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Sometimes a crisis can fuel innovation. With an opioid problem gripping the United States, medical providers are looking for ways to treat patients’ pain without resorting to addictive drugs. Those potential solutions include the use of virtual reality (VR) at institutions such as Cedars-Sinai Medical Center and the University of Washington Harborview Burn Center.

VR’s usage to treat pain is limited. But a heightened awareness of widespread opioid addiction, the efforts of progressive healthcare providers and technologists, and insurers’ mounting costs to pay for opioid addiction may spur an uptake of virtual reality for medical treatment. The cooperation of an ecosystem spanning businesses and the government will be required for VR to break through for chronic pain treatment.

VR Takes Hold

To casual observers, VR is an immersive experience for playing games and watching movies. In fact, companies use VR for non-entertainment functions such selling cosmetics, training workers to assemble machinery parts, and designing automobiles. In fact, medical providers have been using VR to treat pain for a few decades by tapping into VR’s ability to entertain by transporting users to a different world.

The University of Washington Harborview Burn Center created the first virtual world designed expressly to reduce pain. Known as SnowWorld, the experience distracts patients from intense pain typically experienced during procedures such as burn wound-care sessions. While patients endure a painful treatment, they use a virtual reality headset to enter another world where they can fly through a make-believe canyon and throw snowballs at snowmen and penguins. SnowWorld is the result of research into VR as a pain treatment tool going back to the 1990s at Harborview.

Patients using SnowWorld report experiencing 50 percent less pain than patients using other means to distract themselves (e.g., music). Why? Because virtual reality rewires the brain by transporting the user to another world through the power of 3D video and spatial sound. A post on the University of Washington Human Phonotics Laboratory website explains in more detail:

Our logic for why VR will reduce pain is as follows. Pain perception has a strong psychological component. The same incoming pain signal can be interpreted as painful or not, depending on what the patient is thinking. Pain requires conscious attention. The essence of VR is the illusion users have of going inside the computer-generated environment. Being drawn into another world drains a lot of attentional resources, leaving less attention available to process pain signals. Conscious attention is like a spotlight. Usually it is focused on the pain and wound care. We are luring that spotlight into the virtual world. Rather than having pain as the focus of their attention, for many patients in VR, the wound care becomes more of an annoyance, distracting them from their primary goal of exploring the virtual world.

The website notes that “The effectiveness of virtual reality pain distraction has now been documented in a small but growing number of clinical studies published in peer-reviewed medical journals.”

Other hospitals are using VR for pain treatment, too. For example:

• Cedars-Sinai Medical Center uses VR to immerse patients in experiences such as virtual trips to Iceland. In July, The Wall Street Journal reported that “Brennan Spiegel, a Cedars-Sinai researcher, says a virtual-reality experience can reduce pain by 24% or more, according to clinical trials he conducted in the past two years. VR eased different types of pain, from cancer to orthopedic injuries to abdominal discomfort.”

• Pain Consultants of East Tennessee has been researching and applying virtual reality for a few years to treat chronic pain. The institution’s research reveals notable pain reduction among patients using a VR application known as Cool!.

• Children’s Hospital Los Angeles and Boston Children’s Hospital are using virtual reality in studies on pain and anxiety with children.

• New York-Presbyterian/Weill Cornell Medical Center in Manhattan recently launched a VR study on patients in its burn center.

These applications are limited to use within the confines of the medical center to treat acute pain. But VR has yet to become an alternative for people to treat chronic pain after they leave the hospital. The cost of necessary equipment alone – typically entailing a headset, controllers, and a connection to a computer, costing $1,500-$2,000 – inhibits the use of VR to replace opioids for pain treatment. But the development of less expensive headsets untethered to computer equipment, such as Oculus Go, could help VR become a viable alternative.

Ecosystem Needed

For VR to become a serious solution for pain treatment, an ecosystem of content creators, technologists, healthcare professionals, insurers, and the government will need to coalesce.

Patients and Providers

Patients and providers are at the center of the VR healthcare ecosystem. And they should be.

VR experiences such as SnowWorld exist to treat intense pain. The pain that comes with being a burn victim. Or a soldier suffering from PTSD. Or a child recovering from trauma. Anyone weighing the pros and cons of VR treatment therapy must put the patient first – a singular focus sadly missing in the conversation about healthcare.

The physicians who treat patients are entering a new world of pain management, one of training, testing, and articulating the benefits of VR therapy to patients, insurance companies, and the many other players who have a say in the development and compensation for alternative forms of pain treatment.

For clinicians such as Ted Jones, at Pain Consultants of East Tennessee, applying VR for treatment has happened because of personal initiative, not because of support from the healthcare and insurance industries. As noted in a recent Quartz article:

Developing VR into a routine treatment is also going to require new models of funding. So far, Jones has paid for his clinical trials himself. “It’s my hobby,” he says. “I don’t have a boat.” Beyond those, he actively discourages his physician colleagues from referring patients for VR, despite the fact that he is convinced it would help, because he can’t bill for it. VR pain relief needs a “champion” he says, who will fund trials and convince insurance companies to take it seriously. “The VR industry has got some work to do.”

The shift in provider compensation from fee for service to value-based outcomes will further pressure physicians to explore alternative ways to treat patients. In addition, the President’s Commission on Combatting Drug Addiction and the Opioid Crisis recommends the modification of rate-setting policies that discourage the use of non-opioid treatments for pain.

Technologists and Content Creators

Content platforms include companies such as AppliedVR, which has been described as “a VR version of Netflix.” The company says it is the first VR platform designed for healthcare and is working with more than 50 healthcare providers. Technologists consist of equipment manufacturers such as Google, HTV, Oculus, and Samsung. They also work with healthcare institutions to use their products, as Oculus is doing to help providers use VR for training.

The technologists and content creators also play vital roles encouraging the uptake of VR through evangelizing and creating more accessible equipment. And accessible equipment remains an issue, as noted. But the good news for VR treatment is that even though the equipment is expensive, it’s not as expensive and clumsy as it was when the Washington Harborview Burn Center worked with an eight-pound unit that cost $90,000.

Meanwhile, Mark Zuckerberg has been discussing VR as a tool to make society better. (He has good reason: Facebook owns Oculus.) And Matthew Stoudt, CEO of AppliedVR, is all over the news media talking up his product in context of a broader mission to use VR to help patients.

Earlier in 2017, the Food and Drug Administration granted clearance for a few interesting VR products:

• MindMaze’s MindMotion Pro platform, which uses VR and augmented reality for rehabilitation of stroke and traumatic injury patients.

• Saebo’s SaeboVR platform, which also uses VR to help people requiring rehabilitation to learn how to use their bodies again following a trauma.

With President Donald Trump declaring  opioid addiction a national emergency, let’s see if the FDA becomes more aggressive about approving the use of VR technology for medical use.

Insurance Companies

Insurance companies are going to make or break virtual reality as a treatment method. They’ve been blamed for contributing to the opioid emergency in the first place by providing more favorable coverage to addictive opioids prescribed by physicians. So far, insurance companies’ idea of attacking the opioid crisis is to monitor more carefully patients who abuse opioids and to scale back coverage for opioids. Insurers may also need to demonstrate a willingness to cover alternative therapies that would potentially reduce insurer’s long-term burden for underwriting the medical costs of opioid addiction (estimated to be $72.5 billion annually).

Apparently at least one insurance company is taking a holistic view. A November Wired article that focuses on Cedars-Sinai discusses the work of Brennan Spiegel (he is also cited in The Wall Street Journal article noted here). As reported in Wired, “In his next study, [Spiegel is] working with a major insurance company to evaluate whether or not virtual reality can reduce the number of opioids taken by people who’ve been recently injured on the job.”

The Federal Government

Finally, the federal government holds the key to enacting major change.

To date, President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis has focused on educating the public on the dangers of opioid use; giving more money to states to fight opioid addiction; and cracking down on Americans who sell opioids illegally.

The recommendations of the President’s Commission on Combating Drug Addiction and the Opioid Crisis do not discuss finding alternative ways to treat pain. But within the vast government bureaucracy is a sign of change: as noted, earlier this year, the FDA granted clearance for the use of virtual reality platforms for rehabilitation. And days ago, the FDA approved the marketing of a device that uses a brain stimulator to treat opiate withdrawal symptoms. The device, known as Neuro-Stim System Bridge, does not use virtual reality. But the FDA’s approval of its marketing demonstrates an openness on the FDA’s part to alternative forms of treatment. Meanwhile, the Department of Defense (specifically, the Army) is using virtual reality to help soldiers handle PTSDs.

The day may come when insurance companies decide it’s time for creative solutions to helping customers who are suffering (and you had better believe a shift in treatment policy will be motivated by profit). Until then, finding alternative ways to treat patients in pain will come down to enterprising physicians and evangelists.

Image source: https://unsplash.com/photos/nss2eRzQwgw