A Brief History of Pain Management & VR
In 1996, University of Washington investigators Hunter Hoffman, PhD and David Patterson, PhD co-originated the then new technique of using virtual reality for pain control, which later led to the adoption of VR in chronic pain management. In 2000, Hoffman et al. published “Virtual reality as an adjunctive pain control during burn wound care in adolescent patients.”
They reported that VR is a “uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the ‘real world’, allowing patients to tolerate painful procedures.” In a nutshell, it worked via distraction.
Fast forwarding to today, we now know that “in addition to distraction, there are novel mechanisms for VR treatment in pain, such as producing neurophysiologic changes related to conditioning and exposure therapies.” There’s more to it than distraction.
At BehaVR, our progressive, multi-session medical XR experiences are built upon Balance, our foundational program that teaches users stress resilience and emotion regulation—active coping.
How Stress Causes Pain, Including Chronic Pain?
The prevailing perspective in society is that all stress is bad. Consequently, most interventions for stress management focus on reducing the frequency or severity of stressors. This type of stress management ultimately fails because it is effectively impossible to avoid all stressors. Additionally, by simply avoiding stress we miss the opportunity to learn and adapt. A more efficacious approach is to optimize stress responses, becoming less reactive and more resilient to stressors.
The neurological and psychological power of the VR medium is unmatched, making it an ideal vehicle to teach people the skills they need to optimize their stress response—at will. One important technique of several that BehaVR utilizes is mindfulness.
Chronic pain can be considered a form of chronic stress.
The International Association for the Study of Pain defines pain as an “unpleasant sensory and emotional experience.” Today the biopsychosocial model of pain dominates the scientific community’s understanding of chronic pain. According to the biopsychosocial model, signals of distress originate in the nervous system in response to a physiologic stimulus, and the brain receives and interprets these signals—sometimes creating the sensation of pain—in order to draw our attention to the stimulus, so we can protect ourselves.
For some, after an injury, surgery, or other strain on the body, their nervous system remains in a state of hyper-arousal longer than is necessary, and their brain can continue to create the pain response, even after the actual threat or danger to the body is gone.
An individual’s pain experience depends on a complex interaction between various biological, environmental and psychological factors—including stress. Chronic pain is both physical and emotional.
Research confirms that we can exert some control over chronic pain by taking charge of emotions, thoughts, beliefs, attentional processes and coping behaviors using interventions like mindfulness.
A large body of scientific literature indicates that mindfulness can modulate a range of behavioral and neurobiological elements implicated in adaptive stress coping (an amygdala-sgACC pathway; reduced amygdala reactivity, and heightened amygdala-VMPFC connectivity). Practicing mindfulness techniques in VR ‘amplifies’ the effect.
Pain Neuroscience Education [PNE] is an educational strategy within the biopsychosocial model of care for individuals with chronic pain.
Based on Adriaan Louw, PT, PhD, CSMT’s Why You Hurt: Pain Neuroscience Education System and developed in collaboration with Conﬂuent Health, LLC and Evidence in Motion LLC, BehaVR’s “Pain Neuroscience Education+ in VR” program is progressive and personalized PNE in conjunction with stress resilience, non-reactivity and emotion regulation skill building. This includes mindfulness strategies, calming environments and deep-breathing exercises that help activate the patient’s parasympathetic nervous system (thus turning down the stress response in real-time) delivered using virtual reality.
According to a 2019 publication, incorporating stress management in chronic low back pain treatment can help patients to cope with everyday stressors and leads to clinically meaningful reduction in disability even at one-year follow-up.
In an ongoing randomized controlled trial of our “Pain Neuroscience Education+ in VR” module for chronic low back pain patients, conducted by Bellarmine University’s Doctor of Physical Therapy program, subjects are reporting that “Pain Neuroscience Education+ in VR” combined with physical therapy is resulting in reduction of pain and pain catastrophizing. Additionally, standardized pain ratings, disability indices and pain catastrophization scores are all far exceeding their minimum clinically important differences.
Medical XR experiences for pain management such as the ones BehaVR has created have built upon the seminal work of pioneers such as Hunter Hoffman and Adriaan Louw, moving the field well beyond distraction and bringing VR-assisted therapeutics to the forefront of care for this and similar challenging conditions.