the headset that directs a patient’s breath toward the headset’s microphone for use in deep breathing exercises. “The approval sets a positive pathway for future advancements because the FDA provided a special breakthrough designation for the device,” Spiegel says.
Several other companies have entered the VR field to discover the next generation of systems that go beyond being a distraction therapy and instead focus the brain away from pain. One company, CognifiSense, is working on a completely new type of VR therapy, which they have dubbed “VR neuropsychological therapy.” This new approach is different from traditional VR therapy because it aims to change how the brain perceives pain and create a lasting reduction in pain.
“There are so many researchers dedicated to keeping this an evidence-based branch of medicine to further study where VR is appropriate and where it’s not appropriate, and how we can best help patients living with chronic pain,” Spiegel says.
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