Virtual Reality for Pain Management in New York: An Alternative to Opioids

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

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:

  • An ob/gyn at Orange Regional Medical Center in Middletown, New York, has already helped more than 50 women ease pain during childbirth with VR.2
  • Weill Cornell Medicine in Manhattan has been recruiting patients for a study on using VR to treat social anxiety among teens, after having used it for years to ease PTSD and anxiety following the 9/11 terrorist attacks.
  • In August 2018, the Children’s Hospital at Montefiore in Bronx, New York, launched a study and found some success using VR to see if it could lessen pain and discomfort associated with chemotherapy and other painful treatments in pediatric patients.3

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?

The State of the Opioid Crisis

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.

Exploring VR for Pain Management

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

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.11

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 (EHR).
  • 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, it presents patient safety risks. 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.12 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, especially 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.13
  • 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 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.


References


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.

12/18

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