Virtual reality (VR) is a mind-body treatment that’s based on real science. It is a software technology that allows interaction with immersive environments via a headset comprising of a head-mounted display with a small screen positioned in front of the eyes.
VR is a safe, portable, and drug-free solution to alter perception and improve pain tolerance. Additionally, this virtual setting can be adapted and personalized to any scenario, depending on your condition and expectations. It can be delivered in a cost-effective manner using a smartphone combined with an inexpensive VR device, such as a Google Cardboard headset.
Slip-on the VR goggles, and you will be transported to another world. Icebergs, oceans, and sprawling landscapes – these tranquil scenes can distract you from acute pain and anxiety. It is a computer-simulated world that stimulates real-time experience through senses and perceptions. You can “look around” the virtual world, move around in it, and interact with visual features.
Why virtual reality?
If pain is perceived in the brain, then it makes sense to retrain the brain to think differently. Beyond the distracting effects, immersing in VR may also trigger the body’s in-built pain-fighting systems.
VR and the brain share the same underlying mechanism – embodied simulations. The brain creates an integrated simulation of the body to present and predict actions, concepts, and emotions. Likewise, VR attempts to predict the sensory consequences of your movements, providing you the same scene you will see in the real world. To achieve this, the VR system, like the brain, maintains a stimulation of the body and space around it.
We are what we think. We are where we immerse.
The universe is held within your mind as an immersion of all the sensations you perceive, experience, and navigate. These are all based merely on information passing through your consciousness. It is then interpreted and assigned meaning based on emotions, memories, and constructs that make sense.
Immersive VR allows you to experience the illusion of ownership over a virtual body inside an immersive virtual environment. In turn, it allows you to have the feeling of being “embodied” in a virtual body.
Swapping out immersions
VR may be useful in distracting you and tricking your brain into aligning with another reality, one in which the pain is reduced. This overwhelms the brain with information and thereby diverts attention away from pain and anxiety.
The brain can heal itself by rerouting the neuromatrix. As such, VR is also shown to relieve a variety of acute and chronic pain conditions, including fibromyalgia, phantom limb pain, and regional specific pain disorders.
Virtual reality for various types of pain
Current pain management strategies are often incomplete or ineffective. On the contrary, VR is effective in reducing acute, chronic, and severe pain.
VR is a safe adjunctive therapy for pain management within the acute inpatient hospital setting (1). VR can distract you from acute pain and procedural pain.
VR can reduce pain and kinesiophobia in patients with chronic pain, thereby reducing the use of opioids among chronic pain patients. In addition to distraction, VR can also produce neurophysiologic changes related to conditioning and exposure therapies.
Scientists have found that using VR headsets to watch immersive videos could help to combat chronic pain (2). Furthermore, a five-minute VR session is shown to result in significant pain relief in patients with chronic pain (3).
Applied VR in pain management
VR is more than just mitigating pain – it can make the mitigation of pain interesting for you, and the milieu of each universe is as varied as the human imagination.
While VR may be valuable as an independent approach to pain relief, it can also be integrated seamlessly into the conventional pain-relieving methods. VR can be broadly applied to gamification, physical therapy, and psychological therapy.
Virtual reality gamification
The intertwine between VR and ‘gamification’ involves the use of fun and engaging activities that will facilitate compliance. It could also lessen pain intensity during sudden symptom spikes (5).
Every time you put the VR headset on, you become an element in a computer-generated environment that is controlled by the therapist. With VR, the therapist can see if you hesitated or if you are disoriented. Because you interact with the virtual objects, the therapist can analyze the entire sequence that happened before.
You can focus on enjoying your virtual games while seamlessly meeting your therapeutic goals. Meanwhile, the backend of the VR software could generate comprehensive performance data or analysis.
Virtual reality neurophysical therapy
A combination of VR and exercise imagery is shown to have a more significant effect on pressure pain thresholds (but not heat pain thresholds) as compared with VR distraction alone (6). VR can also reduce range-of-motion pain during active physical therapy exercises (7).
VR neurophysical therapy contains two steps:
In the first step, you use the VR system to draw a representation of the pain as an active 3D avatar with audio and visual controls.
The second step allows you to manipulate the pain relief modes during which you are guided through various approaches for reframing your experiences of, and relationship with, the pain. During this period, the brain is learning.
Virtual reality neuropsychological therapy
The Fear-Avoidance Learning Cycle shows the propensity that you develop chronic pain as a function of your tendency to fear pain. When an injury triggers pain, if there is heightened fear, you may tend to catastrophize, leading to hyper-vigilance, disability, avoidance, and depression, all of which worsen the experience. In contrast, if there is little fear, you may tend to confront the fear of pain and recover more quickly.
VR neuropsychological therapy can disrupt the negative Fear-Avoidance Learning Cycle. The goal behind VR neuropsychological therapy is to interfere with the maladaptive learning process by conferring an experiential approach.
It amalgamates the immersion experience of VR and the principles of CBT. The self-efficacy, self-distancing, and fear-extinction of CBT help you manage perceptions, thoughts, and feelings. At a fundamental level, CBT enhances the potency of virtual reality.
Uses of VR in pain management
Virtual reality technology is increasingly being used for a variety of medical purposes.
VR is an engaging and promising intervention that may help to decrease pain and anxiety in children undergoing painful procedures. In particular, VR distraction can reduce needle-related pain distress, given its interactive and immersive virtual environment. The unique qualities of VR, such as presence, interactivity, customization, social interaction, and embodiment, allow it to be accepted by children and incorporated successfully into their existing treatment.
The use of a VR headset is shown to be well-received and reduced overall fear and pain in children receiving immunizations, cannulation, and venepuncture (8, 9). It transforms the procedural experience into a less distressing, potentially pain-free routine procedure, particularly for children with high anxiety sensitivity. Hence, VR holds promise to reduce distress in children and caregivers while facilitating increased satisfaction during the procedures (10).
VR distraction is shown to relieve pain and anxiety during dressing changes in children with chronic wounds on lower limbs (11). It may potentially improve clinical efficiency by reducing the length of time for dressing changes.
Furthermore, interactive VR intervention is deemed acceptable and safe to reduce procedural pain in children and adolescents with cancer (12).
Dental anxiety and fear of dental care create significant problems for pediatric dental patients.
Immersive VR can be used to effectively distract children during short invasive dental procedures (13). For instance, it can be used during periodontal scaling and root planing procedures in the dental hygiene clinic (14).
VR is shown to reduce pain perception in burn patients undergoing dressing change or physical therapy within the clinical setting (15). As a result, VR can reduce the amount of opioid medication necessary during painful wound care procedures (16).
VR headsets can help women get through childbirth pain (17). It confers a medication-free option to help you cope with the pain and anxiety of labor.
Benefits of VR for women in labor include:
- Lower risk to mother and baby
- Empowers a mother in the birthing experience
- Offers comfort during post-birth procedures, like stitches for tears or incisions
Not only does VR help distract and relax women during labor, but it may also increase the body’s levels of endorphins and other pain-blocking chemicals.
Phantom limb pain
Phantom limb pain (PLP) is the perception of discomfort in a limb no longer present, typically after amputation. Its treatment is still challenging.
Still, VR rehabilitation may be particularly useful for PLP associated with distorted phantom limb movement and body representation (e.g., clamping, gnawing) (18).
The combination of VR and mirror therapy has shown promise. Mirror therapy (which uses limb reflection in a mirror) and VR therapy (which utilizes computer limb simulation) have been used to relieve PLP.
Immersive VR technology can also be combined with myoelectric and motion tracking control for the treatment of PLP (19).
Pain relief for military veterans
VR is a feasible adjunct therapy for veterans with chronic pain (20). Virtual environments confer a promising opportunity to safely and gradually expose veterans to movements that are avoided in the real world. It transports them to a safe and calm place, and they don’t have to worry about their pain.
Chronic low back pain
VR is effective in patients with chronic low back pain with associated kinesiophobia. It can be used to encourage physical activity that would otherwise be avoided out of fear of pain or reinjury.
Virtual walking integrated physical therapy is shown to improve pain, kinesiophobia, and function in people with subacute and chronic low back pain (21). It can also benefit certain aspects of neuropathic pain, such as discomfort, as well as certain sensory qualities of that pain (22).
Today, virtual reality devices may require no more than a smartphone and cost-effective special headsets to operate. Playing VR games ore relaxing in a virtual environment can help ease pain, especially when symptoms are intense.
VR goggles could be a feasible, non-invasive alternative to traditional pharmacologic treatment. With further research, VR therapies may eventually help reduce dependence on opioid prescriptions.