Virtual Reality Beyond the Holodeck

If you’re a fan of television’s “Star Trek: The Next Generation,” then you’ve seen virtual reality (VR) at work in the episodes that featured the holodeck. In the series, the holodeck was used mostly to entertain the Starfleet crew. While the holodeck is still science fiction, a goggles-based form of virtual reality has been around for some time and now is being used to treat pain.

Some people may be surprised that the therapeutic value of VR has been researched for more than 20 years. There have been at least 120 papers written about how virtual reality may reduce pain.

Virtual Reality May Help Solve the Opioid Crisis

According to a recent Forbes article, virtual reality has proved effective in treating patients who are experiencing acute pain. However, the technology, Forbes reports, has the potential to provide a risk-free chronic pain treatment and, perhaps, become part of the solution to the opioid crisis.

Most of the research in VR Pain Therapy has focused on VR Distraction Therapy or Relaxation Therapy. These have been primarily fun (or relaxing) VR experiences that help patients refocus away from their pain and onto some other pleasant activity, such as playing Sea of Thieves, Far Cry 5, or another video game or a relaxing 3-D/VR video.

VR “Distraction Therapy” is actually a misnomer, because it is based on focusing the brain on some other activity or scene in an immersive environment. However, it generally provides only temporary relief. Distraction VR has been reported to provide as much as 50% relief for childbirth and similar acute pain applications. Unfortunately, though, there has been little evidence of lasting reduction in chronic pain with distraction techniques.

What Is Virtual Reality Neuropsychological Therapy (VRNT)?

This brings me to a new therapy called Virtual Reality Neuropsychological Therapy (VRNT). This proprietary technology developed by Silicon Valley based startup CognifiSense is a different approach to Virtual Reality than is used with traditional VR distraction techniques and is intended to reduce pain in people with chronic pain for a longer period of time.

To understand how VRNT therapy may work for chronic pain as opposed to acute pain, we need to review, at a high level, what chronic pain is, and how it differs from acute pain.

Chronic pain is not a series of acute pain episodes. Chronic pain is a disease involving the central nervous system. A growing body of evidence suggests that chronic pain is mediated in different parts of the brain than with acute pain. For example, in some types of chronic pain, this mediation is associated with maladaptive changes in the brain regions that involve emotional and motivational circuits; fear and avoidance; catastrophizing and depression; and even addiction and the placebo effect.

Maladaptive behaviors result in dysfunctional and non-productive outcomes—in other words, they are learned behaviors that can be more harmful than helpful.

One negative manifestation of maladaptive behaviors is augmentation of chronic pain. The good news is that many studies have shown the maladaptive behaviors associated with chronic pain can be unlearned with the aid of cognitive behavioral therapy (CBT). VRNT attempts to help patients unlearn chronic pain — not by distraction, but by learned cognitive processes.

There are two key differences between VRNT and traditional VR. First, VRNT is built around a software system that can be continually upgraded or modified as knowledge is acquired and as the technology evolves. The other difference is that VRNT provides patients with “experiential learning” or “experiential training” as opposed to pleasant distractions.

Experts in the field report that experiential learning, or experiential learning combined with cognitive learning, is far more effective than didactic or explicit learning, or cognitive learning. For example, you can read about dance steps in a book. But you won’t make much progress until you actually get into the dance hall and start to practice. VRNT combines the power and immersiveness of VR with well-researched principles of CBT.

Although pain seems as if it were only a physical experience, it is actually a product of physical inputs, and the brain’s cognitive and subjective subconscious interpretations of the inputs. In other words, for each of us, a pain experience is the sum of all our life’s learned responses.

VRNT works by creating a personalized digital copy of the pain experience. It renders a drawing of the pain in a fully active 3-dimensional representation with visual and audio input. Next, it helps patients learn to reframe their perception of pain by utilizing the areas of the brain involved with the maladaptive behaviors in a way that lessens the negative effects of the behaviors and associations, or replaces them with new behaviors or associations.

Through the VRNT software, patients learn self-distancing and self-efficacy, and they acquire fear extinction tools. VRNT is based upon the belief that maladaptive learning drives chronification of pain. Often, these learning cycles are implicit or subconscious.

While VRNT is still in the developmental stages, CognifiSense is actively engaged in studying its potential utility in chronic pain.

At this point, you cannot walk into a holodeck and play poker with Albert Einstein. But, someday soon, I hope that you can use VRNT to treat your back pain and other types of pain without medication.