Many hospitals today try to lessen the pain of patients, especially children, by distracting them with virtual reality games during agonizing procedures.
Now some doctors and researchers think that virtual reality could eventually be used to alleviate chronic pain as well—reducing patients’ need for opioid painkillers.
Here’s how one company, the Sunnyvale, Calif.-based startup CognifiSense, says it would work: The patient, through goggles, sees a three-dimensional image symbolizing his or her own body. (See illustrations above and below.) Then sharp colors light up on the image in the places where the patient is hurting, accompanied by a pulsating beat. The visualization allows the patient to reduce pain by distancing him- or herself from it and overcoming the fear that augments it.
Whether such therapy would work is simply unknown at this stage. Yet the treatment is being taken seriously by parts of the medical community as they strain to reduce Americans’ dependency on opioids, which has helped kill over 300,000 by overdose since 2000.
Virtual reality videos can help “unlearn” the “fear and avoidance that enhance pain and disability,” says Lynn Webster, a prominent, but controversial, pain authority, who has become a champion of the technology.
Last Monday, Webster argued the case at the International Conference on Opioids at Harvard Medical School in a talk titled “Virtual Reality Therapy Alternatives to Opioid Therapy for Pain.” He showed an animated video there, prepared by CognifiSense, from which the stills illustrating this article were taken. CognifiSense declined to permit Opioid Watch to post the video itself, citing “competitive reasons.”
“If we can replace twenty or thirty percent of the opioids with this kind of technology, then I want to be there,” says Webster in an interview with Opioid Watch.
Webster is advising CognifiSense, though both the company and Webster say he receives no compensation. (Webster is now Vice President, Scientific Affairs, at PRA Health Sciences.)
The technology is years away from the government approval it would require to be used as a medical device. CognifiSense declined to share testing results or testimonials. “Given that we’re in early developmental stage, we are not able to share publicly the details of our testing to date, except that the qualitative testing completed so far looks promising,” CEO Tassilo Baeuerle said in a statement. “Given this early stage, we also feel providing testimonials might be premature and not give a meaningful, balanced picture.”
But interest extends beyond the people working on the technology. The American Academy of Pain Medicine organized a session on virtual reality treatment for both acute and chronic pain at its most recent meeting. The technology seems “to be getting some traction in the field,” says Megan Drumm, an AAPM spokeswoman.
“It’s definitely worth studying,” says Philip Bain, a primary care doctor and division chief with Madison, Wisc.-based SSM Health Dean Medical Group, an integrated healthcare system. “Chronic pain is very complicated and different things work for different patients.”
Already, virtual reality video games are used in hospitals as a distraction technique, especially with children, to minimize anxiety and acute pain.
By occupying the patient’s attention, a virtual reality game can shut down neural pathways in the brain that might otherwise be transmitting pain.
CognifiSense has made these types of games, but the technology Webster is advising on would push the use of VR even further, into the more challenging realm of chronic pain. Chronic pain is a broad category, encompassing some forms of pain whose origins are obvious—like bone spurs, or damaged nerves after auto accidents—as well as others that are unidentifiable through examination and are a medical mystery.
(Purdue Pharma, maker of the opioid OxyContin, awarded CognifiSense a grant of unspecified size in January. CognifiSense says it was for a different proprietary technology, which attempts to use VR to measure and quantify pain. Webster says he did not know of the Purdue grant.)
Tassilo Baeuerle, the German-born chief executive whose career includes stints running manufacturers of green building materials and auto parts, called Webster last year and asked him to join a board of pain physician advisers.
Webster, 67, was an attractive candidate because he had been president of the American Academy of Pain Medicine, Baeuerle said in an interview. “He’s well known in the pain industry and has a lot of great insights and he wants to do things differently.”
In 2015, Webster published The Painful Truth, a book about the plight of people living with chronic pain. In 2017, he released a PBS documentary with the same name.
Webster says he agreed to advise, without compensation, because “my motivation is to find safer and/or more effective therapies [than opioids] for people in pain.”
“This technology won’t make you not care about the pain, but it can help remove the anxiety that augments the pain.”—Lynn Webster, MD
In an interview, Baeuerle says that he has long been fascinated by evidence that the brain can adapt itself to relieve pain. “We have to stop putting band-aids on the symptoms of chronic pain and address the root causes,” he continues.
Opioids work by “fogging up, suppressing pain, making you not care about it,” Webster says. “This technology won’t make you not care about the pain, but it can help remove the anxiety that augments the pain.” Eventually artificial intelligence could be used to customize treatments for each individual patient, he adds.
Webster’s promotion of a nonopioid technique for relieving pain represents a pivot for a physician whose reputation has been buffeted by the opioid crisis.
Trained as an anesthesiologist, Webster headed the Lifetree Pain Clinic in Salt Lake City from 1990 to 2010. In 2010, the DEA raided it as part of an investigation into opioid-related overdose deaths, but the US Attorney later declined to prosecute.
Webster is also one of a four “key opinion leader” doctors who have been identified in hundreds of lawsuits by municipalities across the country as having been used by manufacturers, like Purdue Pharma, to propagate false messages underplaying the risks of opioids. In scores of cases—at least 80 now pending in federal court—Webster and two other pain authorities have actually been named as co-defendants in those suits. The physicians’ lawyers have moved to dismiss those suits, and the cases have been stayed while the parties try to work out a resolution.
“I never promoted the use of opioids without talking about the harm of opioids,” says Webster. “I don’t think the companies told me there was no addiction. I learned in medical school that opioids were addictive, and when I started prescribing them, I worried.”
These days, Webster says, he advocates an approach that includes opioids in moderation, but doesn’t rely on them.
Webster blames insurance companies for some of the rise in opioid prescribing. “At the turn of the century,” he says, “we had a thousand multidisciplinary pain clinics, and the insurance companies wouldn’t pay for them.”
In light of the opioid crisis, he says, “we desperately need safer therapies than opioids as we know them today. Maybe VR will be one option.”