Virtual Reality in Medicine

Therapeutic virtual reality (VR), the use of the immersive, computer-generated technology in medicine, is on the fast track to widespread use. In some hospitals and clinics, your doctor can already prescribe a visit to a VR world to ease your pain or anxiety or to explain a complex medical procedure or condition.

Here’s how it works: Put on a motion-sensing VR headset (and sometimes handheld controllers) and your outside environment vanishes. It’s instantly and completely replaced with a 360-degree virtual world that you can enter, move around in, and interact with.

If you need distraction from pain or stress, you may find yourself beneath the ocean, surrounded by dolphins. As you float along, you can look up and see the sun shining through the water’s surface. Look down and you see dolphins swimming around and below you. You can hear the echo of the underwater world and the sounds of the big mammals that surround you.

The experience feels real, and that’s how your brain processes it. It’s this ability that gives VR so much therapeutic power and potential, says Brennen Spiegel, MD, professor of medicine and public health and director of Health Services Research at Cedars-Sinai Medical Center in Los Angeles.

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“Even if you know intellectually that you’re not at the beach, your brain can’t live in two realities at once. Instead, the brain accepts [the input] it’s given,” says Spiegel, author of VRx: How Virtual Therapeutics Will Revolutionize Medicine.

This sense of what scientists call “presence” in the virtual world means it’s harder for the brain to focus on other stimuli, such as negative input like pain and anxiety, Spiegel says.

“VR also triggers strong emotions, and we are primed to learn things when they are tied to emotion,” he says. The boost VR’s emotional engagement gives to learning opens up many other uses, from medical education to recovery from injuries and illness.

Why VR Is Set to Enter Mainstream Care

Doctors have studied VR for pain control and some other medical uses for decades. Now, however, advances in technology mean the hardware is cheaper, smaller, faster, more reliable, and easier to use. This means you can expect to see more and more options for therapeutic VR.

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“The current technology and hardware changes so fast and improves dramatically in such a short time that what we are using today will look quaint and antiquated in just a few years,” says David Axelrod, MD, a pediatric cardiologist at Stanford Children’s Health in the San Francisco Bay Area.

His group uses Stanford’s Virtual Heart program to teach medical students about congenital heart defects, explain complex procedures to patients and their parents, and to help surgeons plan surgeries.

When it comes to pain management, VR may help fill an urgent need in our society for nondrug pain relief.

“We are in the midst of an opioid epidemic and VR offers a drug-free option for pain control,” Spiegel says. He notes that many patients may still need medication, but the addition of VR therapy may reduce the need for drugs.

The FDA recognizes the medical potential of VR and last year held workshops to identify barriers to therapeutic VR and speed development of solutions. The FDA in 2020 granted breakthrough-device designation to a VR system designed to ease low back pain and fibromyalgia pain.

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This kind of recognition of therapeutic VR benefits may help hurdle the technology over one of its major barriers to greater use: insurance coverage, Spiegel says.

Here’s a look at some of the rapidly evolving uses of VR in medicine.

Pain Management

VR for pain control is one of the best-studied and most-used applications of the technology. Doctors have known for decades that this technological “distraction therapy” is an effective tool to combat pain and the fear of pain.

“Pain is a perception that’s coupled to your attention, mood, and emotions,” explains Thomas Caruso, MD, a pediatric anesthesiologist at Lucile Packard Children’s Hospital Stanford and professor of anesthesiology, perioperative and pain medicine at Stanford School of Medicine.

“With VR, we can help modulate a patient’s mindset to be less focused on pain and anxiety,” says Caruso, who is a co-founder of CHARIOT (Childhood Anxiety Reduction through Innovation and Technology), Lucile Packard’s immersive technology program in which more than 150 patients a month use VR as part of their treatment.

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When children are engaged in VR games, they often barely feel the stick of needle or an IV going in, Caruso says. Research has also shown that children who wear VR headsets have less pain during dental care. And children lose — or never develop — fears about these procedures. This means many can skip the sedation that doctors might otherwise need to use.

VR helps with pain control in adults, as well. When VR is used along with medication, it can reduce the severe pain people have during wound care for burn injuries.

It can also help people who live with ongoing pain. In one study of low back pain and fibromyalgia, VR reduced discomfort by more than 30%. Patients in the study were also much less likely to have pain that interfered with their sleep and mood.

VR can ease pain in people with many types of medical conditions, from cancer to orthopedic problems to stomach pain, according to Spiegel’s recent research.

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His colleagues at Cedars-Sinai are also using VR to make labor and delivery less painful. Their 2020 study found that women who used VR for 30 minutes during labor had less pain and lower heart rates than those not using the technology.

All this evidence that VR works to help control pain means Cedars-Sinai will this fall move VR from the research setting to a clinical pain service for hospitalized patients.

“If a patient is interested in VR therapy, they’ll get a visit from a specialist called a ‘virtualist,’ who at Cedars-Sinai is a psychiatrist trained in therapeutic VR,” Spiegel says. “The virtualist will do an evaluation to decide if the patient is someone who can benefit from VR. The technology is not appropriate for all patients or all medical conditions.”

If the virtualist decides VR can help the patient, they will then tailor a prescription for the technology. This includes deciding what kind of virtual experience will best help the individual and how often the patient should use VR.

“VR is like a syringe and it’s the medicine, which with VR is the software, that matters,” he says.

Medical Procedure Anxiety

Chemotherapy is a stressful and sometimes uncomfortable experience. Some medical centers now use VR to help their patients escape from anxiety or the boredom of treatments that can take hours.

Instead of being stuck with a view of IVs or focused on discomfort or worry, patients can put on headset and find themselves in a winter forest, a flower-filled meadow, or on a peaceful beach. A 2020 review of more than 20 studies found VR reduced symptoms of anxiety, as well as depression and fatigue.

Doctors can also use VR to explain complex procedures to young children and their parents. Children who are set to undergo brain surgery, for example, can now use the technology to “fly” through 3D images of their own brain as their surgeon explains exactly what will happen during their procedure.

“Kids think of it like a video game. They use a joystick to zoom in through corridors in their brain, look at their tumor, and view things upside down,” says Gerald Grant, MD, endowed professor of neurosurgery and division chief of pediatric neurosurgery at the Brain and Behavior Center at Stanford Children’s Health.

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VR, he says, brings kids into the process and takes away some of their fear.

“I love it because it engages the kids, who otherwise might not take much part in the conversation,” Grant says. “Often, they name their tumor after some evil superhero and go after it. We give them the ability to shoot at it. It really takes away some of the mystery and fear for the whole family.”

Physical Therapy and Rehabilitation

Therapists are using VR to help people rehabilitate from strokes, Parkinson’s disease, and injuries.

With VR-based physical therapy and rehabilitation, therapists can choose software that helps the patient improve specific skills and targets individual problems. Patients get immediate feedback on how well they’re doing exercises. All of this, along with the immersive engagement of VR, may help motivate patients to do more than they think they can.

Caruso says one of the most striking uses of VR he’s seen has been in children with complex regional pain syndrome (CRPS), a condition that causes ongoing pain in one or more limbs.

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“Children with CRPS can have pain every day of their life,” he says. “With VR rehabilitation, the therapist may use a program in which they make specific movements to squash watermelons. Because they are now focused more on squashing those watermelons instead of on their pain, they can participate more fully in rehabilitation.”

Caruso says this helps propel kids to get better faster. “I’ve seen children come into the clinic on crutches and by the end of the session, they no longer need them. VR empowers them to believe, ‘Yes, I can do this,’” he says.

Medical Training

VR is also opening up new possibilities in the education of future doctors.

“The VR environment is so much more immersive, interactive, and engaging than many other educational formats that it has potential to change the landscape of medical education,” Axelrod says. “We can allow students to actually experience the content they need to learn and understand. They can go inside a beating heart and listen to heart sounds as they watch blood flow within the heart.”

Multiple studies show VR used for medical student education improves learning and the understanding of the body’s physical structures. It also helps students develop the motor skills they need for surgery.

Surgical Planning

VR takes surgical collaboration to a new level. When Grant’s neurosurgical team at Stanford comes together to plan a brain surgery, they can all don linked headsets and interact with a VR setting created from scans of their patient’s brain.

“At the end of day this is all about improving safety,” he says. “We discuss ways to approach difficult cases, such as skull-based tumors. This kind of collaboration allows us to plan well in advance how to safely navigate through these small corridors in the brain to get to the tumor.”

For patients, this can mean less time in the operating room and under anesthesia. For surgeons, it means they can push the envelope and safely explore new ways to do complex procedures, Grant says.

VR Isn’t for Everyone

With all its potential, therapeutic VR isn’t right for every patient or every medical condition, Spiegel says.

“I’ve literally been asked if VR can cure cancer, and the answer, of course, is no,” he says. “VR is not a cure-all for every condition. And in most cases, it’s best used as an addition to traditional therapy, not as a standalone treatment.”

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Most people can use VR without problems. A few get “cybersickness,” nausea that’s similar to that of motion sickness. It goes away when you take off the headset. Better, faster hardware and software mean this issue is happening less often. It affects about 5% to 10% of people who use VR, Spiegel says.

If you have a VR headset, there are now thousands of programs you can use without a doctor’s prescription that promise better health and wellness. If you’re interested in the therapeutic possibilities of the technology, you can check out Cedar-Sinai’s list of recommended VR programs.

Spiegel says his group has vetted these programs for safety but adds that therapeutic VR has the most benefits when it’s part of a collaboration with a medical professional.

“VR opens up conversations between patients and their providers that they might not otherwise have,” he says. “This includes thinking about the role of the mind and its connection to the body. VR requires that we understand the patient in a different, more holistic way. And to me, that is the more humanizing way of thinking about people and how to best care for them.”

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