The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of Clinical Pain Advisor‘s conference coverage.

LAS VEGAS — Virtual reality (VR) is on the verge of revolutionizing pain management, including on the chronic pain front, and may offer a new way to combat the opioid crisis, according to a presentation by Ted Jones, PhD, a pain psychologist at the Behavioral Medicine Institute in Knoxville, Tennessee, at PAINWeek 2017, held September 5-9 in Las Vegas, Nevada.¹

According to the Centers for Disease Control and Prevention (CDC), 91 Americans die every day from an opioid overdose, and prescription opioids are a known driving factor in these deaths.² In 2012, 259 million prescriptions were written for opioids, enough for every adult in the United States to have their own bottle of pills.³ While opioids remain the standard of care for treating acute severe pain and chronic pain from an advanced illness, abuse and addiction pose major challenges.

“We need alternatives for opioid pain treatment. Psychological therapies like cognitive behavioral therapy and mindfulness are effective, but most of our patients won’t practice these like they need to, so they are of limited utility for us. VR is easy to do. Put a visor on and you’re there,” Dr Jones told Clinical Pain Advisor. “Past studies have shown that VR is very good at pain relief, so we need to adapt what has been done to date and develop new ways of treating pain in our opioid[-taking] pain population. We could be on the verge of a new era of pain treatment in which medications are rarely used, and VR is a primary treatment modality.”

VR has been leveraged for pain management since 1996, when it was first used to alleviate severe acute burn pain in patients treated at the Harborview Burn Center in Seattle, Washington.⁴ Since then, VR has been shown to provide significant analgesia in many other acute pain settings, including during wound debridement and dental procedures and following surgery.¹ More recently, studies have indicated VR to be efficacious for the treatment of chronic pain, including 2 studies led by Dr Jones.^5,6

The first study included 30 patients with chronic pain treated with a 5-minute Cool! VR session. During these sessions, patients wore the Oculus Rift headset and virtually travelled a preset route in a computer-generated fantasy world, where they encountered small otters, which they could cast fish or fire-orbs at.⁵ Assessments showed a 66% reduction in pain during the session and a 33% reduction in pain at the end of the session.

The second study, which included 10 patients with neuropathic pain, showed similar results.⁶ Participants received three 20-minute VR sessions 1 week apart. Assessments revealed a 69% reduction in pain during each session and a 53% pain reduction immediately after each session. “As a comparison, morphine is generally thought to reduce pain 25% to 30%,” said Dr Jones.   

Cool! and other distraction-related VR therapies are based on the gate control theory of pain, which postulates that pain perception can be reduced by refocusing the brain’s attention away from the pain. While distraction-based approaches have shown good efficacy, companies on the forefront of VR pain treatment development are working to push this technology toward even more immersive and personalized experiences. One such company, CognifiSense, a Silicon Valley-based startup, is working on a modulated VR distraction therapy that uses data analytics to optimize analgesic effects, as well as a completely new type of VR therapy, which they have dubbed “VR Neuro-Therapy.”

VR Neuro-Therapy is a patent-pending technology that combines the immersive power of VR with implicit learning and other techniques to change how the brain perceives pain,” CognifiSense co-founder and CEO Tassilo Baeuerle told Clinical Pain Advisor. Because the goal of this therapy is to address the underlying neuropsychological issues that contribute to pain perception, such as catastrophization, it might be a particularly powerful tool for combatting chronic pain. Current VR distraction techniques have not been shown to change such psychological variables.¹

Mr Baeuerle envisions that VR Neuro-Therapy may eventually become a powerful alternative or adjunct to pain drugs, thereby reducing or potentially eliminating opioid prescribing in many patient populations. “We hope one day it can be used to avoid prescribing opioids, particularly strong opioids, to patients at high risk of addiction. It could then also be used to help wean addicted patients off opioids or enable a chronic pain patient already on opioids to avoid taking a higher opioid dose,” he explained. 

While VR Neuro-Therapy is still a few years away from being commercially available, it and other VR technologies are providing a ray of hope in the ongoing battle against the opioid epidemic.

Read more of Clinical Pain Advisor‘s coverage of PAINWeek 2017 by visiting the conference page.

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References

1. Jones T. Within You, Without You: Virtual Reality for Pain Management. Presented at: PainWeek 2017. Las Vegas, Nevada; September 5-9, 2017.
2. Centers for Disease Control and Prevention (CDC). Opioid overdose: understanding the epidemic. www.cdc.gov/drugoverdose/epidemic/index.html. Updated December 16, 2016. Accessed August 23, 2017.
3. American Society of Addiction Medicine (ASAM). Opioid Addiction 2016 Facts & Figures. www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf. Accessed August 22, 2017.
4. HITLab. Virtual reality pain reduction. University of Washington Seattle and U.W. Harborview Burn Center. www.hitl.washington.edu/projects/vrpain. Accessed August 22, 2017.
5. Jones T, Moore TM, Choo J. The impact of virtual reality on chronic pain. PLOS ONE. 2016;11(12):e0167523.
6. Jones T, Skadberg R, Moore TM. A small preliminary study of the impact of repeated sessions of virtual reality on chronic neuropathic pain. Under review.

This article originally appeared on Clinical Pain Advisor