As the United States teeters on the brink of a national state of emergency, more than 100 Americans now die every day due to opioid overdose. Ted Jones, a clinical psychologist with Pain Consultants of East Tennessee and an expert on the front lines of pain and addiction issues, has been in the heart of the crisis in Tennessee where the problem is particularly grave.
“Here in southern Appalachia we are having a big, big problem. Folks debate whether the term ‘epidemic’ is appropriate or not, but no one will deny that there is a major issue as overdoses are on the rise,” he says.
Jones says multiple contributors may be to blame for the problem, including pharmaceutical companies, greedy providers, and an overall ignorance about the dangers of prescribing opioid treatments.
Yet amid this backdrop of crisis, a new suite of digital tools, including virtual reality, are emerging as possible alternatives to treating pain.
Using virtual reality to treat pain dates back at least as far as the mid-90s, when a cognitive psychologist at the University of Washington, Hunter Hoffman, developed SnowWorld, a video game that tunnels players through ice-covered canyons while aiming snowballs at moving penguins and snowmen. The game demonstrated success in significantly reducing pain for burn victims suffering from extreme levels of acute pain.
According to Josh Sackman, president and co-founder of AppliedVR, a company working to commercialize VR software similar to SnowWorld, VR is effective at reducing acute pain because it can divert a patient’s attention away from the pain.
“Pain requires a tremendous amount of attention, and as humans we are terrible multitaskers. If you can take someone and distract their focus away from their pain and have them focus on something else, you can reduce the amount of physical pain a patient experiences,” he says.
Sackman points out two unique benefits of virtual reality that give it an advantage over other forms of distraction like television or audio. The first is that VR is an immersive experience that cuts the user off from the world around them. If someone uses a distraction like a tablet device or television screen, there are still plenty of things happening around them which have the potential to steal back their focus, which can allow the pain back in.
The second benefit is that VR can be developed with an active component requiring user participation. The game AppliedVR developed is simple enough. A player aims balls at an ever-approaching group of cartoon bears. It’s the participatory element of aiming the balls that make their platform more effective than a passive form of distraction like watching a movie.
In a small clinical trial, virtual reality was shown to be up to twice as effective as using opiates like morphine—which is certainly a promising, if early, development. As the opioid crisis in the United States looms larger, any alternative pain management approach would be welcome.
In at least one instance a patient—who last year fell from a roof and now suffers from bouts of breakthrough acute pain—was even able to eliminate his use of opioids by using VR.
While stories like Bob Jester’s are exciting, and they do point toward a future where VR might provide an alternative to opioid medications, it’s only one piece of a much larger challenge.
Historically, research looking at VR as a pain treatment has focused primarily on acute pain, the type of isolated bouts of severe pain Jester experiences and uses VR to address. To more fully confront the opioid crisis, VR would also need to be useful managing chronic pain, which, in contrast, is experienced over long periods of time and can be a far more disabling condition.
“Chronic pain is much more difficult to treat and is far more debilitating than acute pain. It also impacts one’s life much more as patients can lose their jobs, relationships, and recreational activities,” says Jones.
Jones also points out that chronic pain is one of the most prevalent and costly of all diseases in the United States. If VR can be used to treat it, that would be a very big deal. To get there, however, we’ll need a new set of techniques.
“If I have a condition as a chronic pain patient, I have persistent pain over weeks, and months, and years. Distraction can provide some relief, but ultimately avoiding pain is not the approach,” Sackman says.
AppliedVR is now turning their attention to chronic pain by developing VR-based methods borrowed from other types of cognitive behavioral therapies and mindfulness-based techniques.
One of the exercises uses a sensor to monitor the patient’s breathing to ensure they maintain a slow and steady pace. As their breathing matches the ideal state, the patient will see an intricate puzzle-like structure forming inside their headset as a type of visual reward to reinforce progress.
Sackman says this kind of sensor-based biofeedback will help patients learn to control their breathing and increase relaxation to cope with pain. “The basic assumption is that patients can learn that they have control over what happens in their body so that when they are faced with pain, they can focus on something within their control,” he says.
As the opioid situation in the US worsens, there is now an urgency to finding new ways to treat chronic pain patients. Both Jones and AppliedVR are working quickly to do the research to acquire clinical data demonstrating whether VR is a viable treatment option.
While he doesn’t believe that VR will completely replace opioids, Jones does say it could become a centerpiece for treating pain and that he’s hopeful about its potential.
“VR could be a major player in chronic pain treatment, and it has more potential than any new pain treatment on the horizon.”