From chronic pain management to help with patient loneliness and isolation, virtual reality (VR) could have big health care potential.

How VR could alleviate chronic pain

Around 50 million Americans live with chronic pain, and it is one of leading causes of long-term disability worldwide, the New York Times reports.

According to the Times, chronic pain can not only affect the body, but also the brain. For example, research from A. Vania Apkarian's pain lab at Northwestern University found the brains of patients with chronic pain had significant gray matter loss in the prefrontal cortex and the thalamus, both of which help the brain process pain.

How virtual reality provides non-opioid pain relief in the hospital

In addition, chronic pain can shift brain activity away from the sensory and motor regions to the regions associated with emotions, such as the amygdala and hippocampus. This causes pain to be "part of the internal psychology," Apkarian said, "a negative emotional cloud to take hold."

Currently, there are few effective treatments for chronic pain. Daniel Clauw, who leads the Chronic Pain and Fatigue Research Center at the University of Michigan, said there isn't "any drug in any chronic-pain state that works in better than one out of three people."

Now, many researchers are turning to therapies that target the brain, including VR technology, to help patients reduce and manage their chronic pain symptoms.

Currently, one of the pioneers in VR technology for chronic pain is a company called AppliedVR. In 2017, the company was using VR to treat anxiety and acute pain in patients, particularly children, undergoing hospital procedures, but it has since redesigned its technology to treat chronic pain.

The company's product, which is called RelieVRx, provides therapy to chronic pain patients through game play or scenes that help control their breathing and soothe their nervous systems. Each VR session lasts seven minutes, and patients are instructed to do one session a day for eight weeks.

Beth Darnall, the director of Stanford University's Pain Relief Innovations Lab and AppliedVR's chief science advisor, said the technology's visual elements, including a tree that grows leaves as a patient's breathing calms, "reflect back to the user the changes that are occurring in their own physiology."

"It's a powerful way to teach principles and concepts [to manage pain] that extend well beyond what we do in traditional didactic cognitive behavioral therapy," she said.

In a recently published study, researchers, who were affiliated with AppliedVR, found that 43% of patients who used the RelieVRx technology reported a reduction in their chronic back pain compared with 25% of the control group. In addition, patients in the treatment group also reported that pain interfered less with their sleep and activities. Overall, these results lasted between three to six months after patients' last VR session.

Although there is no concrete evidence on how VR technology works with chronic pain, Todd Maddox, a cognitive neuroscientist and AppliedVR's VP for research and development, hypothesized that the company's program "alters structure and function of the brain."

"You don't get changes in patient-reported outcomes without changes in the brain," Maddox said.

In November 2021, FDA authorized RelieVRx as a treatment for chronic back pain—making it the first VR technology authorized for such use, and likely leading the way for other similar products to follow.

VR's potential future in health care

Researchers are also testing VR's potential to assist with different health problems, from anxiety and depression to surgeries and stroke rehabilitation. Some health experts have also suggested VR and holograms could help hospitalized patients with loneliness and isolation, such as when quarantine procedures separated many Covid-19 patients from their loved ones early in the pandemic.

Compared with most drugs and procedures, VR has relatively few side effects, primarily nausea and motion sickness. VR headsets are also now much cheaper and have improved graphics, which make the experience more immersive.

However, experts say companies need to convince decision makers in the health care industry, as well as individual patients, that VR technology can provide concrete benefits before it can be widely accepted and used.

"There's no point in developing a technology just because it's cool," said Leonardo Angelone, deputy director of the Office of Translational Initiatives and Program Innovations at the National Institutes on Drug Abuse.

So far, the health care industry has been slow to fully back VR technology, particularly since it's still so new. However, Lincoln Nguyen, founder of Karuna Labs, a company that combines VR with telehealth counseling to help patients with chronic pain, said VR could be a beneficial option for patients who have exhausted other treatments.

"[O]ur way in is: 'Just try it out. What do you have to lose? You tried everything else,'" Nguyen said. (Ouyang, New York Times Magazine, 4/26; Kirubanandan, MedCity News, 4/27)