Virtual Reality in medical settings has grown in popularity in recent years. Numerous studies have shown how VR can help significantly reduce pain, anxiety, and discomfort for patients with various conditions, with the greatest concentration of studies demonstrating VR’s positive effects on burn pain, cancer pain, phantom limb pain, chronic pain, rehabilitation, and pain attenuation with various other causalities (1). Companies like AppliedVR, VRHealth, VR Vision, Deep VR, The body VR, FeelsGood, OnComfort, Firsthand Technology, and Rescape Innovation are developing various engaging VR solutions for pain and healthcare-related stress which are improving the patient experience by creating powerful distraction from the distress of treatment and introducing fun into the equation.
This kind of VR treatment involves headgear that blocks out the view of the hospital setting in order to deliver HD VR imagery to patients experiencing significant pain, stress, or discomfort. The premise is to refocus the patient’s attention from the aversive experiences of their treatment onto a perceptually pleasant alternative world (2). The VR headgear engages patients’ attention by guiding them through a world full of characters, landscapes, and activities that they can tour through and even engage with.
Patients exposed to VR treatment consistently report feeling less pain, less time thinking about their pain, and even experiencing fun during painful treatments (3, 2, 4, 5, 6). VR treatments work because the experience of pain arises from the neural processing of signals from pain receptors, which means that attentional resources play an important role in creating the subjective feeling of pain (7). VR engages a significant amount of these resources and therefore leaves less of them available to focus on the pain. Scientists have used fMRI to observe whether the brain behaves differently when a patient is engaged in VR while being made to feel pain, and they have found that along with a subjective rating of significantly less pain, objective measures of neural activity showed 50% or greater reductions in pain-related brain activity in the anterior cingulate cortex, insula, thalamus, and the primary and secondary somatosensory cortex (8).
After years of research and implementation, the effectiveness of the VR approach has been proven significant and generalizable. The scope of existing research shows that patients in VR treatments report experiencing an average of 35-50% less pain than patients being treated as usual (1). Research has also found that the analgesic effects of VR existed equally for people irrespective of age, sex or ethnicity (5).
Although proven as effective as drugs in some instances of pain conditions, shortcomings of the VR approach when used alone limit its widespread use and health benefits in medical settings and at home. Some of its limitations are the following:
1) Since its power is primarily in distraction, the alleviating effects are generally confined to the duration of the VR exposure. Therefore there is no accumulative, educational and learning effect manifested via changed expectations, health-related abilities and attitudes due to fostered neurogenesis, such as the kind observed with bio/neurofeedback and hypnosis.
2) Immersive VR is applicable primarily for distraction from pain/discomfort and therefore is of limited use in pre-, during, and post- surgery and in any other treatment that requires more holistic or continuous change of the patient’s psychosomatic state.
3) The patient is a simple recipient of the VR stimuli and does not develop a sense of mastery or self-efficacy over their bodies, thus the method will not have a continuous and significant effect over the distressed psychosomatic state.
4) VR technology alone doesn’t remove pain, but only helps patients forget about their pain via distraction and redirection of attentional resources from the experience of pain.
The above limitations are addressed to a degree by VR-augmented hypnosis which has shown very promising results. However, considering that only about 20 to 25% of the population is considered highly hypnotizable, this approach also has limited applicability. In addition, for a significant number of patients who have low hypnotizability or just a general distrust of hypnosis, the method can even have an adverse effect.
Psychoneuroimmunology and the Power of the Mind
The number of studies researching the key role and involvement of the mind and brain in the healing (or worsening) of the body is conclusive and has developed into an entire field of study called Psychoneuroimmunology (PNI). One example from this field is a series of recent studies by Ben-Eliyahu and colleagues (9, 10, 11, 12) demonstrating that there is a very sensitive and critical window before and immediately after cancer surgery that can determine future outbreaks of preexisting micrometastases and the initiation of new metastases depending on levels of stress during that period. This window of time is so critical because the immunosuppressive effect of stress hormones before and after a treatment can have a highly detrimental effect on procedure success and treatment outcomes. Research has shown how a patient’s preoperative mental state can significantly influence physiological state and responses during surgery (13, 14, 15, 16) and the rate of postsurgical recovery (17).
With this in mind, it has been found in numerous studies (18, 19, 20, 21, 22, 23, 24) that effectively altering the psychosomatic state of the patient before and after treatment leads to decreased anxiety and stress, less postoperative complications, fewer hospital days, overall better treatment compliance, reduced perception of pain and decreased use of analgesics, and alterations in physiological indexes (25).
With the aim of creating a solution to maximally improve patients’ psychosomatic states during the critical windows of time before and after medical treatment, we developed the patented VRsano method. The VRsano method uses virtual reality to capture patients’ attention via immersive HD imagery and to distract them from their distressed mental states, as do other previously mentioned approaches in the VR healthcare field. However, VRsanoalso employs VR-augmented neurofeedback and clinical hypnosis in an interdependent fashion to combat the weaknesses of using VR alone and to create lasting positive change within the patient.
Clinical hypnosis has been reliably proven to alleviate pain and anxiety, alter somatic functions and lead to improved outcomes after surgery, radiology and chemotherapy, and other invasive medical procedures and treatments (26, 27, 28, 29, 30). Medical hypnosis has been shown to reduce intra-operative blood loss, hospital stay, and pain and to accelerate bone and wound healing (31, 32, 33, 34). It has also been used as a successful adjunct to numerous invasive treatments including coronary bypass surgery, severe burn treatment, and emergency medicine (35, 36, 37, 38). VRsano’s clinical hypnosis module leads patients to alter the state of the problematic target area in their bodies in such a way that is most conducive for the particular treatment and fosters the healing process before, during and after medical procedures. Hypnosis trains patients to beneficially alter their psychophysiological state by will both inside and outside of the virtual environment and this mastery over their symptoms and bodies lasts beyond the duration of the session, therefore making it possible for the patient to achieve long-term benefits through neurogenesis (More on Clinical hypnosis with VR).
VRsano neurofeedback module makes the method interactive and allows patients to regain a cumulative sense of agency which the vulnerability of their medical state takes away from them. Patients often feel victimized by their ailment and medical treatment and feel like they are merely being subjected to medical procedures in which they take no part, which is the main reason for the development of a highly distressed state. By engaging with the interactive neurofeedback mechanism within the VR landscape, patients are trained on how to change their physiological markers and brainwaves, resulting in necessary physiological changes. In this way, patients begin to feel empowered to resume a sense of control over their healing process and overall health, thereby lowering the distressed state.
What mostly differentiates VRsano method from the current VR approaches in healthcare is that in addition to distraction from the pain and suffering in a short-term the use of VRsano technology actually will foster faster healing that is to remove or minimize pain and symptoms in a long-term.
The VRsano method will be a powerful tool in the future of healthcare because of its ability to greatly alleviate patient distress in the short- and long-term, its applicability to patients of various ages, backgrounds and medical conditions, and its ease of use and implementation. It will create a significantly more positive experience for patients and practitioners alike, addressing many of the hurdles in healthcare that stand in the way of treatment effectiveness.
Others benefits of the method include:
- The method will be easy to incorporate with patients’ existing treatment because it doesn’t include any invasive elements to interfere with other aspects of the patient’s treatment/medication or to introduce additional risks.
- The method will require very little training from the practitioner as the feedback data controls the progression of the session. In rare cases when the level of distress is too significant, the device will resume the basic relaxation and distraction mode until the needed state is achieved to progress through the next steps of the session, or it will terminate the session and signal the provider.
- VRsano addresses the limitations of hypnosis wherein it is a challenge for a clinician or a VR device to detect when the patient is ready for the next step of the induction, thus maximizing the effect. In VRsano, the output of induction steps is dependent on precise brainwave markers received from the EEG component that is built into the VR helmet. If the patient is low on hypnotizability, an alternative algorithm will be deployed to achieve similar results as hypnosis, thus making it suitable for virtually any patient.
- The data from sessions will be recorded, allowing for analysis and audit of the sessions and customization by the algorithm of future sessions over the course of treatment, thus ensuring progressive and optimal benefit.
- The affordable, measurable, auditable, and easy-to-implement VRsano will be favored by payers and managed healthcare due to the fact that it will significantly lower the cost of medical services by decreasing the duration of hospitalization and re-hospitalizations, required procedures and complications, and drug and opioid use.
The VRsano method will also be available as a mobile application. It will be easy to use since the patient will only need to enter their demographic information, their desired immersive environment, target symptoms (if applicable) and type of medical treatment (if applicable). The recorded physiological data will be auditable later if needed and/or directly streamed to the practitioner or a customer service center. The design of the method makes personal use safe due to the biofeedback sensor’s ability to detect distress symptoms in real time. Such distress signals will lead the algorithm to switch to distress-dampening modules or end the session if necessary and alert the practitioner (or the customer service center). The device will be an invaluable tool in the practice of Telemedicine and digital healthcare.
Using VR in medical settings is an incredible step in the evolution of healthcare and the existing companies in the field have consistently shown powerful, positive impacts. However, we can go further in harnessing patients’ own abilities to control the effectiveness of their treatment. By incorporating clinical hypnosis and feedback, two methods that have been consistently proven effective by research and practice, VR’s ability to improve treatment outcomes can reach its full potential. VRsano offers a research-supported, clinician-developed method to do so in the most efficient way possible. If you are interested to know more or to partner with us, contact us at email@example.com
- Sulea, C., Soomro, A., Boyd, C., Wiederhold, B. K. (2014). Pain management in virtual reality: a comprehensive research chart. Cyberpsychology, Behavior, and Social Networking, 17(6), 402-413.
- Hoffman, H. G., Chambers, G. T., Meyer III, W. J., Arceneaux, L. L., Russel, W. J., Seibel, E. J., Richards, T. L., Sharar, S. R., Patterson, D. R. (2011). Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Annals of Behavioral Medicine, 41(2), 183-191.
- Hoffman H. G., Meyer III W. J., Ramirez M., Roberts L., Seibel E. J., Atzori B., Sharar S. R., and Patterson D. R. (2014). Feasibility of articulated arm mounted oculus rift virtual reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients. Cyberpsychology, Behavior, and Social Networking, 17(6), 397-401.
- Maani, C., Hoffman, H. G., DeSocio, P. A., (2008). Pain control during wound care for combat-related burn injuries using custom articulated arm mounted virtual reality goggles. Journal of CyberTherapy and Rehabilitation, 1:193-198.
- Flores A., Hoffman H. G., Russell W., (2008). Longer, multiple virtual reality pain distraction treatments of Hispanic and Caucasian children with large severe burns. CyberTherapy Conference. San Diego, Calif.
- Sharar, S. R., Carrougher, G. J., Nakamura, D., Hoffman, H. G., Blough, D. K., Patterson, D. R. (2007). Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Archives of Physical Medicine & Rehabilitation, 88(12), s43-s49.
- Eccleston, C., Crombez, G. (1999). Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychological Bulletin, 125:356-366.
- Hoffman H. G., Richards T. L., Bills A. R., (2006). Using FMRI to study the neural correlates of virtual reality analgesia. CNS Spectrums 11:45-51
- Ben Eliyahu, S. Page, G. G., Yirmiya, R., Shakhar, G. (1999). Evidence that stress and surgical interventions promote tumor development by suppressing natural killer cell activity. International Journal of Cancer, 80(6), 880-888.
- Ben Eliyahu, S. (2003). The promotion of tumor metastasis by surgery and stress: immunological basis and implications for psychoneuroimmunology. Brain, Behavior and Immunity, February; 17 Suppl 1:S27-36.
- Neeman, E., Zmora, O., Ben-Eliyahu, S. (2012). A new approach to reducing postsurgical cancer recurrence: perioperative targeting of catecholamines and prostaglandins. Clinical Cancer Research, 18(18), 4895-902.
- Neeman, E., Ben-Eliyahu, S. (2013). Surgery and stress promote cancer metastasis: new outlooks on perioperative mediating mechanisms and immune involvement. Brain, Behavior and Immunity. Suppl:S, 32-40.
- Abbott, J., Abbott, P. (1995). Psychological and cardiovascular predictors of anaesthesia induction, operative and postoperative complications in minor gynecological surgery. British Journal of Clinical Psychology, 34, 613-625.
- Greene, P. G., Zeichner, A., Roberts, N. L., Caltahan, E. J., & Granados, J. L. (1989). Preparation for cesarean delivery: A multicomponent analysis of treatment outcome. Journal of Consulting and Clinical Psychology, 57, 484-487.
- Markland, D., & Hardy, L. (1993). Anxiety, relaxation, and anesthesia for day-case surgery. British Journal of Clinical Psychology, 32, 493-504.
- Scheier, M. E., Matthews, K. A., Owens, J. E, Magovern, G. J., Sr., Lefebvre, R. C., Abbott, R. A., & Carver, C. S. (1989). Dispositional optimism and recovery from coronary artery bypass surgery: The beneficial effects on physical and psychological well-being. Journal of Personality and Social Psychology, 57, 1024-1040.
- Liu, R., Barry, J. E. S., & Weinman, J. (1994). Effect of background stress on postoperative recovery. Anaesthesia, 49, 382-386.
- Contrada, R. J., Leventhal, E. A., & Anderson, J. R. (1994). Psychological preparation for surgery: Marshaling individual and social resources to optimize self-regulation. In S. Maes, H. Leventhal, & M. Johnson (Eds.), International Review of Health Psychology, Vol. 3, 219-266. New York: Wiley.
- Devine, E. (1992). Effects of psychoeducational care for adult surgical patients: A meta-analysis of 191 studies. Patient Education and Counseling, 19, 129-142.
- Gil, K. M. (1984). Coping effectively with invasive medical procedures: A descriptive model. Clinical Psychology Review, 4, 339-362.
- Johnston, M., Vogele, C. (1993). Benefits of psychological preparation for surgery: A meta-analysis. Annals of Behavioral Medicine, 15, 245-256.
- Johnston, M., Wallace, L. (Eds.). (1990). Stress and medical procedures. Oxford, England: Oxford University Press, p 184.
- Mumford, E., Schlesinger, H. J., Glass, G. V. (1982). The effect of psychological intervention on recovery from surgery and heart attacks: An analysis of the literature. American Journal of Public Health, 72, 141-151.
- Suls, J., Wan, C. K. (1989). Effects of sensory and procedural information on coping with stressful medical procedures and pain: A meta-analysis. Journal of Consulting and Clinical Psychology, 57, 372-379.
- Kiecolt-Glaser, J. K., Page, G., Marucha, P. T., MacCallum, R. C., Glaser , R. (1998); Psychological influences on surgical recovery. Perspectives from psychoneuroimmunology. November; American Psychologist.
- Lang E. V., Berbaum K. S., Faintuch S., Hatsiopoulou O., Halsey N., Li X., Berbaum M. L., Laser E., Baum J. (2006). Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy. Pain. 126(1-3):155-164
- Lang E. V., Benotsch E. G., Fick L. J., Lutgendorf S., Berbaum M. L., Berbaum K. S., Logan H., Spiegel D. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. 355(9214):1486-1490
- Montgomery G. H., Bovbjerg D. H., Schnur J. B., David D., Goldfarb A., Weltz C. R., Schechter C., Graff-Zivin J., Tatrow K., Price D. D., Silverstein J. H. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. J Natl Cancer Inst. 99(17):1304-1312
- Lee J. S., Spiegel D., Kim S. B., Lee J. H., Kim S. I., Yang B. H., Choi J. H., Kho Y. C., Nam J. H. (2007). Fractal analysis of EEG in hypnosis and its relationship with hypnotizability. Int J Clin Exp Hypn. 55(1):14-31
- Colgan S. M., Faragher E. B., Whorwell P. J. (1988). Controlled trial of hypnotherapy in relapse prevention of duodenal ulceration. Lancet. 1(8598):1299-1300
- Lynn, S. J., Kirsch I., Barabasz A., Cardeña E., Patterson D. (2000). Hypnosis as an empirically supported clinical intervention: The state of the evidence and a look to the future. International Journal of Clinical and Experimental Hypnosis, 48(2), 239-59.
- Lang, E. V., Benotsch E. G., Fick L. J., Lutgendorf S., Berbaum M. L., Berbaum K. S., Logan H., Spiegel D. (2000). Adjunctive non-pharmacological analgesia for invasive medical procedures: A randomised trial. Lancet, 355(9214), 1486-1490.
- Ginandes, C., Brooks P., Sando W., Jones C., Aker J. (2003). Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial. American Journal of Clinical Hypnosis, 45(4), 333-351.
- Ginandes, C. S. & Rosenthal, D. I. (1999). Using hypnosis to accelerate the healing of bone fractures: A randomized controlled pilot study. Alternative Therapies in Health and Medicine, 5(2), 67-75.
- Mehmet, C. O. (2000). About self-hypnosis and coronary artery bypass surgery. Journal of Cardiothoracic Surgery (Torino), 41(2), 335-336.
- Peebles-Kleiger, M. J. (2000). The use of hypnosis in emergency medicine. Emergency Medicine Clinics of North America, 18(2), 327-338.
- Gallagher, G., Rae, C. P., & Kinsella, J. (2000). Treatment of pain in severe burns. American Journal of Clinical Dermatology, 1(6), 329-335.
- Spiegel, R. B. (2011). The integration of heart-centered hypnotherapy and targeted medical hypnosis in the surgical/emergency medicine milieu. Journal of Heart-Centered Therapies, 14(2), 87-106.