Can rheumatologists use virtual reality (VR) to manage pain for patients with rheumatic conditions? Learn more.
What is virtual reality, and can it be used as an adjunctive therapy to address pain for patients with rheumatic conditions? In a session titled "Into the Metaverse: Virtual Reality Advances to Treat Pain" presented at ACR Convergence 2022, Dr. Nancy Baker, an Associate Professor and Chair of Occupation Therapy at Tufts University explored the key mechanisms of virtual reality (VR) that make it an effective modality to address pain and discussed how rheumatologists can integrate it into clinical practice.
Dr. Baker began by sharing data from her scoping review of VR's role in pain management, which incorporated research from 70 studies used to represent 4,000 patients. Data from this review showed that VR was effective in managing rheumatic pain and chronic pain, measured by assessing the intensity and quality of the pain, but there was very limited data available on the role of VR in managing chronic pain.
This scoping review is what prompted Dr. Baker to dive into this area further. She emphasized that VR is a great choice for pain management, even chronic pain management, for several reasons: it's relaxing, provides escapism, is a distraction from pain, can be interesting and fun, and is non-invasive.
Dr. Baker then took a look at some of the mechanisms of VR, defining it as a three-dimensional life-sized computer-generated environment interacted via a headset that can place patients on the reality/virtual reality continuum. It combines augmented reality and augmented virtuality to create something she referred to as mixed reality. And she stressed that this immersive mixed reality can be a great alternative to more invasive treatment options for pain.
The primary benefit? According to Dr. Baker, it's finding distractions to pain. By helping patients engage resources that would otherwise be used to attend it pain, it redirects their focus. And for patients suffering from chronic, daily pain, it can be used to improve their overall quality of life.
But another unexpected benefit can be found in the embodiment of pain. VR offers patients an opportunity to have a subjective experience where they can see a simulated body and the properties of that simulated body are processed as if they are the properties of the person’s own biological body.
Dr. Baker demonstrated this through the "rubber hand illusion," an experiment where one volunteer sat with his left arm placed in front of him, his right arm placed on another table, with a lifelike rubber hand placed in front of his right shoulder. A piece of cloth was placed on her right arm to prevent the volunteer from seeing it.
To induce the illusion, one of the researchers stroked his right arm and the rubber arm with two rulers simultaneously for a few minutes. After that, the researcher just stroked the rubber hand, but the volunteer believed he was still feeling the ruler. According to the researchers, his brain had then concluded that the rubber hand was an actual part of his body.
According to Dr. Baker, this illusion proves that VR can help with guided motor imagery, and be a resource to patients looking to treat their pain.
Dr. Baker then focused on implementing VR in the clinic, and emphasized a few key considerations for rheumatologists interested in doing this:
- Match the VR interface to the patient's goals and preferences. It can be customized and adapted, so it should be developed to best fit the needs of the patient
- Share any potential adverse events with patients, such as visual occlusion, motion sickness, and infection
- Encourage rheumatologists to be trained in the use of VR systems and software and do more research on VR to support specific utility
- Be aware of potential barriers, such as client acceptance, institutional support, payor allowance, need for documentation of skilled intervention, equipment limitations, and overall implementation in practice
She ended her session by explaining that while VR is very much in its infancy, rheumatologists need to do more research and gather more experience to better understand the role of VR in the management of rheumatic pain.