Chronic pain isn’t always physical.
The mind-body connection is “a well known phenomenon” in chronic pain treatment, according to Ted Jones, PhD, a pain psychologist at Pain Consultants of East Tennessee. As much as two-thirds of the reason chronic pain develops in individuals can be attributed to a central nervous system that is “really wound up,” often due to instances of past abuse and anxiety, Jones says.
“Distraction by itself is a really helpful analgesic,” he says. “If you focus on pain it makes the sensation worse.”
With that in mind, Jones, along with doctors in several pain clinics throughout the United States, have turned to exploring virtual reality (VR) as a treatment for chronic pain. Jones has published two studies on the subject. The first study, published in 2016, looked at the experiences of 30 patients with a variety of chronic pain conditions who were each given five-minute VR sessions and asked to rate the severity of their pain on a 0-10 scale before, during, and after the treatment. Overall, patients reported a 33 percent decrease in pain after the sessions, and a 60 percent decrease during the sessions. Jones is in the midst of a pilot study tracking patients who will be using VR therapy for chronic pain independently at home for the next few months. Jones has paid for these clinical trials himself.
Other research shows similar results. At Cedars-Sinai, researchers found in a 2019 study that Virtual Reality therapy was effective in reducing pain in hospitalized patients. In a study of 120 patients, half were given a VR therapy while the other half watched a 2D relaxing video on TV screens, with the VR patients reporting a significantly greater decrease in pain on a scale of 1-10. “We believe virtual reality creates an immersive distraction that stops the mind from processing pain, offering a drug-free supplement to traditional pain management,” head researcher Brennan Spiegel said in a press release.
VR has already been found in several studies to be useful for acute pain, such as treating skin wounds from burns.
“Drug-free” is an important and increasingly necessary component of VR treatment. Jones says that until the 1980’s the primary treatment for chronic pain was a multidisciplinary rehab, where a patient would spend up to a month working daily with physical therapists, occupational therapists, and psychologists on developing skills to manage pain. Many of these skills involved mind training for relaxation and stress management, such as imagining oneself on a beach or in the mountains, a “kind of self-hypnosis,” Jones says. “It works really well.”
However, insurance companies stopped paying for these kinds of multidisciplinary programs in the 1980’s, and the shift was made to prescription opiates as the main treatment for chronic pain.
Now, due to backlash caused by the opiate crisis, many physicians are unwilling to prescribe them at all. So, when it comes to treating chronic pain, says Jones, “there’s nothing left. There’s no multidisciplinary treatment left. There’s no opiate treatment left. Patients are really hung out to dry.”
VR is a natural entrant into the space, Jones says, because the programs used in VR for chronic pain are similar to the mind-training offered in those early, multidisciplinary pain rehab programs.
One of the primary ways VR is used for chronic pain is with gamefied relaxation techniques and visualizations.
In his studies, Jones has used programs created by Los Angeles-based Applied VR, the leader in the field. Their program includes an Oculus Go headset with a device called an amplifier attached, which senses the patient’s breath. A patient might see a visualization where a tree changes color and a sun comes up as their breathing slows and calms.
Applied VR has written a program for the Oculus Go and is currently working on producing studies intended to result in FDA approval for the program—along with the necessary equipment—as a medical device that helps alleviate pain, similar to a TENS Unit. If FDA approval comes through, virtual reality for chronic pain could be paid for by insurance companies.
Another way VR is used to treat chronic pain is to do range of motion training. San Francisco-based Karuna Labs developed a program for this kind of treatment that is currently being used in seven clinics nationwide. Karuna Labs is a startup that raised $3 million in seed funding in 2018 and is currently raising Series A funding in order to commercialize their product.
Karuna’s simulations involve having patients embody avatars in VR and then showing their avatars moving the body in ways the patient believes to be impossible. For example, a patient with shoulder trauma who can only lift their shoulder 45 degrees up might see their avatar lifting it 65 degrees up.
According to Karuna founder Lincoln Nguyen, this technique is “a way to rewire the brain to recognize that movement is non-threatening. You’re using VR as a way to trick your brain to move more.”
A 2019 study conducted by Karuna Labs found that patients using the technology experienced a decrease in pain during the sessions.
For Nguyen, who has also worked as a meditation teacher, VR is intrinsically connected to consciousness expansion. “I can’t deny the power of it doing things like shift your sense of self and, basically, be a contemplative tool,” he says.
Many of Karuna’s programs were inspired by Buddhist meditation techniques. In particular, Nguyen compares the way chronic pain patients embody avatars to see themselves moving with increased range of motion to Deity Yoga, a practice in Tibetan Buddhism where practitioners visualize themselves embodying a fully enlightened being or Buddha and, as a result, achieve results like becoming more compassionate.
Karuna Labs is launching a home unit in June, which will be available for Workers Compensation patients to begin with. Nguyen says Karuna is in talks with several major insurance companies about the prospect of reimbursing the product as a bundled payment for pain treatment.
Nguyen anticipates that changes brought upon the healthcare industry because of COVID-19 will be a new normal. “It’s a ripe time for VR and a lot of these tools that allow patients to do exercises at home,” he says.