Pilot Study
The team recruited 20 adult rheumatology patients from a private practice clinic in Los Angeles. The participants were primarily female and Caucasian. The most common diagnosis was rheumatoid arthritis, followed by lupus and fibromyalgia. All participants had active, but stable, disease. They all had some degree of ongoing pain as assessed by a score of at least 5 on the Visual Analog Scale (VAS) for at least four days of the preceding month. Most of the patients had some knowledge of VR prior to the study. Three participants were excluded due to medical conditions that might theoretically be aggravated by VR, such as vertigo.1
All participants experienced two different VR environments: a guided meditation environment and a respiratory biofeedback environment. The latter provided interaction to help patients breathe at six breaths a minute. Some participants experienced the guided meditation environment first and others the biofeedback environment. Both modules provided immersive experiences in similar natural environments for 10–15 minutes.1
The team also performed pre-VR, between VR and post-VR assessments using scales from the Patient-Reported Outcomes Measurement Information System (PROMIS), as well as the VAS. They also collected general impressions from the participants.1
“I would say that the main finding of the study was that this intervention was very well tolerated by 100% of the patients,” says Dr. Venuturupalli. Only one participant found the device uncomfortable, though 44% said they would prefer to use a lighter device. All said they would be willing to participate in another VR study.1
The pilot project was not powered to draw definitive conclusions about effectiveness. However, about two-thirds of participants reported positive responses to at least one of their two VR sessions, and the researchers found a statistically significant reduction in VAS scores after both types of VR modules. Most patients said they could see themselves utilizing VR for relaxation and pain reduction if it were available to them.1
Looking Forward
Although much work remains to be done, Dr. Venuturupalli sees VR as a promising potential treatment modality that comes with very few risks. Since development of early VR systems, the technology has become less expensive, more portable and easier to use. Ultimately, Dr. Venuturupalli predicts that VR devices will become as ubiquitous as smartphones are today.
Many important research questions remain about how best to approach VR interventions. Dr. Venuturupalli points out that in addition to pain and anxiety reduction, VR may be used for instruction, such as teaching movement skills in elderly patients with osteoarthritis. He notes that we need to learn about how best to dose VR in terms of how long and how often patients would use it, and how long the effects last.
“What we need is some sort of virtual reality prescribing guide, where certain conditions are treated with certain kinds of protocols,” he says. “That will require a lot more research.”
Dr. Venuturupalli notes that in addition to VR, other technologies, such as augmented reality and mixed reality, are being used for various medical purposes. Unlike VR, such technology does not place participants in a completely immersive environment. Instead, the external world is enhanced in particular ways to help patients build specific skills.
The National Institutes of Health awarded Dr. Venuturupalli’s group a grant to study VR for back pain. The study will be led by Brennan Spiegel, MD. The team is also hoping to get more funding to research other aspects of the technology. The researchers would like to curate a library of VR programs that could target pain, anxiety, movement and sleep for patients with chronic rheumatic diseases. Rheumatologists could then prescribe specific interventions for their patients.
“Down the road, the possible treatment interventions are innumerable,” Dr. Venuturupalli says.
For pain control, the need for new interventions is more pressing than ever. As Dr. Venuturupalli points out, “The current opioid epidemic is making it necessary for the medical profession to find different ways to manage pain. But we don’t have very much guidance about what can work for our patients.” VR may represent one new potential tool in the pain treatment armamentarium.
