Using virtual reality to improve pain management, reduce opioid usage
WHEN SICKLE CELL DISEASE patients experiencing a pain crisis show up at the emergency department hoping for relief, they’re often treated with a heavy dose of opioids and other medications.
If the pain—a hallmark of the disease described as a severe throbbing, aching, beating-you-with-a-hammer kind of feeling—doesn’t dissipate after a few hours, patients are typically admitted to the hospital for more opioids delivered through a patient-controlled pump.
But St. Jude Children’s Research Hospital is trying something new. To enhance the effect of medication, cut the amount of opioids used in treatment and lower the chances a patient is admitted, the Memphis, Tenn., hospital is experimenting with virtual reality to see if it can reduce pain.
As part of an ongoing clinical trial, half of the sickle cell patients who visit the ED during an acute pain crisis receive the standard care; the other half receive standard care plus 15 minutes in a virtual reality headset that allows patients to travel through an underwater world firing bubbles at turtles, whales and dolphins that swim by.
“The virtual reality engages pathways in the brain that would otherwise be occupied to translate pain,” said Dr. Doralina Anghelescu, director of St. Jude’s pain management service and a researcher in the trial. “So it is distraction through immersion in this virtual reality.”
About 35 patients have enrolled in the trial, which is likely to be completed in a year. While there are no results to report yet, St. Jude’s trial is following in the footsteps of other hospitals that have successfully used virtual reality to manage patients’ pain and address other conditions.
UCSF Benioff Children’s Hospital in Oakland, Calif., tested the same virtual reality game—KindVR’s Aqua—to reduce acute pain among sickle cell inpatients. Benioff Children’s researchers found that patients who used virtual reality reported pain intensity and number of body parts affected decreased.
Beyond sickle cell disease, virtual reality has also been used to distract burn patients during painful dressing changes, reduce anxiety among children getting blood drawn, and even train emergency physicians to stay focused in high-pressure situations. Los Angeles-based Cedars-Sinai is completing a randomized controlled trial testing the use of virtual reality to reduce pain with contractions during childbirth.
“The goal is for this to be the new first line of defense for pain management, so it’s the first thing we try, not the last thing we try,” said Matthew Stoudt, CEO of virtual reality software company AppliedVR, which has partnered with health systems like Cedars-Sinai. “Anything we can do to cut down on opioid consumption upfront can have a big impact.”
AppliedVR’s technology is being used by 30,000 patients at more than 200 providers in eight countries. Self-reported pain scores are being reduced by as much as 50%, Stoudt said. The company is now starting to develop virtual reality interventions for chronic pain, anxiety, depression and other behavioral health conditions that can come with pain.
“What we are really trying to build here ultimately is what we call a VR pharmacy,” Stoudt said. “The thing is if you can get the headset in a patient’s hands, now you’ve basically got a clinic sitting in their home that you can use to start to deliver a wide variety of interventions.”
That could be years away, though. For now, physicians and researchers are still testing the technology and collecting data. Software companies are attempting to demonstrate the economic value of their tools. Because insurers are not yet reimbursing for virtual reality interventions, hospitals are paying for the tools on their own. KindVR’s kit costs around $4,000 for an annual subscription; it comes with the headset, software, cleaning supplies, training and support, founder Simon Robertson said.
The cost isn’t deterring St. Jude. If the trial is successful, Anghelescu said the hospital would incorporate it as standard care for sickle cell patients who come in with acute pain.