Study: Virtual Reality Can Relieve Severe Chronic Pain

By Pat Anson, PNN Editor

Therapeutic virtual reality (VR) may finally be on the verge of going mainstream. For the first time, research has shown that VR can help relieve a variety of pain conditions and is most effective for severe chronic pain.

 "I believe that one day soon VR will be part of every doctor's tool kit for pain management," says Brennan Spiegel, MD, director of Health Service Research at Cedars-Sinai Medical Center in Los Angeles.

Spiegel is lead author of a new study published in PLOS ONE, which looked at the effectiveness of VR in 120 hospitalized adult patients suffering from neurological, orthopedic, gastrointestinal or cancer pain. All of the patients were being treated with opioid medication and had a pain score of at least three on a 1 to 10 pain scale.

“There’s been decades of research testing VR in highly controlled environments — university laboratories, the psychology department and so on,” Brennan told MobiHealthNews. “This study is really letting VR free and seeing what happens. What I mean by that is it’s a pragmatic study where we didn’t want to control every single element of the study, but literally just see [what would happen] if we were to give it to a broad range of people in the hospital with pain; how would it do compared to a control condition already available in the hospital?”

Half of the patients were given VR goggles with a variety of relaxing and meditative experiences to choose from. They were advised to use the headsets three times a day for 10 minutes — and as needed for breakthrough pain – for three days.

The other participants were instructed to tune their hospital room TVs to a health and wellness channel that offered programs on guided-relaxation, yoga and meditation.

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Several times a day, nurses asked all the patients to rate their pain on the pain scale.

The study found that on-demand use of VR resulted in a small but statistically significant improvement in pain scores compared to the TV group, with patients in the VR group averaging 1.7 points lower on the pain scale. VR patients with the most severe baseline pain of 7 or more reduced their pain scores three points lower than the TV group.

"This is our largest and most ambitious VR study to date," Spiegel said. "Our results support previous research that VR can meaningfully reduce pain using a nonaddictive, drug-free treatment for people experience a range of different pain conditions."

In the previous study, patients who watched a 15-minute nature video had a 13% drop in their pain scores, while patients who played an animated game had a 24% decline.

Spiegel says the current study showed that VR can do more than just distract the mind from pain, but may even block pain signals from reaching the brain by overwhelming the brain with visual and audio stimulation.  

Several patients found VR so helpful in managing their pain that they now use it regularly at home. One of them is 70-year old Joseph Norris, a retired Air Force lieutenant colonel, who suffers from chronic pain in his spine, back and hips. Norris started using VR six months ago, and today uses his VR headset once a week to help relax and distract. 

"VR is a tool I use to successfully divert attention away from my pain, and it helps me reinforce my breathing pattern," he said.

There remains a great deal of skepticism about VR, particularly among older patients. Spiegel and his colleagues evaluated nearly 600 patients for the study, but many chose not to participate.

“Patients expressed varying degrees of skepticism, fear, sense of vulnerability, concern regarding psychological consequences, or simply not wanting to be bothered by using the equipment. We believe it is important for the digital health community to recognize that despite the great promise of health technology, clinical realities can undermine expectations,” he wrote.    

Spiegel and his research team are currently involved in a study following patients using VR in their homes for 60 days.

48 Alternative Therapies to Help Lower Pain Levels

By Barby Ingle, Columnist

A year ago, I began this series of columns on alternative therapies for chronic pain management. There are so many different treatments, we presented many of them by letter – the 4 A’s, the 4 C’s, the 4 E’s, etc. This is my final column in the 12-part series.

In all, we covered 48 different treatment options. But we only scratched the surface. There are literally hundreds of alternative pain therapies and I've tried many of them myself. Many didn’t help me or provided only minimal relief. But I know of others who received great benefits from them.

This final month I am spotlighting trigger point injections, virtual reality, yoga and the yucca plant.

Trigger Point Injections

Trigger point injections can be beneficial in treating myofascial pain syndromes. That is when a patient has chronic musculoskeletal pain in specific parts of a muscle where a knot has formed due to inflammation. This is known as the “trigger point.” Steroids or analgesics (or both) are injected into the trigger point area to get the knot to release and the muscle to relax.

I have had trigger point injections done on my wrist and shoulder at various times. Although it was helpful long-term for my wrist injury, which occurred prior to my developing reflex sympathetic dystrophy, it was not as helpful with managing the RSD symptoms in my shoulder.

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I could usually feel the muscle knots under my skin, but that was not always the case. I would also get a twitching response, which my doctor first thought was a sign of low calcium.  But after ruling that out, he realized that it was tight muscle fibers and inflammation.

There are risks with any type of injection. The injection or solution can cause damage to the skin and small nerve fibers, or cause infections and bleeding. If you think that trigger point injections could help, talk with your doctor first to find out if this would be a good option for you.

Virtual Reality

Virtual reality (VR) has been used in different forms of pain management since 1996. It operates under the theory that pain perception can be reduced by refocusing the patient’s attention away from their pain. Typically, that means wearing a headset or goggles that provide a 360-degree view while watching a realistic video or animated game.

AppliedVR in Los Angeles is developing a variety of virtual reality content to help treat pain, depression and anxiety. To give you an idea how it works, watch this promotional video by the company:

VR was first used to alleviate severe pain in patients treated at a burn center in Seattle, Washington. Since then, it has shown to be effective in treating acute pain in hospitals or when patients undergo lengthy testing procedures and need a distraction. I am hearing more and more from providers that VR can help lower the need for medication. 

VR is a fun activity that my husband and I have both tried. We quickly realized that it had therapeutic benefits and helped me to relax and keep my mind focused during long MRI’s and infusions. Like most therapies, the benefits of VR are usually short term. But VR is a promising field that is likely to improve as technology and personalized experiences are brought together in practice. 

Yoga 

Yoga is a mind-body exercise that uses controlled breathing, meditation and movements to stretch and strengthen your body. There are several types of yoga and people have been using yoga moves and thinking for thousands of years. The emphasis for all of them is on treating the mind and body equally.

Yoga can be used for pain relief for many types of chronic conditions, but patients must be cognizant of not pushing themselves into a flare by doing too much at one time. 

One study found that patients with chronic low back pain who took a weekly yoga class increased their mobility more than standard care like physical therapy. Other studies have shown that yoga is comparable to exercise therapy in relieving symptoms from arthritis, fibromyalgia and migraine. 

I have been using yoga in modified positions to strengthen myself. I don’t push myself too hard, because when I did I found myself in a pain flare. But when I go slow and easy, I find that it helps me build strength. For example, I will do the moves in a chair instead of on the floor and skip certain positions that may aggravate my pain. 

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Practicing yoga has also helped with my mood, positive thinking and overall well-being. A typical yoga session lasts 45-90 minutes; mine are shorter, about 15-20 minutes at a time. Many people will go to a yoga class, but I do it at home using routines that I modified. Each session usually begins with deep breathing exercises that help me relax and lower stress levels. Then I use a series of yoga positions that are either seated, standing or laying down. Some positions are done quickly and others are held for a few minutes. If it starts to get too much for me, I stop or take a break.

At the end of the yoga session, I go back to breathing and mediation exercises to cool down. Be sure to modify your yoga to fit your needs. Doing some movement and breathing is better than nothing, even if it’s only a few minutes each day.  

Yucca

The Yucca is a plant with more than 40 species that typically grows in desert regions. It is used to make medicines for many conditions, including migraines, headaches, gastrointestinal disorders, osteoarthritis, high blood pressure, diabetes, vascular constriction, and more. 

Yucca medications are applied directly to the skin, made into extracts, or used in carbonated beverages. Some Yucca compounds have even been used in the manufacture of new medications. 

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I first heard about the use of Yucca derivatives to treat pain while on a tour of the Desert Botanical Gardens in Phoenix, Arizona. That was where I found out that the Yucca can be used to treat sores, bleeding, sprains and joint pain. My husband is almost bald, and they suggested some people even use it for baldness. 

Researchers have found several Yucca compounds that are similar to anti-inflammatory medications.  Some of the chemicals in Yucca can also help reduce blood pressure or control cholesterol levels. For me, it helps reduce osteoarthritis symptoms by lowering the aching pain, swelling and stiffness I deal with. 

The Yucca plant is native to the southwest United States, where I currently live, as well as Mexico. Around here it is common for people to use the bark and root of the Yucca as a dietary supplement to promote joint health. There are even Yucca products on the market for treating pain in horses, dogs and other animals.

Be Open Minded

My alphabet series on alternative pain management is meant to spark ideas and discussion about treatments that you may not have known about before.  Before you try any of them, I encourage and remind you to talk it over first with medical professionals who are familiar with your past and present care. It is important to also remain open minded about your options and only do what you are comfortable with. 

There is no cure yet for chronic pain. So the more proactive we are in managing the symptoms -- even if we don’t get complete relief -- the better off we’ll be. Being positive, hopeful and creative in finding new ways to manage our conditions can help get our pain levels down.  

Want to see the rest my series on alternative treatments?  Here’s where to find them:

  • The 4 A’s: acupressure, acupuncture, aromatherapy and art therapy.  
  • The 4 C’s: Calmare, Chinese medicine, chiropractic, and craniosacral therapy. 
  • The 4 E’s: energy therapy, electromagnetic therapy, equine therapy, and exercise. 
  • The 4 F’s: faith healing, Feldenkrais Method, food, and functional medicine. 
  • The 4 H’s: hypnotherapy, hyperbaric therapy, holistic living and herbal therapy.
  • 4 Infusions: Ketamine, lidocaine, immunogoblins and stem cells.
  • The 4 M’s: Mindfulness, magnets, massage and music.
  • The 4 N’s: Nerve blocks, nitric oxide, neurotransmitter regulation and nabilone.
  • The 4 O’s: oral orthotics, orthomolecular medicine, osteopathy and occupational therapy.
  • The 4 P’s: Physical therapy, pain medications, prolotherapy and psychology. 
  • 2 R's, a Q and an S: Quell, radiofrequency ablation, reflexology, sonopuncture

As I have stressed in all 12 articles, each of us is different, even if we are living with the same diseases. Your task is to find creative, effective ways to get the pain conditions you live with under control. I look forward to reading what worked and didn’t work for you.

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Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain FoundationShe is also a motivational speaker and best-selling author on pain topics.

More information about Barby can be found at her website. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Virtual Reality Relieves Pain in Hospitalized Patients

By Pat Anson, Editor

Virtual reality therapy significantly reduced both acute and chronic pain in hospitalized patients, according to a new study that adds to a growing body of evidence that virtual reality (VR) can give temporary relief to pain patients. The study is published online in the journal JMIR Mental Health.

Researchers at Cedars-Sinai Medical Center in Los Angeles enrolled 100 patients in the study who had an average pain score of 5.4 on a pain scale of zero to 10.

They suffered from a wide variety of conditions, including gastrointestinal, cardiac, neurological and post-surgical pain.

Fifty patients watched a 15-minute nature video on a computer screen that included mountain scenes and running streams, accompanied by calming music.

The other 50 patients wore virtual reality goggles to watch a 15-minute animated game called Pain RelieVR, which was specifically designed to treat patients who are bed bound or have limited mobility.

The game takes place in a fantasy world where users shoot imaginary balls at a wide range of moving objects by maneuvering their heads toward the targets. The game also uses motivational music, positively reinforcing sounds and direct messages to patients.

The patients who watched the nature video had a 13 percent drop in their pain scores, while patients who watched the virtual reality game had a 24 percent decline in their pain levels. The VR group had no change in their blood pressure or heart rate.

“We found that use of a 15-minute VR intervention in a diverse group of hospitalized patients resulted in statistically significant and clinically relevant improvements in pain versus a control distraction video without triggering adverse events or altering vital signs,” wrote lead author Brennan Spiegel, MD, director of Cedars-Sinai’s Health Service Research.

“These results indicate that VR may be an effective adjunctive therapy to complement traditional pain management protocols in hospitalized patients.”

scenes from virtual reality game

scenes from virtual reality game

Researchers say it’s unknown exactly how VR works to reduce pain levels, but one explanation is simple distraction.

“When the mind is deeply engaged in an immersive experience, it becomes difficult, if not impossible, to perceive stimuli outside of the field of attention. By ‘hijacking’ the auditory, visual, and proprioception senses, VR is thought to create an immersive distraction that restricts the mind from processing pain,” said Spiegel.

Because the VR therapy was only 15 minutes long, Spiegel says lengthening the period of pain reduction might require sustained and repeated exposure to a variety of virtual reality content.

Another small study of VR therapy, published in PLOS, found that just five minutes of exposure to a virtual reality application reduced chronic pain by an average of 33 percent.

VR therapy is not for everyone. It may induce dizziness, vomiting, nausea or epileptic seizures, so patients have to be screened and monitored for side effects. Another barrier is age related. Two-thirds of the people who were eligible for the Cedars-Sinai study were unwilling to try VR therapy, particularly older individuals.  

A larger study is underway at the hospital to measure the impact of VR therapy on the use of pain medications, length of hospital stay and post-discharge satisfaction scores.

The Pain RelieVR game was created by AppliedVR , a Los Angeles based company that is developing a variety of virtual reality content to help treat pain, depression and anxiety. Below is a promotional video released by the company.