Virtual Reality for Pain Management: An Alternative to Opioids

Miranda Felde, MHA, CPHRM, Vice President, Patient Safety and Risk Management, The Doctors Company

Science teacher Bob Jester fell off a roof, broke 19 bones, and underwent surgery for his badly broken back. Doctors prescribed oxycodone, an opioid, during Jester’s extended recovery. Worrying that he would become dependent on opioids, he jumped at the chance to try virtual reality (VR) as an alternative to opioids when an acquaintance told him about a company that was using VR for pain management. When he started using a mobile headset connected to a smart phone that plays VR apps, Jester found his pain lessened and the effect lasted for several hours each time. About a year after his accident, Jester was able to wean himself off opioids.¹

Could other patients with severe acute and/or chronic pain experience the same results?

The State of the Opioid Crisis

According to the Centers for Disease Control and Prevention (CDC), the number of opioid prescriptions written annually in the U.S. per 100 persons decreased more than 30 percent from 2012 through 2019. In 2019, however, some U.S. counties were still experiencing prescribing rates six times higher than the national average. Opioids, though intended to help patients, sometimes cause harm: The CDC reported that in 2019,136 people died every day from opioid overdose (including prescription and illicit opioids).

While the financial costs of the opioid epidemic can be tallied—in 2019, the opioid epidemic’s toll hit $78.5 billion, with healthcare costs concentrated in emergency room visits, hospital admissions, ambulance use, and addiction treatment²—the personal costs to those who have lost loved ones are uncountable. The opioid epidemic’s impact is far-reaching and has emotional, physical, and financial implications for our entire society.

Exploring VR for Pain Management

Many physicians and hospitals are exploring VR technologies as an alternative to prescriptions.³The Gate Theory of Pain, proposed by Melzack and Wall in 1965, suggests that a person may interpret pain stimuli differently depending upon mental/emotional factors such as attention paid to the pain, emotions associated with the pain, and past experience of the pain. VR addresses both attention paid to pain and the patient’s emotional state: The immersive distraction of VR can help a patient mentally transport to another space, such as an underwater seascape, which may also positively affect the patient’s emotional state.

In 1996, the Harborview Burn Center in Seattle, Washington, successfully piloted the use of VR for burn patients with severe acute pain. Since then, more providers have found VR can provide relief for patients experiencing acute pain, such as the type of pain Jester experienced following surgery.

Recent studies have explored whether VR can relieve chronic pain, and have shown high levels of patient satisfaction with significant reductions in pain.^4,5

Getting Started with VR

To explore VR as an alternative therapy, first consider the distinctions between two key terms:

• Virtual reality (VR): Provides an immersive experience via a computer-generated 3D environment for the user to explore. The user may be able to move objects or otherwise change the environment.
• Augmented reality (AR): Adds sounds, videos, and/or graphics to an existing environment, such as an outdoor planetarium where AR viewing glasses show constellations highlighted in the sky.⁶

Then, evaluate VR interfaces that are relevant for patients managing pain, such as:

• Head-mounted display (HMD): Like a heavy-duty pair of goggles plus headphones. Completely surrounds the user’s visual field for an immersive experience.
• Treadmills and haptic gloves: Allow the user to physically move around in the virtual environment, and to physically move objects within that environment.

And weigh the value of interfaces that are more relevant for physician use, such as:

• Smart glasses: May look more like regular eyeglasses or more like safety glasses. May display information or help the physician capture information for the electronic health record.
• Desktop VR or Window on a World (WOW): Uses a desktop or laptop computer to run simulation programs, including those for training.

Mitigating VR Patient Safety Risks

While therapeutic VR for pain management shows promise, patient safety risks still exist. They include:

• Falls: Patients wearing a full-surround headset cannot see their real-world environment and may walk into or trip over objects. Even patients in bed can knock things over while waving their arms around. Create a safe physical environment for VR use.
• Motion sickness: Many people experience some combination of eye strain, headaches, and/or nausea. Patients who are ordinarily prone to any of these symptoms may not be good VR candidates.
• Psychological effects: The brain can store VR experiences as memories in almost the same way it stores physical experiences. Young children, especially, may confuse VR experiences with real experiences, particularly when remembering them later. “If you were to do this in the real world, how would it affect you? That’s the way to think about virtual reality,” says Jeremy Bailenson, director of Stanford’s Virtual Human Interaction Lab.⁷
• The unknown: VR technology is still in its infancy, and therefore, little is known about the long-term consequences of VR use.

The Future of VR for Pain Management

Some physicians imagine a future of wireless headsets that allow patients in pain the freedom to escape reality and transport to another emotional space. To reap the potential benefits of VR while mitigating its risks, clinicians could start with a two-part approach: identifying patients with specific clinical indications that would benefit from the use of VR and assessing patients for potential risk factors. Successful implementation of VR for pain management depends on wisely deciding which patients are VR candidates—and which are not.

If you have questions, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.

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