November 10-15

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ACR Convergence 2023

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Virtual reality shows promising results for pain management


3 minutes

Brennan Spiegel, MD
Brennan Spiegel, MD

With an ongoing opioid epidemic spreading across the United States, clinicians are increasingly looking for alternative pain management strategies. Virtual reality therapy has gained the attention of clinicians across a variety of specialties and may prove useful in the treatment of rheumatic diseases.

An expert on this novel therapeutic tool will share the lessons he’s learned about this emerging technology during Top 10 Lessons Learned Using Virtual Reality for Pain Management. The clinical symposium will take place from 7:30 – 8:30 am Wednesday in Room 5 B.

Brennan Spiegel, MD, Director of Health Services Research at Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, said that virtual reality has proved successful in treating pain. It also has been used to treat a variety of other conditions from anxiety and depression to high blood pressure.

“A couple of years ago, we started using virtual reality for patient care,” Dr. Spiegel said. “We have developed a sort of library of virtual reality experiences. We call it a ‘virtual reality pharmacy.’ If you can find the right virtual reality prescription for the patient based on their needs and conditions, you can see remarkable results.”

Dr. Spiegel describes virtual reality as an immersive experience.

“It sort of highjacks the brain,” he said. “It makes the brain think the body is elsewhere. With virtual reality, we can help people with pain escape their bodies and go on fantastical journeys. They can fly over glaciers. Sit on a beach. Meditate.”

Dr. Spiegel’s research has shown this type of virtual reality therapy can reduce pain by about 24 percent, on average, compared to control conditions.

“Anti-inflammatory medications and other pain-reduction strategies only go so far,” he said. “We need to support traditional therapies with alternative treatments, and using virtual reality therapy is very effective. For example, we have been able to show that virtual reality reduces pain over and above opioids. In a controlled trial, we’ve shown that if you have two groups getting equal amounts of opioids, the group receiving virtual reality has greater pain reduction than the group just getting opioids.”

While this is promising, Dr. Spiegel said, studies have not yet proven virtual reality can reduce opioid dependence, though a couple of studies are underway to specifically answer that question.

“We’re also starting to look at people who have not yet started opioids,” he said. “We’re studying patients with acute musculoskeletal injuries. These are patients at risk for being placed on opioids for the first time during their recovery period. There’s striking new data that just came out from the CDC earlier this year that shows just one day of opioid exposure predicts a 6 percent risk of dependency a year later. So even the smallest amount of opioids starts to increase your risk of long-term dependency.

“Can we introduce virtual reality systematically to supplement non-opioid pain management to get patients through difficult patches without having to use opioids?”

In addition to reviewing the evidence about the effectiveness of virtual reality as a therapeutic tool, Dr. Spiegel will share important practical lessons he’s learned since he began using virtual reality in the clinic.

The session will include a practical discussion of the nuts and bolts of using virtual reality clinically. He will talk about the types of headsets to use, how to instruct patients on their use, and how frequently patients should use this therapy. He will also discuss how virtual reality can help with the mental health aspects of pain management.

“They go hand in hand,” Dr. Spiegel said. “Pain is a mental problem as much as it is a physical problem. Virtual reality, when used correctly, can address some of the physical aspects of pain, but it can also address some of the cognitive and psychosocial components of pain.”