Virtual reality may help ease chronic pain

By: HELEN OUYANG

Chronic pain is generally defined as pain that has lasted three months or longer. It is one of the leading causes of long-term disability in the world. By some measures, 50 million Americans live with chronic pain, in part because the power of medicine to relieve pain remains woefully inadequate. As Daniel Clauw, who runs the Chronic Pain and Fatigue Research Center at the University of Michigan, put it in a 2019 lecture, there isn’t “any drug in any chronic-pain state that works in better than one out of three people.” He went on to say that non-pharmacological therapy should instead be “front and center in managing chronic pain — rather than opioids, or for that matter, any of our drugs.”

Virtual reality is emerging as an unlikely tool for solving this intractable problem. The V.R. segment in health care alone, which according to some estimates is already valued at billions of dollars, is expected to grow by multiples of that in the next few years, with researchers seeing potential for it to help with everything from anxiety and depression to rehabilitation after strokes to surgeons strategising where they will cut and stitch. In November, the Food and Drug Administration gave authorization for the first V.R. product to be marketed for the treatment of chronic pain.

In the 1990s, Hunter Hoffman, a cognitive psychologist at the University of Washington, began to use V.R. to provide relief to burn patients who were having their dressings changed — an excruciating ordeal that is difficult to medicate. “Nobody was using virtual reality to reduce the pain of patients before us,” he says. In his V.R. program, called SnowWorld, patients who tumbled through the wintry scene, chucking snowballs at penguins, reported that their relief was similar to what they got from intravenous opioids. Brain scans confirmed these findings: V.R. and opioids each resulted in remarkable reductions in neural activity in pain-related areas. Unlike most drugs and surgical procedures, V.R. has far fewer side effects — mostly nausea and motion sickness. Headsets now cost a fraction of what they once did, and graphics are markedly improved, resulting in more immersive experiences and fewer potential side effects. What’s more, Hoffman says, “all the major computer companies are pumping billions of dollars into virtual reality as a kind of internet” — what Mark Zuckerberg called an “embodied internet” when he announced last fall that Facebook was becoming Meta. A few months later, Microsoft unveiled plans to acquire Activision Blizzard to “provide building blocks for the metaverse,” the company said. The downstream effects of all this technological ferment, Hoffman predicts, is that V.R. therapies, powered by private-sector investments, will swiftly develop into a standard treatment for pain.

Applied VR is considered the pioneer and the company that is most likely “furthest along in getting devices to patients,” according to Amanda DiTrolio, a health care technology analyst at CB Insights, but several other companies are also closing in. Karuna Labs, a start-up based in San Francisco, has created a hybrid model that mixes V.R. with aspects of telehealth. “We’re neuroscience people” with “whiz-bang tech,” says Lincoln Nguyen, its founder. He is reluctant to call his firm a V.R. company, because he considers coaching sessions to be central to what Karuna does.

Patients are paired with a pain coach, who makes weekly video calls to supplement the self-guided V.R. modules that patients go through daily for three months. Jon Weinberg, Karuna’s chief operating officer, emphasizes that the human engagement is essential.