According to the New York State Department of Health, reported opioid overdose deaths have reached a record high in the Empire State.1 With opioid abuse reaching epidemic proportions both in New York and across the nation, providers have become increasingly attuned to the risks involved in prescribing opioids for pain management.
Physicians and researchers alike have been working urgently to identify safe and sustainable alternatives to opioids for pain management; many of them have set their sights on virtual reality (VR) as a solution. This has resulted in a wide range of applications of VR for pain management, and New York has been on the cutting edge of this innovative research:
As physicians adjust their prescribing habits in accordance with the increase in opioid-related deaths, many patients are left with concerns that they will lose their primary source of pain relief and be left without another option that works for them. With these early signs of success in using VR to treat pain, could other patients with severe acute and/or chronic pain experience the same results?
In 2015, prescribers in New York State wrote over 10 million opioid prescriptions.4 And sometimes opioids, though intended to help patients, cause harm: In 2016, the opioid epidemic in New York claimed the lives of roughly 15 people per 100,000.5
While the financial costs of the opioid epidemic can be tallied—reports have estimated that the opioid epidemic’s toll in New York state is as much as $1.2 billion each year 6—the personal costs to those who have lost loved ones are uncountable. The epidemic’s impact is far-reaching and has emotional, physical, and financial implications for our entire society.
Many physicians are exploring VR technologies as an alternative to prescriptions.7 The Gate Control Theory of pain, proposed by Melzack and Wall, 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.8 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 pain following surgery.9
Recent studies have explored whether VR can relieve chronic pain. One small, but promising, study of patients with neuropathic pain found that patients experienced a 69 percent reduction in pain during each session and a 53 percent pain reduction immediately after each session.10
To explore VR as an alternative therapy, first consider the distinctions between two key terms:
Then, evaluate VR interfaces that are relevant for patients managing pain, such as:
And weigh the value of interfaces that are more relevant for physician use, such as:
While therapeutic VR for pain management shows promise, it presents patient safety risks. They include:
Some physicians imagine a future of tetherless 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.
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit our Risk Management and Patient Safety page.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.