Virtual Reality in chronic pain management

Virtual Reality is becoming popular in chronic pain management.

For decades, VR has been used to help people overcome phobias and anxiety disorders. One common use of VR in the mid-90s was to distract patients with severe burnt injury from the excruciating pain of changing their wound dressings. Hunter Hoffman, a cognitive psychologist, developed a virtual environment and named it SnowWorld, intending to relieve the pain from severe burns.

The use of Virtual Reality in entertainment and teaching has led to its increased popularity. Recently, VR is trending in the gaming world; however, it has also become popular among researchers who are exploring how the technology can help people living with chronic pain.

Definition of terms

In 1968, Margo McCaffery, a leader and pioneer in pain management, defined pain as whatever the experiencing person says it is, existing whenever and wherever the person says it does. This only means that, in the assessment and management of pain, its subjective nature should be considered. The WHO went some steps ahead and defined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. When pain persists for three months or more, it is said to be chronic.

On the other hand, virtual reality (VR) is a state-of-the-art technologically advanced system that transports users into a virtual world where they are engaged in a fully immersive VR experience through a combination of technologies.

The need for VR

A while ago, John Tim, as we can call him, presented at the University College Hospital, Ibadan, South-Western Nigeria. He was sixty-one, an architect who enjoyed his work until his early 50s when he fell off a plank and fractured his shoulder. He had surgeries done, and after months, he was ready to work again. However, One day, he was hit by a spasm of pain in his back with progressive severity, and soon, became unbearable.

At first, the orthopaedist had taken several X-rays, and they all revealed nothing out of ordinary. Tim was then sent to a pain specialist, who injected a syringe full of steroids and local anaesthetic into his spine. The first few doses of these epidural injections worked for days, then subsequent ones provided steadily diminishing relief, until they didn’t work at all. He then had several other medical tests done, including computed tomography of his spine; all test results came out normal.

It is exceedingly common to find a patient with chronic pain but no physical finding to account for it. Most times, Physicians tend to be dismissive and conclude that pain like Tim’s is all in the head: not physical pain, but a different, somehow less real “mental” pain. However, whether physical or psychological, pain is what the patient says it is. And, in the absence of an absolutely effective medical treatment to combat chronic pain, the need for complementary therapy becomes apparent. Is this where VR comes in?

How can VR help relieve chronic pain

Despite all the excitement around VR and its potential for managing pain and reducing the need for opioids, the exact principle behind how VR eases the pain is yet unknown. There is speculation that VR creates a non-medicated form of analgesia by altering the activity of the body’s pain modulation system. Another theory is that VR serves as a “pain distraction” by reducing the perception of pain through absorption and diversion of attention away from the pain.

VR isn’t intended to excite you but to calm you by launching you into a serene virtual environment– a grassy field with a brilliant blue sky and a rolling stream nearby, maybe. VR devices for chronic pain reduction have other features, such as a narrator’s voice guiding the wearer to do breathing exercises, take in the virtual surroundings, learn about pain responses, or redirect negative thoughts about pain.

Pain is complex and may not always have a specific etiology; stress, anxiety, depression, fear, and all forms of emotional instability contribute to pain. Comprehensively, the VR eases chronic pain by employing different strategies which include cognitive behavioural therapy (CBT), mindfulness, meditation, or guided imagery. VR puts all these therapies together and immerses individuals into an environment where it’s easier to focus.

The future of VR for chronic pain management

The use of VR for chronic pain management has garnered significant interest in medicine. In November 2021, the FDA authorized the marketing of the first VR technology for chronic pain reduction. EaseVRx, the approved VR, uses the principle of CBT for pain reduction and interferences in adult patients with diagnosed chronic lower back pain.

Many other companies aim to go further and discover the next generation of VR systems that go beyond being a distraction therapy and instead focus the brain away from pain. They aim to bring a new approach that focuses on changing how the brain perceives pain and creating a lasting reduction in pain.

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