Letter from the Editor

Dear Reader,

As I write this, I have a headache. I am in good company– 45 million other Americans will suffer from chronic headaches this year.

Wouldn’t you be outraged if you knew that one in five people worldwide suffered from a chronic disease that was largely ignored and under-treated? Yet, that is often the case with chronic pain, for a variety of reasons:

• Pain is subjective. My pain and your pain are very different. How can we describe it? Only recently have we been encouraged to use a common vocabulary, such as stabbing, burning, or throbbing, to communicate our pain to our doctors, along with the familiar 0-to-10 scale.
• Secondary pain takes a back seat to a primary diagnosis. If a doctor discovers I have cancer, they will concentrate on treatments that will result in complete remission. Pain caused by the tumor or the treatment is recognized, but in the doctor’s mind, and maybe in my mind too, alleviating the pain is less important than fighting the cancer.
• “It’s all in your head.” Certainly, pain has a psychological component. If I am depressed, I am more likely to have chronic pain. If I allow my negative emotions to take over, my suffering may increase. Nevertheless, this is no reason to ignore my pain, rather, my underlying psychological condition needs to be addressed, too.
• If I am a member of a minority group, I may not have equal access to treatment. If I am an African-American living in the U.S. or Western Europe, painkillers may be unavailable in my neighborhood. These barriers to effective treatment are greater in developing countries and in resource-limited neighborhoods worldwide.

The cost of pain is both financial and emotional. “Pain in itself probably costs the American population upwards of $120 billion each year,” says Marc Hahn, D.O., president of the American Academy of Pain Medicine. “That’s not only in its medical treatment, but in its impact on society, in missed days, and decreased productivity at work.” The International Association for the Study of Pain estimates that the global cost is about the same as the cost of cancer or cardiovascular disease.

We cannot ignore the emotional cost of chronic pain. Pan-European and Danish studies found:

• From one-half to two-thirds of chronic pain patients were unable or less able to exercise, enjoy normal sleep patterns, perform household chores, attend social activities, drive a car, walk, or have sex.
• For one in four sufferers, relationships with family and friends were strained or broken.
• For one in three sufferers, an independent lifestyle was either no longer an option or difficult to maintain.
• For one in five sufferers, depression was a comorbid condition.
• Some days, 17% of sufferers wanted to die. Among chronic pain sufferers, 39% felt their pain was inadequately managed, and half of these individuals felt their doctor did not view their pain as a problem.

At CyberTherapy & Rehabilitation, we believe that virtual reality pain-management systems can be an important part of the solution. Preliminary results from a study conducted by The Virtual Reality Medical Center (VRMC) showed a 75% drop in self-reported pain ratings, correlated with higher temperature ratings, indicating immersion and physiological stabilization. In studies using VR software at the clinic with patients experiencing pain lasting longer than two years in duration, these patients achieved a 50% reduction in pain symptoms in addition to improvements in quality of life scores.

How does it work? We do not have all the answers yet, but Hunter Hoffman has done the most work in this area. His brain imaging study showed that distraction has a real effect in decreasing the intensity of pain signals in the brain, and preliminary research indicates that VR actually changes how the brain physically registers pain, not just people’s perception of the incoming signals. His latest published research on the effect of VR on pain shows a reduction of 30% in reports of “worst pain” (sensory component of pain), 44% in “time spent thinking about pain” (cognitive), and 45% in “pain unpleasantness” (emotional). It is interesting to note that this type of treatment can offer relief from the mental affects of pain as well as the physical component of pain itself.

Hoffman’s work and others is further proving the advantages of using VR as a nonpharmacological treatment option for pain sufferers. Distraction of procedural pain in children appears to be the most mainstreamed of the uses for VR pain distraction because of the desire to avert the risks of using anesthesia with children, but as we gain more insight into the ways VR can provide distraction and pain relief, the applications will become more widespread.

Additional very exciting work is ongoing by Dr. José Mosso of Mexico City. Dr. Mosso has used VR to eliminate general anesthesia in over 500 patients during minimally invasive surgical procedures. The fact that VR can provide significant improvements in safety for patients is really remarkable. Finally, many of these applications continue to be supported on mobile phones and other handheld platforms. This will go a long way in migrating the advantages of VR in the clinic to outpatient settings and the patient’s home.

With the worldwide trends of reduction of healthcare costs and expansion of coverage to all citizens, we encourage increased funding of large-scale clinical trials for pain-relief alternatives. We look forward to the consequent acceleration of the mainstreaming of VR to the millions worldwide who will thank us for easing their pain.

Create your own reality!

Brenda Wiederhold