Virtual reality (VR); a computer-generated, 3-dimensional, interactive environment, is increasingly used in medical settings as an adjunct (VR-augmented rehabilitation), or a replacement for conventional therapy (VR-based therapy), in a variety of conditions. Some simulations use a teach-by-example approach, some use an active, video game-style, and some are designed to expose the patient to a phobia or past traumatic event.
VR therapy can be administered in a distance-based, or telerehabilitation format and offers increased adaptability and variability compared to some forms of conventional therapy, as well as transparency in data storage and reduced medical cost.
Cognitive behavioral therapy (CBT) along with exposure therapy, is effective and has been viewed as the standard of care for PTSD. However, real-world exposure, as would be required in CBT can be difficult for PTSD patients, or even impractical for some patients, such as combat veterans. VR therapy provides a compromise that makes exposure therapy more tolerable and easier to access.
VR creates an immersive simulation of the patient’s initial trauma and virtually exposes the patient to visual, auditory, and proprioceptive stimuli they perceive as threatening of fear-inducing. The goal is for the patient to gradually generalize the virtual experience to their current, safe reality through repeated exposures in the virtual environment. This allows a treating physician to recondition the patient’s responses and reduce hyperarousal and reactivity, thus allowing trauma-associated memories and physiological reactions to be diminished or even potentially extinguished.
In an early study which used VR therapy for veterans that had both traumatic brain injury (TBI) and PTSD from blast exposure, participants reported modest symptom improvement and decreased avoidant behavior in everyday situations, i.e., restaurants, subways, movie theatres. A recent meta-analysis found significant improvement in depression across studies, however, there were mixed results for anxiety.
VR therapy has been found to reduce pain and anxiety in chronic pain patients and has received high patient satisfaction ratings. VR works, in part, by distracting the patient’s focus away from painful stimuli and is based on an inherent central nervous system pain-inhibiting mechanism. It reduces the need for sedatives and analgesics, resulting fewer adverse side effects and lower risk for addiction. VR used in the context of chronic pain also reduces costs and speeds recovery time by eliminating the need for expensive procedures. Additionally, VR can help build pain-management skills, such as regulating breathing to control pain and increasing a patient’s sense of control.
This year, the FDA approved VR for treating low back pain based on the results of a clinical trial in which 66% of participants (vs 30% of controls) reported > 41% pain reduction. Similar results were obtained in another study in which patients with work-related injuries received home-based VR therapy and reported an average of 40% pain reduction as well as reduced depression and fatigue and improved sleep; and 69% reported reduction or cessation of opioid use.
For many years the healthcare system has relied on subjective patient reports as the standard for pain measurement. However, pain is highly subjective and unique to each individual. It is difficult to objectively quantify and is both influenced and mediated by emotional and cognitive states.
Pain is known to cause movement to become slower and stiffer and VR technology has the potential to objectively measure pain levels by correlating pain with changes in movement patterns. In a 2019 study, VR was used to identify characteristics of movements that indicate pain effects and was able to quantify those effects. This creates an objective pain scale that can be used to guide treatment decisions and assess patient progress and treatment efficacy, which opens the possibilities for creating pain scale models which are specific to patient characteristics, such as age or sex, types of pain, and pain-response types.
Workplace Safety Training
The development of VR for workplace safety and injury prevention is expected to dramatically alter the structure and administration of worker’s compensation. VR training addresses every level of the safety chain, including the individual (attitudinal), group (information exchange), and organizational (resource) levels. In a study of construction site safety, immersive VR training resulted in a significant safety advantage over conventional lecture-based methods. VR was more effective at maintaining trainees’ concentrated attention and was more effective over time than conventional training. The benefits occurred in task-related, but not general site safety. Another study found that immersive VR safety training improved safety-related knowledge base among workers with short-term work experience and civil engineering students, two groups at increased risk of injury on construction sites.