Virtual reality may be a new, cheaper weapon in the war on pain

The best treatment for pain may not be a new drug, but a technology that’s seeing more investment and advancement due to its use in gaming.

Physicians and researchers have been experimenting with using virtual reality as a way to reduce pain for years, but the recent increase in the hardware’s quality, matched by the rapid decrease in price, suddenly makes VR pain control a much more exciting option.

Why this is so helpful

For patients going through intensely painful medical procedures — such as the process for cleaning and re-bandaging a burn — virtual reality provides an immersive, fully-engaging distraction from pain.

“The theory behind it is that there’s only so much attention available to process pain, and if you’re able to pull that attention away, they think about the pain less and they experience it less,” says David Patterson, a professor of psychology at the University of Washington. Patterson uses virtual reality to help alleviate pain in burn patients.

While burns themselves are extremely painful injuries, the healing process can be moreso. Burns must be frequently cleaned and have their dressing replaced to keep the wounds healthy and free of infection, Patterson says. The key to alleviating pain during these procedures is to not just distract the patient with a virtual world, but to engage them with a game.

In the early ’90s, Patterson worked with another researcher, Hunter Hoffman, to try out a game called SnowWorld on burn patients. In the game, patients are immersed in a white, snow-covered world, where they are challenged to throw snowballs at snowmen.

Patients playing SnowWorld report that they feel less pain — which is reflected through Hoffman and Patterson’s brain imaging studies. When patients are in VR, the parts of the brain that are associated with the sensation of pain have less activity than when they’re not playing the VR game.

The applicability of VR goes beyond just burn pain. It can be effective with everything from dental pain to chronic pain. Jeffrey Gold, the director of the Pediatric Pain Management Clinic at Children’s Hospital Los Angeles, is using VR with kids in his clinic. They use a few different games on a Samsung Gear VR to help distract kids from painful and stressful procedures like getting their blood drawn.

Gold described one such game, Bear Blast, which works similar to SnowWorld. The game functions similar to the VR edition of Rez — players are on a rail and can fire off snowballs when they fix their head position on bears in a virtual world.

Gold thinks that virtual reality goes beyond simple distraction. He calls it a form of “top-down inhibition,” where VR helps people’s natural ability to override pain signals by engaging them in another task. It’s essentially a way to assist people in getting their mind to triumph over matter.

But not every game works for every patient. Gold and his lab work with a company called AppliedVR that specializes in making therapeutic virtual reality games.

According to Matthew Stoudt, the CEO of AppliedVR, the one main theme in pain management games is to break with the “live-die-repeat” model of most games. The key is instead to maintain that constant “cognitive load” so people can remain distracted and detached from their pain.

Ben Kuchera/Polygon

“You can’t simply do continuous play at the same pace and engagement, because that creates a cognitive burnout,” Stoudt says. “So you have to figure out the right way to build the experience up to put more cognitive load on the patient and give them a reprieve without breaking the experience itself.”

So games like Bear Blast have levels that get progressively more engaging and difficult.

“You’re going up levels, and you start with a couple bears, there’s five, 30, 60,” Gold says. “You do other things as you increase into other levels. Kids like that reinforcement of getting to the next level, earning points and racing against the clock.”

Patterson says the development of gaming technologies has enabled medical researchers to use virtual reality more easily. What used to cost tens of thousands of dollars is now available for a few hundred, he says, so researchers are expanding what they can do with virtual reality into managing chronic pain and anxiety.

“The primary treatment for chronic pain is movement, but a lot of people with chronic pain are afraid of moving,” Patterson says. Often for patients, movement triggers worse pain. But ultimately, studies show that physical therapy helps in the long-run. “So there’s now some paradigms out there that encourage movement through VR but also address the fear of movement that people have.”

Virtual reality addresses the anxiety people have around movement the same way that it addresses the pain itself: through engaged distraction. If you simply tell a patient it’s important to move, but they know that movement will cause pain, they’re going to have a negative reaction to the treatment. But give them a game to play and it becomes much easier to stay motivated. In one study, patients said that they enjoyed the games so much, they forgot all about their pain and wanted to continue playing even after the trial was over.

Gold says that even trials that use multiple rounds of VR sessions still show good outcomes for pain management. He acknowledges that every patient is different, and perhaps a veteran VR gamer might find the relatively easy games offered to patients to not be engaging enough to distract from pain. But he’s also confident that software and hardware will continue to evolve in ways that will offer patients more ways to avoid pain.

Virtual reality is also progressing rapidly enough with retail products, from low-cost Google Cardboard viewers to the $800 HTC Vive, that it’s already possible for patients outside of a clinical setting to try using VR for pain management under the guidance of their physician.

Gold and Patterson believe it’s only a matter of time before you have more options for your next medical procedure. And, while pain medications are great tools, they can have devastating side effects, like the addiction fueling the opioid dependance crisis across the U.S. Unlike drugs, virtual reality is at a place where the efficacy of the technology is going up while the price of equipment is going down.

Some drugs also simply don’t work in many patients with chronic pain. While Gold and Patterson both agree that medications are still useful, important and relatively safe, they acknowledge it’s nice to have a drug-free alternative. With VR, “there’s no addiction, no side effects, and it’s portable,” Gold says.