Chronic pain: Virtual Reality helps alter pain perception

The cause of chronic back pain can be hard to find. Pain sufferers are typically advised to embark on regular exercise, combined with physical therapy and pain management training to overcome potential psychological and emotional factors. Virtual reality applications could become an innovative treatment tool in this setting – targeting pain perception right in the brain.

In this MEDICA-tradefair.com interview, Prof. Rittner talks about the "ReliefVR" project and explains how virtual reality (VR) can help relieve chronic pain.

Prof. Rittner, your project aims to use VR to treat chronic back pain. What does that look like?

Prof. Heike Rittner: The standard in this case is multimodal therapy. This means patients take part in programs in which they complete multiple training sessions – focusing on the relationship between the mind, pain, and stress, for example – and perform exercises to boost activity levels.

Our approach is based on studies that have shown how burn patients felt less pain during dressing changes when they were distracted by an immersive virtual reality experience. However, pain relief through direction of attention does not work so well with chronic pain. We now want to pursue a different VR approach and combine the VR experience with physiotherapy exercises.

The exercises are designed to change a person's body perception. How does that work?

Rittner: VR can transport people into a different environment. Some approaches used for chronic pain management already apply VR and a treadmill to simulate a nature walk during which the patients must overcome obstacles. The perception of pain is very much shaped by context, and we know the brain can control pain. We want to use these top-down mechanisms – meaning the brain sends stimuli to the tissue – to affect a change in pain perception and pain suppression.

What are the advantages over other treatments for chronic pain?

Rittner: Patients could do these exercises at home without having to visit the physical therapy practice or the pain clinic. VR enables us to manage exercises differently. We also think it is easier to exercise in a VR environment as patients also have access to changing settings when they train at home. It also increases motivation.

Having said that, I also believe we humans are social beings and need social interaction. We can combine this factor with VR. For example, the exercises are recorded at home and therapists telemonitor progress remotely. In doing so, patients do not have to stop by the office several times a week. Instead, they only need to schedule an in-person visit every four weeks, yet still benefit from top remote patient monitoring.

The project has just started. What are your next steps?

Rittner: After a final research literature review related to the subject, we plan to design the VR environment that will subsequently be tested with healthy subjects and patients with back pain as part of a feasibility study. The next funding stage would then entail a comparative clinical study in which we would delve into parameters such as pain reduction or functional improvement in comparison to standard treatment.

ReliefVR is an exciting development project and not as restricted as a clinical trial. We have plenty of room to explore the type of VR environment we want to create. The project was inspired by the "Gesellschaft der Ideen" (English: Society of Ideas) competition launched by the Federal Ministry of Education and Research. Along the way, we were introduced to Ms. Yevgeniya Nedilko, initiator and ideator. We at the University Hospital Würzburg contribute expertise in the areas of medicine, physical therapy, and psychology, and our partners at videoreality GmbH are esteemed VR professionals. It is such an enriching experience.