Miranda Felde, MHA, CPHRM, Vice President, Patient Safety and Risk Management, The Doctors Company
In 2016, the opioid epidemic’s toll hit $95 billion, with healthcare costs concentrated in emergency room visits, hospital admissions, ambulance use, and Naloxone use[i]—the personal costs to those who have lost loved ones are uncountable. The epidemic’s impact is far-reaching and has emotional, physical, and financial implications for our entire society.
Many physicians are exploring VR technologies as an alternative to prescriptions.[ii] The Gate Control Theory of pain, proposed by Melzack and Wall, suggests that a person may interpret pain stimuli differently depending upon mental/emotional factors such as attention paid to the pain, emotions associated with the pain, and past experience of the pain.[iii] VR addresses both attention paid to pain and the patient’s emotional state.
Getting Started with VR
To explore VR as an alternative therapy:
First, consider the distinctions between two key terms:
- Virtual Reality (VR): Provides an immersive experience via a computer-generated 3D environment for the user to explore. The user may be able to move objects or otherwise change the environment.
- Augmented Reality (AR): Adds sounds, videos, and/or graphics to an existing environment, such as an outdoor planetarium where AR viewing glasses show constellations highlighted in the sky.[iv]
Then, evaluate VR interfaces that are relevant for patients managing pain, such as:
- Head-mounted display (HMD): Like a heavy-duty pair of goggles plus headphones. Completely surrounds the user’s visual field for an immersive experience.
- Treadmills and haptic gloves: Allow the user to physically move around in the virtual environment, and to physically move objects within that environment.
Finally, weigh the value of interfaces that are more relevant for physician use, such as:
- Smart glasses: May look more like regular eyeglasses or more like safety glasses. May display information or help the physician capture information for the electronic health record (EHR).
- Desktop VR or Window on a World (WOW): Uses a desktop or laptop computer to run simulation programs.
Mitigating VR Patient Safety Risks
While therapeutic VR for pain management shows promise, there are patient safety risks.
- Falls: Patients wearing a full-surround headset cannot see their real-world environment and may walk into or trip over objects.
- Motion sickness: Many people experience some combination of eye strain, headaches, and/or nausea.[v] Patients who are ordinarily prone to any of these symptoms may not be good VR candidates.
- Psychological effects: The brain can store VR experiences as memories in almost the same way it stores physical experiences. Young children, especially, may confuse VR experiences with real experiences, especially when remembering them later.
- The unknown: VR technology is still in its infancy, and therefore, little is known about the long-term consequences of VR use.
The Future of VR for Pain Management
To reap the potential benefits of VR while mitigating its risks, clinicians could start with a two-part approach: identifying patients with specific clinical indications that would benefit from the use of VR and assessing patients for potential risk factors. Successful implementation of VR for pain management depends on wisely deciding which patients are VR candidates—and which are not.
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
 Castellucci M. Economic burden of opioid epidemic hit $95 billion in 2016. Modern Healthcare. http://www.modernhealthcare.com/article/20171116/NEWS/171119908. Accessed June 25, 2018.
 Barad J. New realities in medicine—exploring the virtual and augmented horizon. Panel presented at: A4M MMI World Congress. December 14-16, 2017; Las Vegas, NV.
 Li A, Montaño Z, Chen VJ, Gold JI. Virtual reality and pain management: current trends and future directions. Pain Management. 2011 Mar; 1(2): 147-157.
 Palladino T. National Geographic’s open-air planetarium displays augmented reality constellations through Aryzon viewers. Next Reality, June 21, 2018. https://next.reality.news/news/national-geographics-open-air-planetarium-displays-augmented-reality-constellations-through-aryzon-viewers-0185390/. Accessed June 25, 2018.
 LaMotte, S. The very real health dangers of virtual reality. CNN Website, December 13, 2017. https://www.cnn.com/2017/12/13/health/virtual-reality-vr-dangers-safety/index.html. Accessed June 25, 2018.