LOS ANGELES - Amanda Greene lives with pain.
"If I don't have nerve pain, I might have joint pain. If I'm not having joint pain, I might have headaches," Greene said.
The unrelenting pain is a symptom of lupus, an autoimmune disease in which a patient's immune system attacks the body. Greene has tried acupuncture, massage and opioids, but realized she was allergic to the addictive pain medicine.
The newest therapy that excites her: virtual reality. Greene participated in a test through the company "appliedVR" to see if and how virtual reality could help patients. Greene's virtual experience helped her to relax and trained her to breathe in a specific way. She saw a tree, crystals, water and her breath as she was guided to inhale and exhale.
"It worked. It works for me," Greene said. "It's the quality of life, it is the range of motion, it is like, forget about quality of life, it is the life."
VR in hospitals and clinics
Brennan Spiegel is a gastroenterologist who has used VR for his patients. He said abdominal pain and gastrointestinal discomfort, in some cases, are related to a patient's mental state.
"Something like virtual reality actually can intercede in the brain-gut axis and sort of rewire the neurocircuitry in a way that helps to reduce abdominal pain," said Spiegel, who is also director of Health Services Research at Cedars-Sinai and heads its virtual reality program.
More than 2,500 patients have been treated with virtual reality at Cedars-Sinai, a hospital with the largest documented therapeutic VR program in the world, according to Spiegel.
"Virtual reality can reduce pain, can reduce blood pressure, can improve quality of life, reduce anxiety and now, we're looking to see can it do really important things like reduce the need for opioids."
Spiegel said more than 100 hospitals across the United States are using VR as a form of therapy for patients to help manage symptoms such as pain and anxiety. He said an increasing number of countries worldwide are taking an interest, and doctors are starting to develop international guidelines on how to apply and validate the technology in health care.
Spiegel is now taking virtual reality outside the hospital to partner clinics such as Attune Health in Los Angeles, where many of the patients suffer from autoimmune or inflammatory diseases that cause symptoms such as joint pain.
A rheumatologist and founder of Attune Health, Swamy Venuturupalli is conducting a study on how VR can reduce the pain levels of patients in his clinic. Virtual experiences include swimming with dolphins and meditation exercises before a campfire. Venuturupalli said VR is not just a distraction for patients experiencing pain; it can also train them in deep breathing exercises and biofeedback.
"It allows you to connect with that part of your brain that you're normally not in contact with — the part of the brain that controls respiration, the part of the brain that controls your heart rate and the emotional part of your brain," Venuturupalli said.
Doctors are also looking into the potential side effects of VR, such as whether it could be addictive.
"It's probably unlikely and, in fact, we have not seen abuse amongst our patients who are using it for therapeutic purposes rather than for gaming or entertainment," Spiegel said.
The most common side effect for some patients, according to Spiegel, is "simulator sickness," the feeling of dizziness and nausea when the patient is wearing a VR headset. He said less than 10 percent of patients experience this, but the symptoms quickly disappear when the headset comes off.
VR pharmacy and clinics
The company appliedVR uses immersive technology to help people manage pain and anxiety. It also is developing content and working with people in entertainment and academia to find VR experiences appropriate for patients. The vision is to have a VR pharmacy.
"You need a wide variety of content because you have a wide variety of people in health care. From infancy to geriatrics and with every personality type," said Josh Sackman, president and co-founder of appliedVR.
Swimming with dolphins may relax one patient, yet terrify another. Greene said watching a fashion show in virtual reality helps her escape her pain.
The medical world's reaction to using VR in the clinical setting has changed in the past three years, said Sackman. In 2015, he experienced skepticism among doctors who wondered why television or a tablet couldn’t be used to distract patients. Sackman said that unlike a screen, VR blocks out the sights and sounds of a hospital or clinic as soon as the patient puts on the VR headset.
"In a matter of moments, you see a patient who is in agony, in terrible pain, stressed, having panic and all of a sudden, their body relaxes, a smile comes on their face and you see a physical transformation," Sackman said.
Spiegel would like to create outpatient VR clinics. He said the aim is not to have patients stay in VR forever.
"The idea is to learn while you're in virtual reality, that you do have governance over your body, that the mind matters and that you can learn these skills that are then reproduceable and could be called upon when you need them in the real world," Spiegel said.