How Is VR Used In Medicine?

Virtual reality (VR) can reduce pain, treat mental diseases and support the training of medical professionals. But how does it work? In a 12-minute video, you will discover the science behind VR therapies.

The movie features an interview with Dr. Brennan Spiegel, author of the book “VRx: How virtual therapeutics will revolutionize medicine”, Director of Health Services Research at Cedars-Sinai Medical Center in Los Angeles.

The interview with Dr. Brennan Spiegel and the full movie script are available below.

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Interview with Dr. Brennan Spiegel (full version).

What are the three VR applications that can have the most significant impact on standards of care?

The most obvious is both acute and chronic pain therapy because pain is so pervasive and substantially impacts the quality of life. There is extensive evidence that VR can help patients with acute pain, for example, after surgeries. We are doing a study on chronic lower back pain funded by the National Institutes of Health. We have also had success using VR in irritable bowel syndrome (IBS), and we are currently developing an IBS treatment program in VR.

Another area is mental health, anxiety. Especially during the COVID-19 pandemic, ongoing quarantines and diminished access to qualified mental health practitioners, people are dealing with anxiety, having difficulty getting access to evidence-based care. So how can we deliver care to people’s homes? Virtual reality has a significant role to play here.

VR also has created an incredible opportunity for training and simulation in healthcare for clinicians who need to learn procedures, operations, how to engage with the patients and maintain skills.

How can we know that VR has no side effects or is not addictive like computer games?

VR is certainly safer than some medicines. For example, opioids, commonly used for pain management, have led to a worldwide epidemic. They are addictive and have severe side effects. We have seen great interest among patients to explore VR in order to reduce medication exposure. We don’t promise that VR could completely replace medicines, although it does for some people.

The idea is that pain is not only a physical experience. It’s also an emotional, cognitive and social experience. If we just focus on the physical phenomena of pain, we may miss part of the problem. Virtual reality can reduce physical pain processed in the brain but also emotional pain. Of course, as with every effective therapy, it has side effects. The most common are dizziness, cyber-sickness, simulator sickness – which may occur in 5% to 10% of people, initially when starting with virtual reality. For most people, it’s minimal – they either continue, and it gets better, or take off the headset and the problem disappears. It’s not only interesting clinically, but it teaches us a lot about our brains.

Advances in VR technology have reduced incidents of cyber-sickness. We are also very careful when we recommend software for therapeutic purposes. These must be stable environments instead of dynamic scenes.

Are doctors ready to implement this new field of medicine into clinical practice? 

Yes, but it requires specific infrastructure to be successful. The barriers to implementation are not scientific anymore. We have plenty of science attesting to the benefits of VR. The obstacles are more trivial but important: training, payment, maintaining the headsets. In Cedars-Sinai, we’ve already used VR in over 3000 patients, mainly for research purposes, and now we are in the final stage of developing a new VR clinic. It starts with having a clinician – a virtualist – trained in clinical medicine and virtual reality. The doctors need to have access to headsets that can be cleaned and reused. There are also programs that people can take home with them.

Finally, insurance companies are looking more carefully at whether to reimburse VR services. That would unlock a lot of opportunities. The FDA is evaluating the regulatory landscape around VR treatments and has developed a medical extended reality program. I was fortunate to play a small role as an adviser. Soon, the FDA will publish a white paper regarding this program.

How would you convince skeptics that VR is not a placebo or just gaming technology but an effective drug?

Randomized control trials are the best way to determine if any new therapy is effective, and that’s already been done with virtual reality. We have studies and meta-analyses of studies that demonstrate the effectiveness of VR for a wide variety of conditions.

This idea that we just treat the body with drugs and the brain with talk therapy is old. Modern neuroscience recognizes that these two sciences are one. The body is an extracranial extension of the brain. VRx is not gaming; we are talking about building skills, cognitive behavior, biofeedback therapy. Think about schizophrenia, where VR helps patients to manage their hallucinations. That’s certainly not a game.

In your latest book, “VRx: How Virtual Therapeutics Will Revolutionize Medicine” you present many clinical studies and examples that confirm virtual medicine’s effectiveness. So if we know it works, what should be the next step to scale up VR?

There are about 200 hospitals in the USA and many more in the world using virtual reality for different purposes. VR is kind of like a syringe – it’s not the syringe that matters but the medicine that goes through it. VR is just a platform – what matters is the software that helps people to experience a new reality.

We have to focus on use cases. In our hospital, VR is helping women to go through childbirth. In the emergency department, people waiting in the hallway could find themselves somewhere on a beach, avoiding unnecessary stress. These are just two of hundreds of examples.

Of course, many other determinants, including reimbursement policies or training, would also help to scale up VR in medicine more broadly. At Cedars-Sinai, we organize a large annual meeting to spread knowledge about using these VR programs. We also run a library of practical information on our website http://www.virtualmedicine.health.

Do we already know how to apply VR in a specific case – for example, what images, how long, and at what level of intensity to use at different severities of pain?

That’s a work in progress – to determine the attributes of VR programs to help to perfect pain therapies. There is limited research looking at different forms of VR in the same condition. The study we are doing right now is skill-based VR vs. distraction-based VR. We do need more research to understand the frequency, duration, intensity and other attributes.

How do patients react when they put on the VR goggles and move to an “unreal” world for the first time? Do emotions vary, for example, by age? 

It’s important to point out that there is a difference between being a healthy person trying VR for the first time versus a patient in a hospital, in pain, anxious, vulnerable. For such a person, the change can be dramatic.

When we use VR in our hospital, we typically see two moments. The first I call the moment of cognitive or conscious immersion – when you realize that you are in a three-dimensional space. The body and brain feel like they are present in this environment. You see people smile, saying “wow.” A few minutes later, there is the moment of physiological immersion – when the brain has become used to the new environment. Patients begin to relax. Sometimes the heart rate slows down, blood pressure drops, the autonomic nervous system is taking over. What we are trying to achieve in the acute setting is physiological immersion.

Why did you write a book on virtual therapeutics?

This book is about a new field of medicine – medical extended reality. There are now over 5000 studies demonstrating the therapeutic benefits of immersive therapeutics, including VR therapeutics. It’s time to take this new field seriously and understand how to implement this technology in clinical practice, not to substitute traditional medicine but to augment it. I wanted to tell stories that we’ve experienced using VR but also to present the science behind it: neuroscience, psychology, sociology, clinical medicine, technology, optics, and of course, philosophy.

This book is for people interested in VR and those interested in knowing what VR teaches us about consciousness, that the brain and body are connected. VRx is about modern neuroscience, the intersection between technology, psychology and philosophy. What is the nature of “self”? What does it mean to be a person? What does it mean that VR can create a sensation like you’ve left your body? How is it neurologically possible? The book begins with these big questions and breaks down the science of immersive therapeutics. If you are looking for non-medical treatments to augment traditional therapies for a wide range of conditions – like dementia, high blood pressure, schizophrenia, anxiety, depression, eating disorders, obesity, anorexia – you will find many examples inside.  

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Prologue

Hi, I’m Artur Olesch from aboutDigitalHealth.com. I’m excited to tell you about the power of virtual reality in healthcare. By watching this video, you will learn how virtual reality can reduce chronic and acute pain, treat mental diseases, and support the training of medical professionals. I will answer the question of whether virtual reality can replace some medicines in the future. But I will also look closer at the risks associated with this emerging therapy.

You will also discover the practical applications of VR in medicine. I interviewed a leading expert in the field of virtual therapeutics – Dr. Brennan Spiegel, who is Director of Health Services Research for Cedars-Sinai Health Systems. We talk about what VR teaches us about consciousness, modern neuroscience, the intersection between technology, psychology and philosophy.

And finally, together, we will take a closer look inside the book “VRx: How Virtual Therapeutics Will Revolutionize Medicine” to explore the latest studies regarding virtual reality in healthcare and intriguing experiments that reveal how we can trick the brain.

So let’s get started.

Explanation

Virtual reality allows people to travel and change places without moving. When you put on VR headsets, you literally enter another world. For example, when playing computer games. VR alters our perception of reality, modifies the way we think and feel. It stimulates our vision, hijacks the brain and creates a sense of psychological presence. It teleports people outside their own body

Suddenly you can find yourself swimming with dolphins, relaxing on a beach, traveling in space or watching nature. Many scientists have studied our sense of self – how the body and brain are connected.

In the “rubber hand experiment,” Matthew Botvinick and Jonathan Cohen demonstrated the convincing illusion of transferring body ownership from one’s real arm to a fake arm. They found out that we can fool the brain into accepting a false body.

Another “Phantom body illusion” study by Henrik Ehrsson confirmed the so-called out-of-body experience – the experience in which a person sees his or her own body from outside the physical body.

This shows the impact of psychological factors on how we perceive reality. A similar mechanism can be observed when we get sick. Two patients with the same disease might experience vastly different symptoms. Thus, quality of life does not always correspond with lab test results.

This approach is relatively new. In 1977, George Engel, a professor of psychiatry and medicine at the University of Rochester, proposed that doctors should not only pay attention to a mechanistic interpretation of disease, but also the emotional aspect of illness. This theory has later opened doors to VR to become a viable therapeutic intervention.

Scientists started to explore the power of VR in medicine. It can help treat people with depression and anxiety, reduce the intensity of pain, allow patients with anorexia to experience life by way of a healthy avatar.

So how can VR reduce pain?

First, it distracts the brain from noxious signals rising up from the body. Second, it creates an illusion of time acceleration, effectively shortening the length of pain episodes. And third, in nips signals in the bud at their origin, blocking pain from reaching the brain. The combinations of these effects supports the ability of immersion to fight pain.

But VR is not always a cure. What for some may be a fantastical relief, for part of patients in distress or with an advanced illness, is an unwelcome intrusion. It is important not to overpromise what technology can achieve in medicine. Every drug and medical procedure has risks. It’s also the case in VR, even if it is very safe compared to just about any other medical treatment.

If VR is a cure, we also need a VR pharmacy with shelves full of VR treatment options that are safe, effective and personalizable for each individual patient. For example, customized VR treatments for pain could include different distractive environments and sounds. Before prescribing a specific option, doctors would analyze patient preferences and test its effectiveness. Medical goggles with embedded sensors could allow you to customize the experience in real life.

Sounds like a Matrix? In a way, it is. In the movie, Morpheus tells us that “If real is what you can feel, smell, taste and see, then ‘real’ is simply electrical signals interpreted by your brain.” The full capabilities of the mind are still undiscovered.

Epilogue

We are at the beginning of discovering the possibilities of VR in medicine. Many companies and startups are working on novel solutions that can, for example, strengthen the doctor-patient relationship, motivate towards lifestyle changes, improve compliance, patient engagement or even prepare terminally ill patients for death. New technologies use biofeedback to enhance the effectiveness of the VR experience.

VR medicine will become real in a few years. Science and technology are not a barrier anymore – we lack staffing with digital literacy, infrastructure, and funding. We need vision and a new mindset in healthcare.

I hope I’ve convinced you that virtual reality can potentially become the next drug of the future.

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