A patient coming to Harvard Medical School’s Spaulding Rehabilitation Hospital for chronic back pain in recent years might have been asked a question: Would they like to try a virtual reality treatment? If they were game, they could have joined a study in which they supplement physical therapy and medication with time in relaxing virtual worlds of their choice—like seascapes or forests—designed to distract their brain from their pain and reduce stress and anxiety.
It sounds futuristic. But Spaulding’s was just one recent example of 550 active clinical trials examining the potential that virtual reality (or VR) has to help heal us, body and mind.
In fact, the medical community has been studying this technology for over 30 years, according to Bob Fine, the president of the International Virtual Reality Healthcare Association. But Fine says recent advancements in technology—particularly the advent of relatively affordable and user-friendly Oculus headsets—and the trumpeting of this tech by public figures like Mark Zuckerberg, has accelerated both interest and activity over the last decade, and in particular over the last two years.
“The industry is very much thinking about this now—they are really recognizing it,” Rich Birhanzel, health consulting lead at Accenture, says.
As a whole, the sector is buzzing. In 2021, the virtual and augmented reality health-care space gained $198 million in investment, which doubled from 2020, and 2022 has seen multiple multi-million dollar investment rounds raised by VR health startups. Fortune Business Insights valued the global VR health-care market at $628 million in 2022, and projects it will grow to $6.20 billion by 2029. Fine has personally seen the membership in his organization double over the past year. “Every day I'm hearing about a new company or a new application or a new researcher,” Fine says. “In my mind, it's a golden age for VR and health care.”
“In my mind, it's a golden age for VR and health care.” Bob Fine, president of the International Virtual Reality Healthcare Association
The Food and Drug Administration (FDA) has taken notice. In July 2022, the regulatory body held a two-day summit specifically to discuss the possibilities and risks of VR in health care, and identified five main areas where it sees the tech’s potential: mental health, neurological disorders, pain management, pediatric conditions, and surgery.
The Veterans Administration, which is the largest health-care system in the country with 9 million members, is already putting some of this tech to the test. It has a rapidly growing VR working group where clinicians share best practices about their VR programs: In 2019, there were 10 people representing eight medical centers; today, there are 1,300 people representing 165 centers. The VA is in a unique position to innovate because it is both provider and payer—meaning, it doesn’t need to get insurance companies to sign off on its practices. “What we've been able to do, and do it at major scale across our entire health-care system—we have headsets in every state—is to actually implement what we've seen in research,” Anne Bailey, PharmD, the director of clinical tech innovation at the VA, says. “That creates a market for all these industry companies to actually see an opportunity for VR use in health care.” Dr. Bailey says the VA is using VR for clinical care in suicide prevention, anxiety, depression, social isolation, procedural education, and more.
But before VR can go truly mainstream, more research needs to be done to prove to the FDA, and then insurance companies, that VR can be an impactful form of health care. “What really drives adoption oftentimes is reimbursement,” says David Binder, MD, the director of innovation at Spaulding.
Right now, overlapping crises in chronic pain management and mental health, coupled with a health-care worker shortage, are adding urgency to VR applications for these arenas in particular. Studies at places like Harvard and Cedars Sinai hospital in Los Angeles are amassing evidence about how immersive VR worlds can play a part in pain management and rehabilitation. Dr. Binder says there is even some evidence that doing VR therapy after surgery might reduce the need for pain medication, including opiates.
In November 2021, the FDA granted approval to the first VR device that doctors can prescribe for chronic lower back pain relief. A post-surgical pain management tool from a company called Pear Therapeutics is also on an FDA fast-track for approval. Pear’s CEO Corey McCann, MD, PhD, explains that the tech activates certain neural circuits so that pain isn’t perceived. “That's something that you can do better with more immersion via the goggles,” he says.
n November 2021, the FDA granted approval to the first VR device that doctors can prescribe for chronic lower back pain relief.
Mental health is another promising area for VR. For instance, University of Queensland researcher Nilufar Baghaei is studying how an interactive VR game can teach self-compassion by interacting with a VR character who needs help. Others are working on virtual cognitive behavioral therapy educational modules, mindfulness training programs, exposure therapy for phobias or post-traumatic stress disorder, and more. “There are a lot of interesting studies in this space, especially on anxiety, phobia, pain management, and addiction,” says Baghaei, who co-authored a review of studies on the use of VR for treating depression and anxiety. And, she adds, they’ve seen “promising results.”
Anyone who can get their hands on a headset can already experience some form of mental health VR. There are several meditation apps available in the Oculus store. One consumer-facing company, Flowly, incorporates user data like heart rate to teach breathing and anxiety management skills. “Our oldest members are in their late 80s and use VR more than their grandkids,” says Celine Tien, Flowly founder and CEO. Flowy operates on a subscription model, which includes providing a VR headset, and costs between $10 and $30 per month, depending on your subscription tier and time commitment.
There are also a few ways researchers are using VR on the health-care provider side. To relieve stress among nurses, one Miami hospital provided nurses with relaxing VR experiences they could do on their break. At the VA, trainees are using VR to gain an understanding of what a patient’s discharge process is like in order to help them anticipate questions and build empathy. VR is being used to help clinicians understand “what it's like to experience the world as a patient with dementia or Parkinson's or as someone who identifies as LGBTQ,” Dr. Bailey says. “We've seen some very triggering reactions and moving responses from our clinicians and caregivers who have these ‘aha’ moments once they've been in that immersive environment.”
Taken all together, VR’s most exciting opportunity is that it can possibly address multiple components of these issues at the same time. For example, anxiety, pain, and depression manifest in related areas of the brain. “With virtual reality, it's not just about one indication or one condition,” Dr. Bailey says. “If you hand a device to a patient that has chronic pain, you may also see improvement in anxiety and depression, which are very often comorbid. ”
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Ideally, this sort of treatment could be done at home, which could help free up overtaxed health-care workers. “Therapists report being at their all-time capacity,” Flowly’s Tien says. “VR apps like Flowly allow people living with anxiety or pain to engage in biofeedback training for relaxation from the comfort of their homes, without a waitlist to get started.”
Still, getting insurance companies to cover VR applications will require studies that are larger and that demonstrate that using the tech cuts down on care costs. And while the Oculus Quest 2 (which has a starting price of $350) has been a leap forward in VR tech, experts all point to needed advancements that make wearing VR goggles less clunky and more enjoyable.
2023 may hold some promise for overcoming those roadblocks. Developers will begin to get their hands on the new Meta Quest Pro ($1,500 and up), which debuted in October. Apple will reportedly release its first VR headset next year as well. Flowly will be releasing the results of its National Institute of Health-backed study, and Fine expects that more of the companies he works with will be applying for FDA approval. Dr. Bailey says tech companies are coming to the VA, looking for input on how they can design headsets that are better suited for health care.
“I think we have a responsibility to do everything we can to deliver the best, most advanced health care in the world,” Dr. Bailey says. “VR is the bleeding edge of health care.” ✙
Opening Photo Credit: Stocksy/Victor Bordera, Hero Photo Credit: Stocksy/Sergey Narevskih
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