How Virtual Reality Worlds Can Help Reduce Pain

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Wanda Gregory, Director of the University of Washington's Center for Serious Play, tests out a virtual reality game intended to reduce the experience of pain.  (Howard Rose/DeepStream VR)

Imagine being an otter in a virtual world where colors and landscapes unfold in endless possibilities. You engage in a game of paintball with other frisky otters. You follow a river as it travels through time and seasons, and the environment responds to your mood, calming anxiety and reinforcing relaxation.

This fantastical landscape is a game developed by DeepStream VR, a virtual reality software company based in Seattle.

Founded by Ari Hollander and Howard Rose, the company aims to implement VR games for pain relief and rehabilitation. One of its earlier games, SnowWorld, has been used extensively during wound care for burn victims as well as with children undergoing painful medical procedures.

This virtual reality game was developed to alleviate stress and anxiety
This virtual reality game was developed to alleviate stress and anxiety (Cool! )

The otter game, called Cool!, is built to address anxiety, pain and the helplessness or loss of control that people feel during painful experiences. These factors have a cumulative effect on pain, and can also slow recovery. That’s why Cool! was written with artificial intelligence that can detect your nerve state as you play, and evolve with you.

This may sound like science fiction, but it isn’t. Research shows that using meditative techniques, combined with play within a virtual reality landscape, can reduce reliance on opioids.


Virtual Reality Distracts From Pain

Most use of virtual reality for pain management has been for acute pain. That is, VR is used to distract the patient from the pain. Dr. Sam Sharar, an anesthesiologist at University of Washington, and his team have amassed research into the analgesic effects of distraction in pain management.

“Cognitive distraction during a painful experience takes some of the conscious attention away from the painful stimulus,” Sharar says. If a patient’s attention can be consumed in an immersive virtual world, they experience less pain.

These images from an fMRI scan show areas of the brain affected by pain, and how they shrink when the patient is immersed in a virtual reality world. (Courtesy Dr. Sam Sharar/University of Washington)
These images from an fMRI scan show areas of the brain affected by pain, and how they shrink when the patient is immersed in a virtual reality world. (Dr. Sam Sharar/University of Washington)

SnowWorld, for example, was designed specifically with burn victims in mind. The environment is blue and white, with icy hues and ice cliffs. Within the arctic world, the player plays with engages with snowmen, throws snowballs, moves through snowy ravines with icicles. The design surrounds the perceptual field; music further immerses the patient in the virtual world.

One hypothesis as to why VR works is that immersion in the virtual world produces endorphins that help mask the pain experience.

Sharar’s team tested that theory using naloxone, a narcotic inhibitor. If endorphins were causing reduced pain, the naloxone would have reversed that affect and the pain would have elevated again, even during VR immersion. This wasn’t the case. Scientists still don’t know exactly why VR works the way it does to diminish the experience of pain.

What About Chronic Pain?

More than 100 million Americans suffer from chronic pain. It may last for months or years and is often accompanied by a cascading variety of other health issues. People suffering from chronic pain experience isolation, fear and frustration from the lack of social understanding about the severity of the condition.

“It is a systemic, degenerative disease,” says Dr. Diane Gromala, Canada Research Chair and Professor at the Simon Fraser University in Vancouver.

[Watch Dr. Gromala speak at a recent TED conference in the video below.]

The total financial cost of chronic pain in the U.S., including lower wages, lost days of work and cost of health care, ranges from $560 to $635 billion and is higher than the annual cost of heart disease, cancer, or diabetes. People who were formerly successful, active and happy have been toppled and rendered paralyzed by this disease.

Yet medical treatment for chronic pain is abysmal, relying intensively on opioid prescriptions that are ineffectual for long-term pain management. Prescriptions and sales of opioids in America have risen dramatically in the last 10 years, by 33% and 110% respectively. Yet people with chronic pain have an overwhelming sense of not being in control of it, especially when they experience breakthrough pain, which can severely impact their quality of life and overall sense of well-being.

New Ways To Manage Chronic Pain

Dr. Sean Mackey, an anesthesiologist at Stanford, experiments with perceptions of chronic pain using the fMRI scanner. His work, combined with Dr. Christopher deCharms’ efforts, has changed focus from how the nerves sense pain to how the brain processes it. Comprehending pain in this way—as a cognitive process that, like other cognitive processes, can be re-wired—is at the heart of their work.

With this foundation, they use the fMRI as both a diagnostic and therapeutic tool. Mackey and deCharms help patients master control over their pain by showing them real-time images of their pain digitally manifested on a screen.

Understanding where and how pain exists informs Gromala’s team at the Chronic Pain Research Institute.

What’s significant about Gromala’s work is that she both incorporates virtual reality as a distraction from acute pain, and also designs worlds aimed at taking advantage of the brain’s neuroplasticity. That is, she wants to interrupt the cognitive processes that make pain be experienced in a debilitating way.

Gromala—a chronic pain sufferer herself—and her team have developed immersive experiences that include biofeedback in order to ask people to focus on pain in order to produce thoughts about it, and better manage it. The Virtual Meditative Walk uses biofeedback sensors that measure physiological symptoms like heart rate, skin temperature, or respiration along with sound, and virtual reality to enable people suffering from chronic pain to better practice Mindfulness-Based Stress Reduction.

Rather than ignoring or repressing pain, the virtual environment coupled with immediate biofeedback teaches patients how much attention their pain consumes. Virtual reality doesn’t so much remove you from your world as it provides you the tools and training in which to more effectively focus and control it.

“It is based on a mind-body practice that scientists have studied and that humans have used for hundreds of years,” Gromala says.

“Technology isn’t necessary for mindful practices, but our VR system gives users immediate feedback in a number of sensory and perceptual ways. That makes it less mysterious, and users often say they feel confident that they can affect their pain, instead of feeling they are victims to it.”


Susan E. Williams is a writer and consultant who specializes in science, technology and healthcare. She provides critical research to efforts including Arizona State University's Project HoneyBee, an initiative focused on validating the clinical utility of continuous physiological monitoring with consumer wearable devices.