Virtual reality has entered a new realm—and it has nothing to do with video games or entertaining kids. In the medical field, virtual reality (VR) is becoming a tool for teaching patients how to distract themselves from pain.
Last fall, RelieVRx, the first prescription-based VR system used to help adults reduce chronic lower back pain, received FDA approval after it was proven effective in a clinical trial. Its maker, Los Angeles-based AppliedVR, which specializes in immersive therapeutics, originally labeled it “EaseVRx” to highlight its ease of use (trial participants rated it easier to use than an ATM) but recently changed its name to RelieVRx to emphasize its pain-reducing capabilities.
Mind over matter
Prescribed by a doctor and self-administered by patients at home, RelieVRx teaches users cognitive behavioral therapy (CBT) skills and other proven methods in an immersive and interactive way, training the brain to think differently about how it experiences pain and to reduce suffering. By treating chronic pain, it also addresses the co-morbidities associated with it: depression, anxiety, fear of movement and the social isolation that results from it.
RelieVRx teaches users cognitive behavioral therapy (CBT) skills and other proven methods in an immersive and interactive way, training the brain to think differently about how it experiences pain and to reduce suffering.
“I’ve used it many times,” said Dr. Brennan Spiegel, MD, director of health services research at Cedars-Sinai Medical Center in Los Angeles. “Patients enjoy the element of distraction. It gives them an opportunity to also think more critically about the experience of their pain and the amount of control they might have over it.”
How RelieVRx works
RelieVRx comes delivered to your home with a controller and a headset, along with an attached breathing amplifier. During an eight-week period, patients participate once a day in a session that takes, on average, about seven minutes to complete, according to Matthew Stoudt, AppliedVR’s co-founder and CEO. The activities are a combination of immersion – taking you away from the world you’re in and transporting you to a different world – and interactivity, allowing you to do something in that world, which drives neurobehavioral change.
For example, one activity might be breathing a tree to life. The patient wears a headset and is taught how to breathe diaphragmatically, Stoudt said. They see their breath in the actual scene, as it brings a tree to life, from the ground up.
“After treatment, when the patient gets a pain flare, they will start to remember that tree and how they brought to life that tree by breathing at a certain pace,” he explained. “They will recall those skills and visual imagery to bring down the pain flare.”
Another lesson might take the patient through a chaotic rainstorm, and as they start to calm themselves down using proper breathing techniques, the rain dissipates, the clouds blow away and a beautiful meadow is revealed.
“It’s the skill building that we’re delivering,” Stoudt said. “We’re taking a multi-modal approach to a multi-dimensional problem. You’re learning new skills, and there are modules to help you practice the skills you learned the previous week. It all builds on itself.”
By the end of eight weeks, patients have mastered the skills to help them reduce their pain and can return the headset to AppliedVR. If they need more time to practice those skills, they can ask their doctor to extend the prescription.
By the end of eight weeks, patients have mastered the skills to help them reduce their pain.
“The idea is you cannot live in the headset,” Stoudt said. “We want to tap into the neuroplasticity of the brain and change the way a patient is able to handle their own pain.”
While it’s not necessarily a complete replacement for pain medication, Spiegel said, it can be used to augment pharmaceuticals and other methods of pain relief, like physical therapy, and provide a more holistic approach to pain management.
“It doesn’t necessarily cure people of their pain,” he said. “But it can help make life worth living if they learn to wield more control over their mind and body.”
Anatomy of pain
Spiegel explained pain includes two parts: physical pain (the actual sensory experience of pain) and the emotional and cognitive component of pain, which are the beliefs and perceptions we have about pain and the way it affects us emotionally.
“Pharmaceuticals like opioids may help sometimes with physical pain but it doesn’t do anything about emotional or mental pain, and sometimes it can worsen that,” Spiegel said. “To be successful in managing pain, we need to reduce physical pain and the emotional pain that goes along with it. Virtual reality can often help reduce both kinds of pain, just as cognitive behavioral therapy can without virtual reality. All we’re doing is making CBT more accessible to patients without requiring a therapist sitting with you at home.”
We need to reduce physical pain and the emotional pain that goes along with it. Virtual reality can often help reduce both kinds of pain.
Spiegel said RelieVRx works for several reasons, including distraction—the idea that our brain can only keep track of so much at once.
“If your brain is exposed to a fantastic, beautiful world that’s immersive and engaging, it’s difficult to keep track of pain at the same time,” he said. “People realize that they are able to alter their attention away from their pain.”
If your brain is exposed to a fantastic, beautiful world that’s immersive and engaging, it’s difficult to keep track of pain at the same time.
He explained the goal is to apply to reality the techniques learned in virtual reality, such as meditation, self-directed mindfulness or hypnotherapy.
“It’s not meant to be a brain trick,” Spiegel said. “It’s meant to give people access to the ability they already have and may not know they have. It turns out those are powerful abilities.”
RelieVRx will soon be available in different regions of Arizona, California, Nevada and Texas, and rolled out nationwide in 2023. Stoudt also plans to expand the RelieVRx label to address more chronic pain issues such as total joint pain, which falls under the category of musculoskeletal pain, fibromyalgia and endometriosis.
“Historically, health care is considered a negative good: People don’t necessarily want to do the surgery or take the pills, but on the other side, they’ll get respite from the affliction they face,” Stoudt said. “With immersive therapeutics, people look forward to the journey itself.”