A recent pilot study explores the feasibility of virtual reality-based pain interventions for people with rheumatic conditions.1 Although the work is in its early stages, it may someday represent a new non-pharmacological tool for patients with chronic pain.
VR for Treatment
R. Swamy Venuturupalli, MD, FACR, is an associate clinical professor of medicine at the David Geffen School of Medicine, University of California, Los Angeles, and a practicing rheumatologist at Cedars Sinai Medical Center. He is the first author of “Virtual Reality-Based Biofeedback and Guided Meditation in Rheumatology: A Pilot Study.”1
Virtual reality (VR) uses a combination of technologies, such as head-mounted displays, headphones and specially designed software, to create compelling sensations of an alternate, interactive environment in three-dimensional space. “The premise is that each person experiencing VR is placed into an immersive environment in which the brain, in a sense, can get hijacked to believe that what is being perceived in that virtual environment is, in fact, real,” Dr. Venuturupalli explains.
Different software for VR systems can be used to create different types of experiences. For example, some programs can take patients through a meditative mindfulness VR experience. Mindfulness meditation practices in non-VR settings have been shown to have positive psychological impacts for some patients with chronic pain.2
Similarly, VR platforms can be used to take patients through biofeedback sessions, helping them learn to control autonomic processes such as respiratory rate.
“Biofeedback allows a person to get into a deep state of relaxation whereby their autonomic nervous system and parasympathetic nervous system in particular is firing at a higher rate,” explains Dr. Venuturupalli. “More parasympathetic activity results in a relaxed state with slower breathing and heart rate and has also been shown in numerous studies to modulate pain.”
VR may mediate its effects through a variety of mechanisms, partly dependent on the software used. For example, VR may reduce pain-related activity in the insula and the thalamus.3 Through engaging the person’s senses, VR modulates how nociceptive signals are perceived by an individual.4 Dr. Venuturupalli points out one of the advantages of using a VR platform to perform such potentially stress-reducing activities: “Even a novice who has never done biofeedback or meditation is able to achieve some of those results in an easy manner when using this technology.”
Dr. Venuturupalli notes that interest in VR as a treatment modality has expanded in the past 10 years. He adds that a fair amount of data have demonstrated the benefit for VR for acute pain episodes, for example, for burn victims having their dressings changed.5 However, less work has been done in chronic pain. The research team could find no studies examining VR specifically in an outpatient rheumatology setting. Dr. Venuturupalli and colleagues initiated a pilot study to gather preliminary information that might ultimately help them develop an intervention for people with rheumatic diseases.