Virtual Reality to Treat Pain

Virtual reality has opened the door for endless possibilities in treating medical conditions including pain management. Chief Medical Officer of Samsung electronics of America, Dr. David Rhew, joins Hari Sreenivasan via Google Hangout to discuss virtual reality advancements in the medical profession.

TRANSCRIPT

Virtual reality has opened the door for endless possibilities in treating medical conditions, including pain management.

Chief medical officer of Samsung Electronics of America, Dr. David Rhew, joins us via Google Hangout to discuss virtual reality's advancements in the medical profession.

Thanks for being with us.

So, you've got a background in both engineering and medicine.

When you see what's been happening with virtual reality over the past few years, what's been going through your mind?

Well, I think the first thing is I'm surprised because I hadn't envisioned how consumer technologies that today are oftentimes thought of as toys, entertainment devices -- possibly even ways that you could consider using them for training -- could be used to actually treat medical conditions.

And that is something that we're starting to see not just through anecdotal evidence but through clinical trials.

We're talking about randomized controlled trials where patients that are hospitalized are randomized to VR versus watching the same type of content on a TV screen, are demonstrating statistically significant reductions in pain and in trending towards lower narcotic use, so some amazing results that we're seeing from clinical trials, and the patient stories are just as amazing, as well.

You know, we saw a glimpse of this in a story that we had done about how it's being used to prevent opioid addiction and, you said, decrease narcotic use.

I mean, the immediate aftermath of a surgery is one of those times where people start to get addicted at large numbers.

Explain how it works.

Why is VR successful at getting us to feel pain differently?

Yeah, I think the first thing that we recognize is that, when you put on the VR headset, you're immersed into a new environment.

And this new environment is, in many ways, tricking your brain to believe that you are in a different place, in a different state of mind.

And during that process, while it may just seem like you're being distracted from the pain, there's some neurochemical changes that are actually occurring.

We've seen this on functional MRIs, where the individuals that have pain, when they have a functional MRI, you can see a significant amount of activity.

But with the VR treatment and even after you've removed the headset, you can see that quiets down.

So what we know is that there's actually something going on behind the scenes, within the brain, at the neurochemical level.

And what's remarkable is, when you do take the headset off, for a large number of these patients, for one to two hours and sometimes longer, they're able to actually have sustained pain relief.

Now, what we believe is going on is it is in some ways breaking the pain cycle.

What ends up happening is, with many of these individuals, they are in such constant pain that it just feeds off of itself.

But when you break that pain cycle, you now have an opportunity to apply some of the techniques that we do know are effective -- mindfulness techniques, deep breathing, and other things that, when you were in the state of acute or chronic pain, it was difficult to recognize how to do, but you now have an opportunity to be able to apply that.

And that's given us the opportunity to start thinking about how we can use this not just for acute pain management but also for chronic pain management and for those addicted to opiates.

So, give me an example of how someone might be able to use this.

Let's say -- I mean, would a doctor be prescribing, say, 'Hey, listen, this is part of your pain-management regimen.

I want you to put this headset on for --' I don't know -- 'five minutes a day.'

Or how would it work?

Yeah, so I'll describe a little bit about kind of how it's been applied in the clinical setting and where we see it extending outside.

So, in many of the clinical trials, the way it's been set up is that an individual is introduced to the VR.

And these are individuals that have real serious pain.

We're talking about cancer pain.

We're talking about pain associated with post-surgery, even women delivering babies.

So what we find is that, in those scenarios, the first line of treatment is, 'Go to the narcotics, go to the opiates,' because, really, that's all we know of to address such severe levels of pain.

What we find is, though, when the headset is provided and the person is immersed into this environment -- it's typically about a 10- to 15-minute video, calming video.

There's music associated with it.

It's been well-curated to the fact that we know that this type of content seems to work very well.

These individuals, within about a minute or so, very quickly get into a different state of mind, and that creates a very calming effect that, even, again, as they take the headset off, they remain in this quiet, calm state that allows their body to be able to better manage that pain for a longer period.

And what we've seen is we've seen that period of pain relief sustained in such a way that patients that have oftentimes required the narcotic pill in the hospital have opted not to take it.

And then, when they're sent home, what's remarkable is that many of these individuals have learned to apply some of those techniques and they're now starting to use this as an alternative to the pill.

And this is why we think that this is such an interesting opportunity to apply this as a non-narcotic alternative to address the opioid epidemic.

Give me some of the benefits from a doctor's perspective on when someone is in a calmer state.

What can you do more efficiently or effectively with a patient if they are breathing more regularly, if their blood pressure's lower?

I don't know what else physically happens when I'm calm.

Well, there's a couple of different scenarios.

First and foremost, if you were to think about even before certain procedures, this is incredibly helpful, and we've seen this done in the preoperative period, especially individuals that are nervous for the surgery and have a high level of anxiety towards the actual outcomes.

This puts them in a state where performing the surgery under normal physiologic conditions is far better than having a person come in who's agitated, anxious, with high levels of catecholamines.

What you want to do is you want to get them into an optimal state, both mentally and physically, prior to the surgery.

After the surgery, same type of concept.

In order for people to recover, what you're really looking at is an opportunity to bring people into a better state of mind.

And it's not just for surgeries.

We're really talking about multiple different types of use cases, everything from obstetrics to medical treatments such as treatments for pneumonia and sickle-cell pain crisis in kids, so really ranging the spectrum from pediatric to adult to OB-GYN to medical-surgical.

I mean, is this something where you could see a child being distracted on something like a shot or a blood draw or even a trip to the dentist's office, where people are thinking about what's happening in their mouth so much and they're so hyperaware of it that they might be triggered to pain faster.

Yes, that is actually one of the common use cases, where people have been using this as a means to calm individuals down prior to surgery and even distract them during the procedure, so removing a cast, giving a shot, doing a dental procedure, all of which have been done.

They're highly effective.

Where I think it gets interesting, though, is when you take the headset off, because of the fact that you can't be in a virtual-reality world all the time.

And what we realize, though, is that most individuals have a difficult time with mindfulness techniques -- you know, the deep breathing and being able to better manage one's pain and stress and anxiety.

And so if we can use this as a mechanism to be able to then introduce those techniques to them, to the individuals so they can better manage these conditions, then we have a really powerful tool in our armamentarium to address conditions ranging everywhere from chronic pain to those who may potentially have anxiety, stress, and conditions that oftentimes complicate the medical condition because of the fact that these individuals oftentimes are nonadherent to the medications and essentially in a different state of mind.

So you're saying that really the VR might be a gateway to better health practices when it's on your head.

Absolutely, and that's really what we want to figure out, and we're doing some clinical trials.

Already we've done clinical trials in the inpatient setting, looking at how this works.

Demonstrated a 52% reduction with a randomized controlled trial performed at Cedars-Sinai.

So significant findings from a clinical standpoint in the inpatient side.

We're now working with Cedars-Sinai and Travelers health insurance to deploy this for patients with lower back pain and other types of orthopedic injuries that are on disability or workers' compensation, and what we want to understand is how can this be used for chronic pain or longer-lasting pain, in which case we're now starting to employ other techniques in addition to that -- use of wearables, other mechanisms for deep breathing.

We've got a Bayer TENS unit.

What we call the 'digital pain-reduction kit' [Chuckles] is being deployed because we think there's a variety of different tools that can be useful in terms of managing these types of conditions.

All right.

Dr. David Rhew, chief medical officer for Samsung USA.

Thanks so much for joining us.

My pleasure.

Thank you very much for having me.