Virtual Reality Programs Now Target Pain, Stress, and Depression

VR programs are about more than distraction these days. See how specific headsets are now designed to monitor, track, and relieve your pain as well as related symptoms.

Whether you are living with migraine, fibromyalgia, or another chronic pain condition, virtual reality (VR) may be worth looking into. Often used in palliative care or with hospitalized patients, it may be an effective adjunctive therapy for pain management at home as well.

According to a Cedars-Sinai Medical Center, patients using VR programs were able to decrease their pain scores significantly without triggering adverse events or altering vital signs.1

 

Wait, Do You Mean Virtual Reality Headsets?

Yes, users wear a head-mounted display, such as an Oculus, with a close-proximity screen that “creates a sensation of being transported into lifelike, three-dimensional worlds,” notes one study.2 Mechanistic theories behind how it works suggest that by stimulating the visual cortex while engaging in other senses, VR programming acts as a distraction to limit a person’s processing of nociceptive stimuli (eg, pain from an injury or surgery.2

 

Virtual reality captures the mind’s attention and blocks pain signals from reaching the brain. (Image: iStock: alexpunker)

How Does VR Work for Pain Exactly?

According to Mark Young, MD, MBA, FACP, of the Oasis Center for Natural Pain Management in White Marsh, Maryland, and a PPM Editorial Advisor, “Virtual Reality is an excellent approach to pain management. It captures the mind’s attention and blocks pain signals from reaching the brain. It’s almost like a form of active hypnosis. VR provides tactile and sensory feedback and allows the patient to rally the neurotransmitter mechanisms that decrease pain.”

In fact, VR programs have increased both in popularity and acceptance by the medical community in recent years as they have been shown to be effective with many types of pain and related symptoms, such as depression and anxiety. And a brand new study led by pain researcher Beth Darnall, PhD, at Stanford University found "a significant reduction in pain outcomes" over a 21-day trial period of just under 100 adults with self-reported chronic low back or fibromyalgia using a skills-based VR program (including cognitive behavioral therapy, relaxation, mindfulness) compared to using an audio-only VR program.

Pain catastrophizing lessened and pain self-efficacy (ie, confidence in the ability to carry out daily activities) improved in both groups. The team concluded, "VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain."3

Virtual reality programs are typically considered to be an effective and safe therapy for pain management in hospitalized patients as well. A Cedars-Sinai study found that pain scores decreased significantly with the use of VR, regardless of the cause of pain or reason for hospitalization. Software has been used to manage pain linked with a wide variety of known painful medical procedures.2 Participants in various settings who were immersed in VR experienced reduced levels of pain, general distress/unpleasantness, and reported a desire to use VR again during painful medical procedures.4

VR is effective because it distracts your brain from thinking of pain, adds Eran Orr, CEO of XRHealth, a company that provides VR telehealth products and services. “The brain is a very powerful tool and if we can convince your brain to think about other stuff when you are in pain, it helps you cope,” says Orr. “Your brain is like the CPU (central processing unit) of a computer. Once you overload the CPU with vision and sound, pain doesn’t take such a big priority.”

However, VR is not meant to be a standalone treatment – the programs are often used in combination with other types of treatment, such as medication or physical therapy, experts say. “These programs amplify the effectiveness of other forms of intervention. It’s a no-lose proposition,” explains Dr. Young.

 

In Practice: A VR-Ketamine Combo for Pain and Depression

Clinician Tim Canty, MD, of the Comprehensive Spine & Pain Center of New York, is using virtual reality regularly in combination with ketamine infusions to help manage chronic pain in his patients, especially those who also struggle with depression.

“Many of the mainstream treatments for chronic pain and emotional conditions, such as depression, simply do not work for a number of patients,” says Dr. Canty. “Without effective treatments, these patients are often left to manage their symptoms in a way that has not, to date, had solid long-term results.”

The combination of ketamine and virtual reality – what he calls “KVR” – has “not only changed the perspective of these patients; it has given them something they have not had in a long while: hope.”

FDA-indicated as an analgesic for surgical procedures and for treatment-resistant depressions, ketamine has increasingly gained attention in the field of pain management, including for relieving cluster headache and CRPS pain. Ketamine is thought to combat pain by acting against a specific chemical receptor known as N-methyl-D-aspartate, or NMDA, which is found in the nervous system and, in part, modulates pain. 

Dr. Canty recently surveyed a small group of 18 patients and found that two-thirds preferred to use KVR over ketamine alone. “The data, and the results we see in our everyday work, give us hope for those whose struggles with pain and depression are severe,” he told PPM.

 

What Types of VR Might Work for Pain?

Wondering which VR program might be best for your pain? There are several VR software programs out there worth exploring.  Here are some options to consider.

BehaVR uses a progressive, multisession VR experience that is built on Balance, a program that teaches stress resilience and emotion regulation. (Image courtesy of manufacturer)

BehaVR

BehaVR, LLC’s progressive, multisession VR experiences are built upon Balance, which is a program that teaches stress resilience and emotion regulation.

"Stress is intertwined with pain,” says founder and CEO Aaron Gani. “Chronic pain is both physical and emotional.” For this reason, the BehaVR strategy is to take “analog,” evidence-based concepts and turn them into “digital” VR experiences. The company’s Pain Neuroscience Education program has been shown to be effective5  by leveraging the neurological and psychological power of VR.

“We have a cloud platform that directs the patient’s experience the whole time, collecting data from the patient during each session,” Gani explains. “With VR, we literally take over and teach patients how to rewire the brain circuitry that keeps them stuck in chronic pain.”

To use BehaVR, a headset and internet are required. Some content is preloaded to the headset, and when the user logs into one of the experiences, information is exchanged over the internet. “We can track what you are doing during each session” including from your pain rating scale, says Gani.

Jennean Munro, a mom of two and a real estate agent in San Diego, California, suffered neck and back injuries in a serious car accident. She shares that the BehaVR program helped her learn to practice the breathing and visual techniques that relax her neck, shoulders, and mind.

“One of my favorite parts of BehaVR was ‘visiting’ a beach or forest and really feeling like I was there,” Munro says. “With my hectic lifestyle, it’s good to have a place to just meditate, and to go over the breathing and visual reminders of relaxation.”

She says the exercises in each session as well as the ability to track her progress helped her see that she was improving. “I genuinely looked forward to ‘checking out,’ so to speak, and feeling like I was able to completely relax by the end of my sessions,” she says.

Pricing & Contact Info: The BehaVR Pain Neuroscience Education+ in VR program is $300 per month for physical therapy clinics. A kit for unlimited patient sessions per individual clinic includes an Oculus Go headset, headphones, and an administrative control panel. An at-home consumer version will be available soon. Visit https://behavr.com/pne/ for details and ask your doctor about how to best access the program.

  

The XR Health virtual reality telehealth kit includes an evaluation and a VR headset pre-installed with applications suited to your needs. Apps can be geared toward pain management, stress and anxiety, memory decline, and physical therapy.(Image courtesy of manufacturer)

XR Health

XR Health offers a virtual reality telehealth kit to patients with chronic pain. Interested users participate in an evaluation and then the company mails them a VR headset pre-installed with various medical applications suited to their needs. There are various apps geared toward different conditions, including pain management, stress and anxiety, memory decline, and physical therapy. The two approaches used for pain management include distraction and cognitive behavioral therapy (another technique you can practice at home).

After you have time to get familiar with the headset, XR Health arranges a call between you and one of its clinicians. “The client signs up on the website and once the details are worked out with the insurance company, an appointment is scheduled with their assigned physician for an evaluation,” explains Orr.

During this call, which lasts no more than 15 minutes, the user wears the VR headset and is immersed in different environments that are suited for pain management. You may see different types of sequences, such as swimming with dolphins, or sitting next to a waterfall. “Different types of environments and sequences are meant to help you cope with pain.”

While connected, your assigned clinician can see everything that you see and monitor your vitals in real time, Orr adds. “All the clinicians are certified in the state of the patient they are assigned to.”

Pricing & Contact Info: A VR Telehealth Kit includes unlimited access to your VR headset and treatments, two video calls with a healthcare professional, and consistent remote monitoring of your progress. The monthly cost can range from $30 per month (if your insurance covers it) up to $399 per month. https://www.xr.health/

 

Cynergi VR

Cynergi VR offers a variety of virtual products aimed not only at helping to relieve chronic pain, but also to aid with anxiety disorders and substance use disorders (including in clinical rehabilitation settings). An immersive 360-degree experience with calming, gentle music, and visual imagery helps the user feel relaxed. The user may be instructed to take a deep breath, hold it, and then let it out, or follow steps for progressive muscle relaxation.

The software, which runs on the Oculus quest headset, is unique in that it monitors the user’s heart rate (the monitor is placed on the user’s skin) and modifies the relaxation program to provide a more effective response, according to Arshya Vahabzadeh, MD, MRCGP, co-founder of Cynergi Health Partners.

"We use an external device that links with the Oculus quest and our program to provide feedback,” Dr. Vahabzadehsays. “This way, we are able to modify the user’s experience based on how they are feeling at that particular moment. “

Pricing & Contact Info: Cynergi’s current offerings are Business to Business, but interested individuals can email info@cynergihealth.com to learn more. "We can work  on a select basis with consumers if they would like to purchase," says Dr. Vahabzadeh. For general information, visit Cynergihealth.com

Updated on: 07/15/20
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