Using Healthcare VR Technology to Improve Pain Management

November 06, 2023 - Amid the ongoing digital transformation of healthcare, stakeholders are exploring the potential utility of various advanced technologies in patient care. These advanced technologies include artificial intelligence, blockchain, and virtual reality.

Virtual reality (VR) is “a simulated 3D environment that enables users to explore and interact with a virtual surrounding in a way that approximates reality, as it is perceived through the users' senses.”

Applying VR to healthcare delivery opens a wealth of possibilities to enhance clinical outcomes and patient experience. Researchers nationwide are examining various healthcare VR use cases, including supporting rehabilitation, mental healthcare, and pain management.

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Henry Xiang, MD, PhD, director of the Center for Pediatric Trauma Research at Nationwide Children's Hospital, is one such researcher. On an episode of the Healthcare Strategies podcast, Xiang discussed the research into healthcare VR’s impact on pain relief, as well as the advantages and hurdles to VR use in healthcare.

HOW VR COULD BOLSTER PAIN MANAGEMENT

One of the most prominent use cases for healthcare VR technologies is in pain management.

Xiang, who is also a professor of medicine at the Ohio State University (OSU) College of Medicine, recently worked on a study examining the use of VR in alleviating pain resulting from dressing changes for burn injuries.

The research team recruited adult patients with burn injuries between May 2019 and February 2020 and randomly assigned them to one of the following treatment arms: active VR, passive VR, or standard of care.

The active VR group played four VR games specifically designed for the study, the passive VR group toured the same virtual environments as the active VR group but without any of the interactive elements of the games, and the standard care group received common distraction tools like music.

The researchers found that average self-reported pain was lowest among those in the active VR group and highest in the passive VR group across three dressing changes. Also, the average self-reported ‘worst’ pain was lowest among active VR group members during the first and last dressing change, but control group members had the lowest self-reported ‘worst’ pain during the second dressing change.

This is just one of the studies assessing VR use in pain management at Nationwide Children’s and OSU. Others include research examining VR’s ability to alleviate pain among pediatric burn patients during at-home dressing changes and VR simulation for post-operative pain management.

For instance, Xiang’s fellow researchers and former post-doctorates developed a VR tool for traumatic brain injury (TBI) rehabilitation.

“Currently, a lot of these TBI rehabilitation [processes] use paper and pencil, or maybe use other traditional [tools], but there's a big potential if we can convert all these bio-behavior interventions into virtual reality actions. People were likely to follow the [rehab] treatment and then have a better outcome.”

Further, researchers are studying VR use in patient education, for example, providing patients with information about upcoming procedures.

“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,” Xiang said.

BENEFITS AND CHALLENGES OF VR USE

Improving patient experience is a significant benefit of VR use in healthcare.

“We can see from our observations when those people receive VR treatment, particularly the pediatric patient [population], they are so excited about VR, and they are having a wonderful experience,” Xiang said.

Child life specialists, pediatric nurses, and physicians typically use tools like iPhones or iPad games to distract patients from pain, but VR is more effective.

“VR is fun, VR is engaging,” Xiang said.

VR’s reported efficacy in managing pain could also bolster efforts to curb the opioid crisis. Opioid use disorders and overdoses have grown exponentially over the last two decades with the growing prescription of opioids for pain relief. According to the Centers for Disease Control and Prevention (CDC), more than 75 percent of the nearly 107,000 drug overdose deaths in 2021 involved an opioid.

“Virtual reality was found actually effective for managing chronic pain such as lower back pain, and also some research hypothesizes that virtual reality will also be very effective for helping children manage chronic pain,” Xiang said.

By supporting pain management, Xiang believes VR could help reduce opioid pain medication use.

However, there are several barriers to VR adoption and use in healthcare, including the lack of large-scale clinical trials.

According to Xiang, even though the healthcare VR field has been evolving since the 1990s, there have not been enough large clinical trials to generate the necessary evidence to boost the application of VR in clinical care. The lack of clinical trials has left the healthcare industry with several unanswered questions about VR, for instance, which VR tools can be effective across different organizations and patient populations.

Also, incorporating innovative technologies into clinical care generally takes time.

“There is research actually showing that it took on average 17 years for all of those established innovative technologies to be adopted by the clinical practice,” Xiang said.

Another barrier to the adoption of VR is the reimbursement landscape. In November 2021, AppliedVR’s RelieVRx (formally EaseVRx) became the first virtual reality-based digital therapeutic approved by the US Food and Drug Administration (FDA) for pain relief.

In March 2023, the Centers for Medicare and Medicaid Services (CMS) established a unique Healthcare Common Procedure Coding System (HCPCS) Level II code for RelieVRx, categorizing it as durable medical equipment (DME). Though CMS has not made a final payment determination for RelieVRx, the code creates a more definitive pathway for the solution to secure Medicare coverage eligibility.

“We would like to see more bin codes created for all kinds of VR applications,” Xiang said. “VR application is not very expensive, given the new portable VR... and I think, compared to other medical treatment, VR application if it's effective, can really improve the patient outcome and reduce the lengths of stay.”

But, even amid these challenges, Xiang believes that the growing interest in healthcare VR and consequent collaborations will ultimately help propel the use of the technology.

For instance, a nurse PhD candidate from Texas contacted Xiang and asked if they could use one of his smartphone VR tools for their dissertation. On completing the dissertation, the candidate’s clinic plans to integrate the technology into their clinical practice, Xiang said.

As collaborations grow, the field will continue to evolve, resulting in exciting new possibilities for VR technology use in healthcare, he added.