By Mark Odlum

Virtual reality (VR) for pain control dates back to at least the 1990s, when researcher Hunter Hoffman at the University of Washington provided burn victims with a chilled environment and VR headsets that allowed them to move through an “icy” world, throwing virtual snowballs at virtual penguins.

While immersed in the game, the injured individuals were more easily able to complete painful processes such as having their bandages changed. Hoffman and his team discovered that when an individual was placed in a highly stimulating and engaging environment, they could be redirected from their own pain.

This discovery reinforces the Gate Control Theory, which posits that the “gate” through which pain signals travel to the brain can be opened or closed. “When we focus on one thing, it will close the gate on other thoughts, such as pain,” explains Celine Tien, founder and CEO of Flowly, a virtual reality therapy app aimed at helping individuals who live with pain take back control of their nervous systems.

“If I’m focused on the VR distraction, I’m not thinking about the pain; therefore, I do not feel it,” Tien explains.

Despite the success from these early studies, it was still the 1990s. Yes, we had Space Invaders and Tron, but VR technology was clunky, expensive, and required an entire room to set up the environment. Three decades later, VR technology has evolved dramatically, particularly with the ubiquity of smartphones.

“VR is safe, non-invasive, and you can literally do it in your bed,” says Tien.

Training the body’s responses through imaginary worlds

Virtual reality has been found to help treat the acute pain of an injury or medical procedure. But it can also be a useful tool in the long-term management of chronic pain. One of the ways this works is by combining VR with biofeedback therapy.

Biofeedback therapy uses sensors to measure key bodily functions, including heart rate and electrical skin conductance to reflect emotional states; similarly, neurofeedback measures electrical brain activity. Biofeedback has also been around for decades, but for a long time, it was bulky, difficult to access, and very expensive. Today, though, the service is much more accessible.

Flowly combines VR distraction with biofeedback’s long-term training of the body, through the combined use of a VR headset and a heart-rate sensor that clips onto the finger. “[Suddenly] you’re sitting on the beach or wandering through a bamboo forest,” Tien explains. “But at the same time, you’re actually seeing your real-time heart rate, which we’re collecting through that sensor on your finger. We’re actually teaching you in the VR experience how to not only decrease a rapid heart rate, but actually improve your own heart rate variability, which allows you to shift your nervous system from the fight-or-flight mode, where a lot of pain and anxiety lives.”

Easing the fight-or-flight mode to a “rest, digest, and recovery mode” allows the body to “recover, sleep through the night, and address much of the inflammation that happens with chronic pain,” Tien adds.

Virtual reality as a remedy for dysregulation

The reason VR can be helpful for so many different types of pain is because chronic pain causes dysregulation of the nervous system. In the case of acute-to-chronic pain—for instance, when an injury has healed but long-term pain persists—the brain continues to process pain signals, even when the root of the pain is gone. The nervous system starts to live in what is called “sustained fight-or-flight mode,” Tien explains. The system’s constant scanning for threats, or pain, makes a person living with pain anxious, elevating the heart rate and affecting sleep.

“[VR can] teach you how to shift into your rest and digest mode, on command,” Tien says. “And that is extremely helpful for people whose nervous system is dysregulated, which is the case for many chronic pain patients.”

A helpful tool in a variety of scenarios

Mark Johnson, PhD, a psychologist at IPM Medical Group, a California practice that focuses on the management of chronic pain, has experienced success in implementing virtual reality alongside other modalities in his practice.

One of his patients lives with complex regional pain syndrome (CRPS), a neuropathic condition that often stems from an injury and is characterized by severe pain that is beyond the scope of the injury. During one visit to Johnson’s office, the patient was experiencing a severe flare and entered the office holding up her arm so that it wouldn’t brush against anything.

“We put some goggles on her and set up a distraction application,” Johnson says. “I watched her arm gradually go down until she was resting it on the table. It only took about 10 minutes. She was amazed at the difference in her pain levels.”

He adds, “One of the main uses with VR is when pain levels are at such a significant level that we’re just trying to take the edge off and bring them back to baseline, or bring a flare-up back down to its normal level.”

Virtual reality therapy has been shown to help people with both acute and chronic pain, along with treating anxiety, depression, and sleep issues—all of which are tied to the nervous system. Everybody’s different. But we all have a nervous system.

“You go through school and you learn math, English, science, and a second language—things that a lot of times you may never use again. But no one has ever taught you how to control the biggest, most controlling factor in your body: your nervous system,” says Tien. “I really think it’s something everybody needs to look into, no matter which platform you use.”

Virtual reality companies, tools, and apps for pain

  • AppliedVR
  • BehaVR
  • CognifiSense
  • Cynergi VR
  • Flowly
  • REAL System
  • XRHealth