Conference Peers Into VR's Future in Medicine

It was an emotional moment for Clarke, 35—who has struggled with the pain of Crohn’s disease, ulcerative colitis and related health problems since his teens—as well as for attendees of the second annual Virtual Medicine Conference.

The two-day gathering, which drew roughly 400 people from about a dozen countries, featured talks by Cedars-Sinai virtual reality experts along with researchers and technology executives from other major institutions.

VR’s seemingly vast potential to deliver the sort of alternative pain relief that Clarke described—by providing the distraction of a deeply immersive experience—was one of the key themes. Speakers also touched on many other uses of VR and related technologies. That included the use of avatars for mental health counseling for patients—including soldiers traumatized on the battlefield—who lack access to a psychiatrist or who ordinarily are reluctant to talk about their psychological scars.

Likewise, experts talked about techniques to help dementia patients recapture memories from their youth, to provide early detection of reading problems among young children and to improve training for surgeons and other healthcare workers.

Yet throughout the conference, the high hopes expressed for the technology were balanced against reminders of its limitations and the need for more research to find out about its actual benefits.

VR sometimes is thought of as simply a gaming technology that requires players to wear headsets with big goggles to enter a 3-D virtual environment. But as Brennan Spiegel, MD, director of Cedars-Sinai Health Services Research and the founder and co-director of the conference, views it, the technology of VR is evolving. The field is not about a specific device, but rather "a new type of immersive therapeutic," which uses sensory stimulation in ways that can, among other things, "manage pain, lower blood pressure and combat anxiety using a technique that does not rely on medication," added Spiegel, a professor of Medicine.

With the nation’s opioid crisis as a backdrop, one researcher after another addressed the idea that VR could be part of the solution.

Melissa Wong, MD, a fellow in Maternal-Fetal Medicine at Cedars-Sinai, outlined her research that is tracking whether VR is effective in helping women cope with the pain associated with labor contractions. Milton Little, MD, a Los Angeles orthopaedic surgeon affiliated with Cedars-Sinai, discussed his randomized controlled trial on post-operative pain control.

The evidence so far, Little said, is that patients appreciated the use of VR, and the technology is associated with "less of an increase in post-intervention pain, which I think is a big deal." Little said the evidence also shows "a trend toward decreased opioid usage," although the difference so far in the trial is not statistically significant.

Perhaps the most dramatic testimony about the potential pain relief benefits, however, came from the personal stories of four patients who participated in a panel discussion on their experience with medical VR.

Clarke told how he hit his low point in late 2017. He was feeling "trapped in a hospital bed," separated from family because of his compromised immune system, in extreme pain, unable to eat or drink, and in need of emergency surgery to have his large intestine removed.

"I was in a very depressed, dark place in my life, death was looming all around me, and I really thought my life was coming to an end.... So, when Spiegel came in, I was like, 'Really? You're going to treat my severe pain with some technology? This is ridiculous.' But he said that this may be able to help manage, may help me sleep better, just feel a little bit better. So, at this point, I was willing to try anything."

After putting on a clunky headset, Clarke chose to be immersed in a simulated adventure involving flying over waterfalls in Iceland.

"For those few minutes, I viscerally felt like I was in Iceland, like I could feel the sun glistening on my skin," he said. "I could hear the waterfalls. It was almost like the water was splashing in my face, like I was there. I’ll never forget that moment.... The nurse came in a few hours later, she said, 'You haven’t requested your pain medicine yet.' And I realized that I had gone far beyond my normal time regimen for pain and it was because I was so immersed in this world, and that's when I realized there that were alternatives to the pain medicine."