How Virtual Reality Altered the Landscape of Pain Management Therapies

November 09, 2023 - Virtual reality (VR) adoption in healthcare is growing quickly.

Together with augmented reality tools, the market is expected to be worth nearly $10 million by 2027, around 3.5 times its value in 2022. But the ideal use cases for VR in the healthcare industry are still emerging.

Virtual reality tools simulate an immersive environment using a combination of hardware and software. VR therapies may involve video games, glasses or headsets, and even treadmills or stationary bikes, depending on the level of immersion.

As a result of their immersive capabilities, these tools promise many possibilities for improving care delivery and patient experience. On this episode of Healthcare Strategies, we explore potential uses for VR in pain management along with the challenges that VR adoption and implementation face.

Anuja Vaidya:

Hello and welcome to Healthcare Strategies. I'm Anuja Vaidya, senior editor and special events lead at mHealthIntelligence.

The use of virtual reality technologies in healthcare is growing at a very fast rate, with researchers examining its potential across numerous use cases. While VR can offer exciting benefits to enhance patient care, there are hurdles towards implementation and use.

Today, Dr. Henry Xiang, director of the Center for Pediatric Trauma Research at Nationwide Children's Hospital and Professor of Medicine at the Ohio State University College of Medicine, will discuss how VR is currently being used in healthcare, the research into the technology, as well as the advantages it provides and the challenges to adoption.

Henry, thank you for speaking with Healthcare Strategies today.

Henry Xiang:

Thank you so much for having me on.

Anuja Vaidya:

Fantastic. Let's start by level setting a little bit. First, I want to just discuss healthcare VR as a whole and what the landscape looks like today. Henry, could you provide an introduction to how VR came to be used in healthcare settings and how it has evolved?

Henry Xiang:

I don't know the exact date when people start using VR, but I read articles about VR application in medical field by Dr. Hunter Hoffman, starting in 1990s. For example, he started this new world for pain management in 1997 and, since then, many researchers have started the research in the area of any virtual reality for all kinds of applications in [the] medical field. Now as the new technologies, I can say this is still involving and we are very excited about the new possibilities.

Anuja Vaidya:

Absolutely, absolutely. And as we've seen there can be numerous use cases for this technology that can really help boost patient care, patient experience, and provider workflows as well. Henry, your organization is implementing and assessing VR healthcare technologies in various ways and I'd love to hear more about your efforts in this area. I first was introduced to your work in VR through a very interesting study that you led recently, examining the use of VR in alleviating pain resulting from dressing changes for burn injuries. Could you describe the study and what you found?

Henry Xiang:

Yeah, we have several studies in this area. Our VR is called VR Pain and Alleviation Therapeutics. We have finished a study among outpatient pediatric burn patients and also a panel study for at home self pain management among children. We also recently published a study about our panel study among adult burn populations. All of those studies provide very exciting and promising results, which suggest that virtual reality can significantly reduce the pain among those burn patients. We are allowing a process to do a large-scale studies among pediatric burn patients for at-home change. This is a multi-site study with another medical centers in Texas. Our hypothesis is: VR pain alleviation intervention will significantly reduce the pain during the burn dressing changes.

Anuja Vaidya:

Are you researching or studying the use of VR in any other clinical specialties outside of pain management or is right now the focus on pain? And if the focus is on pain, why did you start there?

Henry Xiang:

Yes, we have other researchers at our Nationwide Children's Hospital, also at OSU [Ohio State University], are conducting research to evaluate virtual reality for all kinds of medical conditions. Some of them may be related to education. For example, my team focuses on acute pain management using pain alleviation interventions, but there are other researchers that are looking at post-operational pain management, VR simulation for educating people about their upcoming heart surgeries, and other stuff. Also, educating professionals for other kinds of behavior training and all kinds of stuff. Like I said, this is a very exciting field and researchers in this field are trying to collaborate with each other, but different people may have different priorities.

Anuja Vaidya:

What does VR offer in terms of benefits? Why is this technology being evaluated for clinical care? What are some of the biggest advantages linked to its use?

Henry Xiang:

Yeah, based on my experience, I can say VR is very beneficial, I think, in two areas. One is improved patient experience and also help them to have the best outcome from their medical treatment. We can say from our observations when those people receive VR treatment, particularly the pediatric patients, they're so excited about VR and they are having a wonderful experience and we feel so happy when they feel happy and to help them go through all the painful procedures and then use this innovative technology to help them reduce their pain.

Anuja Vaidya:

Absolutely. Absolutely. What are some of the ways in which VR can improve patient care or patient experience, that maybe other digital health technologies aren't quite able to do? I guess, what sets VR apart from other digital health technologies that are being used to enhance patient care currently?

Henry Xiang:

Yeah, digital health technologies and the application of digital health technologies, have already or will revolutionize medical practice in the next 10 years. Digital health technology includes a wide spectrum of all technologies, but if we want to compare VR pain alleviation therapies with other currently-used pain non-pharmaceutical interventions, VR definitely provides tremendous benefits.

VR is fun, VR is engaging and also is very active to pediatric patients. If we compare these distractions currently used by child life specialists, the nurses or physicians during their practice--now, they may use iPhones, they may use iPad games, they may use music--but if we compare virtual reality with those currently-used distraction tools, VR definitely is more attractive, more fun to children and to some of the adult populations, because VR creates an immersive environment that children can be immersed in the VR environment and to have fun, [while] the nurses and child life specialists or physicians are doing other things.

I view that as a pain alleviation therapeutics, but however, also VR can be used for other purposes. For example, psychologists can use VR to expose people to the spider situation to reduce their spider phobia. Also, my team and my former post-doctors developed virtual reality for traumatic brain injury rehabilitations. That's another exciting area because currently a lot of these--TBI, we call it; traumatic brain injury rehabilitation--use paper and pencil or maybe use other traditional ways. But there's a big potential if we can convert all these bio-behavior interventions into this virtual reality actions. People were likely to follow the treatment and then have a better outcome than those traditional ways. Like I said, this is a potential because [no] clinical trial has been done in the area of use virtual reality for traumatic brain injury rehabilitations.

Anuja Vaidya:

Right. The potential is definitely vast, but there needs to be more research in the area.

I do want to go back to what you mentioned about--we are providing that non-pharmacologic pain relief approach for patients. I'm just wondering, do you think that this has the potential to help address maybe some of the challenges around the opioid crisis? A lot of that crisis arises from needing to use those medications for pain management and so do you think VR is another tool, maybe, in the toolbox as we work to address the opioid crisis?

Henry Xiang:

You have a very good point here because US very unique and the US is facing opioid crisis. Physicians, families, and patients, they all realize now our current treatment over-rely on the opioid pain medications, but scientific studies have shown that we're seeing long-term opioid use has a risk of long-term use and then eventually some of them were developed addictions from that opioid use. That's why a lot of people actually are trying to say, use the non-pharmaceutical interventions as adjunctive--I want to emphasize here, adjunctive [with emphasis] pain management interventions--which means we will offer the nurses, child life specialists, and physicians a toolbox. They can use the intervention with the hope actually to reduce the opioid use, but not necessarily totally reduce the opioid use for the acute pain management.

There's another exciting area. Virtual reality was found actually also effective for [managing] chronic pain such as lower back pains and also some research [hypothesize] virtual reality will also be very effective for helping children manage chronic pains. As you can see, there are so many children actually that are suffering chronic pains from many underlying chronic conditions. We hope to help them to reduce their pain and then eventually probably reduce the opioid pain medication use.

Anuja Vaidya:

Absolutely, absolutely. That's definitely an exciting new frontier in a longstanding battle with the opioid crisis.

I want to flip the script a little bit now. We've talked quite a bit about the many ways in which VR could really help enhance patient care, enhance patient experience, really kind of transform pain management and help support numerous use cases. But I want to talk a little bit about the challenges now. I thought we could discuss both the patient and provider challenges to adoption.

Let's start from the patient side. Have you seen any barriers to adoption on the patient side when it comes to VR? Anything you could imagine being a barrier, the way healthcare is set up today?

Henry Xiang:

Yeah, medical care field is a very special field and is heavily regulated. You can see the current barriers I can see include the following.

The first one is, although VR field has been developing and evolving in the last 20 to 30 years, but however, there [is] still a lack of large-scale clinical trials to generate evidence that those physicians and nurses say, "okay, this is a rigorous signs" and show this and then we can actually apply or use the virtual reality in our clinical practice.

Second factor is, generally speaking, there is very slow adoption of new technologies, innovative technology, into clinical practice. There are research actually showing that it took 17 years, on average, 17 years for all of those established innovative technology to be adapted by the clinical practice. That's a long term.

The third one is, there's a network of larger-scale implementation and dissemination studies. We have developed this virtual reality at one medical centers, but would this work at other children's hospital or would this work at community hospital or would this work at adult hospital where treat patient? There are a lot of unanswered questions. Those questions need to be addressed using implementation and dissemination studies.

Last factor is--I think you were talking about this--currently reimbursement by the insurance companies is a barrier. We are excited to say there's one billing code established for reimbursing virtual reality for chronic pain management, but we would like to see more billing codes created for managing all kinds of VR applications. VR application is not very expensive, given the new portable VR and other stuff. I think comparing to other medical treatment, VR application, if it's effective, really improve the patient outcome and reduce the lengths of stay, reduce the medical use. I think insurance companies should reimburse the hospitals and the physicians who will use it.

Anuja Vaidya:

In light of these challenges, I'm curious, at Nationwide Children's, are you using any of these technologies in patient care or are they more in the research phase right now?

Henry Xiang:

I'm very excited about this. I can give you some background information. I used to be an injury epidemiologist. Injury epidemiologists are trying to identify injury patterns and violence injury patterns and give people evidence about how do we develop interventions to prevent those injuries from happening. I made a paradigm shift about 10 to 15 years ago, say I would like to work together with nurses and physicians to develop effective clinical interventions. After we publish our studies, I'm so excited. Actually so many clinical divisions reach out to us to say, "I saw your publications, I saw your presentations. Can you help us implement this study at our clinic?" Not only at our hospitals, but also at other hospitals. I have an example. One nurse, PhD candidate from Texas, reached out to me and to say, "Hey Dr. Xiang, can I use your smartphone VR to do my dissertations?" and then I got a permission from our hospital and then we said, "Yes, here is a code for you to scan." She did that and she finished her PhD dissertation and then her clinic is now implementing plans to actually integrate that into their practice.

At our hospital and at other hospitals, you can say, I'm so grateful they saw the benefit, they reached out to us. This is the other ways. When I was an injury epidemiologist, I needed to go out and pursue other people to adapt. A lot of them are not very interested to say, "oh, you have a very nice injury epidemiology studies, but this is not very relevant for us to implement here, to see the immediate results." Now you can see people are very excited.

Anuja Vaidya:

Fantastic. It sounds like while there is a lot that needs to be done to prove out these technologies to ensure that they do work on a large scale, it is slowly being integrated into patient care settings and healthcare settings, which is very exciting. Fantastic.

Henry, with that, we'll close out our conversation today. This has been a truly fascinating conversation. I'm excited to continue following the trajectory of healthcare VR technologies going forward. I'd like to thank you so much for coming on the podcast today and sharing your thoughts on this very innovative and interesting technology. Really appreciate your time.

Henry Xiang:

Thank you so much.

Anuja Vaidya:

For our listeners, feel free to reach out to share your thoughts on this topic. My email address is avaidya@techtarget.com. That's A-V-A-I-D-Y-A, @techtarget.com. You can also use that email address to share any healthcare-related questions or stories that you would like us to consider covering. Also, if you enjoyed today's conversation, please do let us know. You can rate us and write a review on whichever platform you use to listen to the podcast. Thank you so much for listening.