Being brought on fire by the Metaverse can treat mental illness, who will take the lead in this $40 billion market?

China’s digital therapy technology will also have the opportunity to affect the world’s medical care more.

Digital therapy can be standalone software or a combination of software and software, medical devices, hardware devices and services. So even digital therapeutics have different technology paths and maturity levels. Arterial Network has noticed that digital therapy based on XR technology has shown an increasingly popular trend.

Not long ago, OxfordVR’s digital therapy for schizophrenia and other serious mental illnesses received the FDA’s Breakthrough Devices Designation . In less than a year, the FDA has approved several digital therapies based on XR (Extended Reality) technology.

In addition to the FDA, digital therapeutics based on XR technology have also been approved by regulatory agencies in other regions of the world. There is no doubt that this unique digital therapy is already showing great potential and showing clear results in the real world, on the eve of an explosion.

XR Digital Therapy – Beneficiaries of the Metaverse

XR is an umbrella term for several technologies including VR. In addition to the common VR (Virtual Reality, Virtual Reality) and AR (Augmented Reality, Augmented Reality), MR (Mixed Reality, Mixed Reality) has gradually emerged in recent years.

In layman’s terms, VR is to isolate the user from the real environment through the helmet, allowing the user to immerse in a purely virtual digital environment generated by the computer. AR is the addition or removal of interactive virtual objects or information generated by computers in real time in the real environment.

MR can be seen as the combination of VR and AR. Conceptually, it is similar to AR, which is the mutual mixing of real environment and virtual environment; but in the way of combination, it is similar to the principle of VR, through digitally generated and interactive digital interface to combine reality and virtuality.

In addition, there may be new and similar technologies that are different from the above in the future, and may even appear in science fiction or film and television, and can fully simulate the sense of touch and smell, that is, the ideal “Metaverse” (such as The Matrix, Ready Player One Wait). All of these, we can divide it into XR.

From 2014 to 2015, several VR products with significant technological progress came out one after another, driving the XR concept to a remarkable industry peak. 2016 is considered to be the first year of XR. In that year, XR-related companies attracted US$533 million in financing in the primary market, and large-scale financing was frequent. The ten companies that received the most venture capital raised a total of US$396 million in financing.

However, although XR has always been optimistic, its high-gloss application scenarios are mainly concentrated in the fields of social networking, entertainment, games, travel and shopping. The application scenarios of XR in medical and health were still quite limited at the time, mainly focusing on relatively marginal medical education and training. Although other application scenarios such as clinical assistance, disease treatment and rehabilitation have room for imagination, there was no progress at that time.

On the one hand, XR was still not mature enough in key technologies at that time, and further development was needed to meet the requirements of medical and health applications; Strict supervision, as well as long-term research and development and clinical trials. The characteristics of the long-term cycle of the medical and health industry are undoubtedly evident here.

Some regulators saw the trend early and started planning ahead. In 2018, the Korean Ministry of Food and Drug Safety (MFDS, Ministry of Food and Drug Safety) issued the “Guidelines on review and approval of AR/VR-based medical devices” (Guidelines on review and approval of AR/VR-based medical devices). Definitions and elements and approval criteria for VR and AR based medical devices.

Although XR only experienced a short-lived boom, and soon fell into a trough. But in 2021, the overnight popularity of the Metaverse concept saved XR-as the main interface of the current Metaverse, XR has naturally received great attention.

According to McKinsey, the 2021 Metaverse concept has raised $13 billion in primary market financing. In the first five months of 2022, the entire Metaverse industry received a total of $120 billion in investment for technology and basic R&D, double the $57 billion invested in all of 2021. The entire Metaverse industry is expected to be worth a staggering $5 trillion by 2030!

After several years of concentrated development, XR+ medical has made substantial progress in the core fields of medical treatment such as disease treatment and rehabilitation, and has begun to bear fruit. Coinciding with the rise of digital therapeutics, visible progress has been made in the post-pandemic real world, gradually gaining more and more recognition. This has provided another big impetus for XR+ Medical. XR+ Medical, which is backed by two popular themes, has finally begun to work hard and is about to exert its strength.

According to the latest report from Fact&Factors, the global XR+ medical market size is expected to surge from US$2.7 billion in 2020 to US$40.98 billion in 2026, and the compound annual growth rate from 2021 to 2026 is forecast to reach 34.89%.

Arterial network sorting found that the current XR digital therapy is mainly concentrated in the treatment of mental disorders, disease rehabilitation, pain relief and ophthalmology and other related fields.

Being brought on fire by the Metaverse can treat mental illness, who will take the lead in this  billion market?

Major XR digital therapy companies (incomplete statistics, arterial network mapping)

Mental Disorder Treatment – Approved in China, Approved in Foreign Countries

VR digital therapy for the treatment of schizophrenia and other serious mental illnesses is one of its main categories. Patients with these diseases often experience fear and anxiety under certain conditions (such as fear of heights, fear of crowds, and fear of the open space), leading to the onset of the disease. This anxiety, if not relieved for a long time, will cause the patient to withdraw from their daily environment, confining their life to places and activities that are considered safe enough.

The traditional treatment of specific phobias is mainly achieved through cognitive behavioral therapy. One of the main manifestations is “exposure”—that is, to fully expose the patient to an environment that may induce symptoms to achieve psychological desensitization. Among them, it is divided into “imagination exposure” and “real exposure”.

Imaginary exposure is the most commonly used method. In the case of acrophobia, psychotherapists ask patients to imagine themselves in high places before proceeding with the next step of treatment.The advantage of this method is that the treatment environment is less demanding, and the disadvantage is that the effect is very unstable.

“The effect depends on the richness of the patient’s imagination, the severity of the patient’s disease, the effect of possible treatment, the persuasion of the doctor himself, and the establishment of the alliance between the doctor and the patient. The final result of this form can be very unstable.” , said Dr. Zhou Dong, co-founder and chief medical officer of Coagulation Medical .

Reality exposure involves taking the patient to a real environment for exposure, for example, taking a patient with acrophobia to heights to desensitize them to the environment that causes the fear.However, this method has higher requirements on the treatment environment, and the cost and pressure are also very high. In addition, there are some unknown security risks.

“In the study, some patients also told us that they were afraid of heights because they were afraid that they would not be able to control their urge to jump from a high place after they stood up. This shows that exposure to reality is actually risky.” , said Dr. Zhou Dong.

In contrast, XR digital therapy can achieve a better balance between effect and cost, and provide patients with an absolutely controllable and safe environment, adjust the corresponding intensity according to individual progress, thereby helping patients achieve low-cost personalization. Treatment.

Take OxfordVR’s digital therapy for fear of heights, for example, which conducted a clinical trial in the UK with 346 participants between 2019 and 2021. The final research report will be published in The Lancet in April 2022. The most severe patients experienced a 49 percent reduction in avoidance behavior, a 41 percent reduction in paranoia, and a 21 percent improvement in quality of life after six weeks of using the therapy. At the same time, the trial also confirmed that VR digital therapy can be easily scaled on the premise of ensuring standardized treatment, greatly reducing the dependence on trained trainers, thereby reducing the cost of treatment.

At the same time, because the patient’s biofeedback data is systematically recorded and analyzed, it has bid farewell to the traditional diagnosis and treatment method based on subjective judgment in the field of mental and psychological diseases. This positive result will obviously help OxfordVR to be approved by the FDA and officially launched.

In addition, Amelia Virtual Care and Limbix, which also implement behavioral cognitive therapy based on VR, have also released corresponding results: the former uses VR to combine with mindfulness, which shows better results in reducing college students’ stress and enhances treatment compliance; The latter significantly reduced depressive symptoms in clinical trials using VR for adolescent depression, with remission rates of 21% and 29%, respectively, compared to 4% and 16% in the control group.

However, none of these digital therapies have yet been approved by the FDA. In contrast, in this field, China is even at the forefront. In February 2022, the VR technology-based “specific fear psychological rehabilitation training software” of Ningdong Medical passed the approval of the NMPA and obtained the second category Medical device registration certificate .

Clinical results showed that patients with acrophobia who received VR exposure treatment had a reduction of nearly 50% in their high anxiety and avoidance behaviors (indicated by the Acrophobia Questionnaire AQ), and their cognition of heights (indicated by the High Deduction Questionnaire HIQ) and Clinical manifestations of anxiety (as measured by the Baker Anxiety Inventory BAI) were also significantly improved. In addition, with the exception of mild vertigo induced by the VR device (as measured by the Simulator Vertigo Scale SSQ), no subjects expressed inability to adapt or needed to terminate the trial during treatment, nor during follow-up after study completion voluntarily report or mention any adverse reactions.

The approval of this product also fills the gap in the relevant treatment fields in my country, providing a friendly and controllable auxiliary tool for the majority of clinical psychiatry professionals for the environment and treatment objects, and also for patients suffering from acrophobia. Provides a stable and reliable solution.

In addition, domestic companies such as Sai Wengsi, Shuyao Intelligent, Wangli Technology and Xinjing Technology have also carried out corresponding explorations in the use of XR digital therapy to achieve the treatment of mental disorders.

Disease recovery – domestically approved, leading the world

Disease recovery is another important use of XR digital therapy. This type of digital therapy allows patients to recover from exercise in a limited space. The technology not only allows precise control of the environment, but also adjusts the difficulty based on the patient’s skill level. Due to its accessibility and safety, it increases the usage scenarios of patients and is beneficial to the implementation of cognitive rehabilitation.

In addition, this type of digital therapy could enable rapid, standardized scaling, allowing rehabilitation staff to serve more patients simultaneously, increasing efficiency, and reducing costs for healthcare facilities.

Nunap is undoubtedly one of the biggest names in this space. The South Korean company, founded in 2017, has since its inception been dedicated to the fusion of medicine, neuroscience and AI technologies to develop digital therapeutic products for the treatment of neurological diseases.

Nunap Vision, a digital therapy owned by Nunaps, uses VR technology to perform visual perception rehabilitation training for visual impairments caused by brain injuries such as stroke. In terms of design, it uses Visual Perceptual Learning (VPL, Visual Perceptual Learning) to improve visual perception. Through specific visual perception task training, the visual system’s ability to perceive external information is significantly improved, and visual stimuli are generated and transmitted to different areas of the brain. . Ultimately, it is attempted to develop new visual pathways through repeated visual perception training to treat visual field defects.

In July 2019, South Korea approved a clinical trial of Nunaps’ Nunap Vision digital therapy. This is also the first clinical trial of a digital therapy approved in South Korea. However, it may be because Nunap has chosen a more cutting-edge neurological field, which has not yet passed regulatory approval.

It is worth mentioning that, based on the corresponding industry promotion, South Korean regulators have also successively promoted the release of some policies. The Korean Ministry of Food and Drug Safety released the Guideline on Review and Approval of Digital Therapeutics (For Industry) in October 2020. Subsequently, in 2021, MFDS updated the VR/AR medical device guidelines issued in 2018, namely, “Software Review as the Only Requirement for Approval of AR/VR-based Medical Devices” (Software Review as the Only Requirement for Approval of AR/VR-Based Medical Devices).

The domestic approval in this field has come to the forefront. As early as 2020, Virtual Reality’s “cognitive function rehabilitation software” obtained the NMPA Class II certificate , which can be applied to rehabilitation training for cognitive impairment caused by various brain function diseases, such as degenerative brain diseases, Attention, memory, executive control disorders caused by mental illness and brain damage. Even on a global scale, this is one of the first XR digital therapies to be approved.

The therapy simulates real-life scenarios through virtual reality technology. For example, the supermarket module allows trainers to be in a virtual supermarket scene and pick up various items according to the prompts, including geometric objects, kitchen utensils, tea sets, vegetables, drinks, fruits, etc.

The difficulty of the task will gradually increase during the training process, from taking one item to taking multiple items, exercise the trainer’s memory, attention and executive ability, and finally achieve the purpose of improving the trainer’s cognitive function state. For elderly patients with cognitive impairment who have been disconnected from society for a long time, this virtual social activity scene is equivalent to external stimulation, which can delay the progress of cognitive impairment.

In addition to the supermarket scene, the rehabilitation system also includes other therapy modules to meet various needs, and can provide personalized treatment according to different scenes.

For example, for a patient with degeneration of motor function and mild cognitive impairment, the doctor let him first experience a table tennis simulator, and then use the breathing module of relaxation therapy, so that the patient can delay the brain nerve through appropriate exercise. The deterioration of degenerative diseases can also help to relax the physical and mental tension after exercise by training it to control the frequency and depth of breathing.

In 2019, the “Cognitive Rehabilitation System” of Xingzhishi launched a multi-center clinical trial in four hospitals. Based on the MCCB scale, the clinical research data of 120 enrolled patients were verified. The results of the clinical trial showed that, compared with the control group where doctors performed traditional intervention, the comprehensive score of the training group using the “cognitive rehabilitation system” increased by an average of 7% in a one-month course of treatment, and increased by an average of 15% in a three-month course of treatment, which can be more effective. Improve cognitive function in patients with mental disorders.

Ophthalmology – Approved at home and abroad

It is generally believed that XR technology will have a certain impact on the vision of patients due to long-term use of the eyes. Interestingly, ophthalmology is also a major indication for XR digital therapy. Especially for children with strabismus and amblyopia, the emergence of XR digital therapy is a boon.

Amblyopia is a disease caused by poor development of visual cells in the macula. Although the children’s eyes have no organic lesions, they cannot see clearly whether they wear glasses or not, and even lead to blindness in one eye in severe cases. In layman’s terms, the brain favors one eye, which causes vision problems in the other eye.

The traditional treatment method is to block the stronger eye with patch eye patch or blur potion, forcing the brain to rely on the weaker eye to provide appropriate visual stimuli (such as beads, pricks and lights) to the amblyopic eye to establish a normal retinal correspondence in both eyes, Promote visual recovery.

The entire treatment process was long and boring. Even if many medical device manufacturers introduced newer hardware, it was still difficult for children to adhere to repeated content training for 3-6 months, or they were perfunctory during the treatment process. treatment effect.

XR digital therapy can greatly improve children’s treatment compliance through fresh immersive environments and gamified treatment methods. For the child, the painful and lengthy treatment process becomes a fun and entertaining time.

Following this principle, Luminopia’s Luminopia One was approved in October 2021 through the FDA’s De Novo form . It is also the first digital therapy for amblyopia in North America. In fact, the domestic XR digital therapy for children with amblyopia was approved earlier – in February 2021, Vision Medical achieved the approval of XR digital therapy through a registration change .

Not only that, in November 2021, Vision Medical’s XR technology-based digital therapy for children’s myopia was approved as a Class II certificate , which shows us another possibility.

With the deepening of myopia research in recent years, among the many mechanisms of myopia development, the theory of adjustment tension, optical defocus theory and scleral hypoxia theory has gradually become the mainstream cognition. By integrating these medical research theories with the latest digital technologies, an innovative set of myopia prevention and control solutions can be provided to users.

Being brought on fire by the Metaverse can treat mental illness, who will take the lead in this  billion market?

Vision Medical Beibeile Myopia and Amblyopia Comprehensive Treatment Apparatus

Vision Medical’s XR digital therapy integrates red light feeding, VR adjustment training and VR visual function training. Muscle adjustment training to achieve the purpose of delaying the growth of the eyeball and controlling the progression of myopia.

The red light feeding training is to irradiate the fundus with low-energy high-red light of a specific wavelength (650nm) from the product host, which can improve the blood supply and oxygen supply of the choroid and sclera of the fundus, and promote the growth and thickness of the choroid and sclera.At the same time, the bright red light shrinks the pupils, thereby increasing the depth of field of view and reducing blur. This kind of red light has a clear effect on controlling the development of myopia by acting on the oxygen feeding of the fundus and the triple linkage phenomenon of the eye.

The adjustment training function is through the combination of soft and hard, using the game method to carry out the adjustment training of the brain + object image infinite close and infinite, effectively relax the ciliary muscle, improve and restore the adjustment function. In addition, the therapy also sets up visual function training, which also allows patients to fixate, follow, saccade and other eye movement training through gamification. Combined with fusion function training and stereo vision function training, it can improve the coordination of the brain to the eyes Control, improve visual function defects, improve binocular vision function.

Compared with traditional myopia prevention and control methods, XR digital therapy breaks through the limitations of traditional treatment and can provide personalized management and treatment plans. Considering the huge population base of patients with visual function rehabilitation in ophthalmology, once the effect is verified in long-term application, it will undoubtedly be an application scenario worth looking forward to.

Pain – the rise of foreign countries, the emergence of domestic blue oceans

Chronic pain is generally moderate to severe pain in one area for a long period of time that may inhibit the ability to perform daily activities. Typically, chronic pain is primarily treated with medications (pain medication or steroid injections), exercise, surgery, and transcutaneous electrical nerve stimulation.

Psychological approaches, including cognitive behavioral therapy and hypnosis, have long been shown to be effective in reducing pain. Of these, distraction is a well-established psychological pain intervention that has been shown to have considerable efficacy. Typical distraction interventions include deep breathing, listening to soothing music, and watching a favorite video.

The rationale for this therapy is that humans have limited attentional resources. Therefore, distracting tasks that deplete some of these resources are thought to reduce the cognitive capacity available to process pain and thereby achieve pain relief.

Researchers have also recently begun experimenting with more immersive XR techniques to distract patients. In 2010, researchers demonstrated that VR distraction can effectively relieve pain. However, due to the extremely high cost of VR equipment at the time (up to tens of thousands of dollars), this technology was not really considered for clinical use.

The great development of XR technology in the last two years has made it possible to apply this type of digital therapy. In November 2021, AppliedVR received De Novo approval from the FDA for its RelieVRx (formerly EaseVRx) digital therapy . This cognitive-behavioral therapy based on a combination of VR technology and games can help patients with chronic low back pain 18 years and older reduce pain through methods such as mindful escape, pain education, diaphragmatic breathing improvement and relaxation/interoception.

The 8-week therapy begins by enhancing diaphragmatic breathing with a reflex-training play session that activates and controls its parasympathetic response. The therapy then educates the patient about pain management, such as how the body perceives pain and how the patient can manage it. In these ways, patients gradually become distracted from pain during immersive play.

Subsequently, the patient will gradually understand and feel the changes when the body relaxes. The therapy can also simulate a variety of calming immersive environments (such as quiet snow) through VR technology, so that patients can use mindfulness to further relieve pain.

AppliedVR’s safety and efficacy were demonstrated in an 8-week randomized controlled trial, with trial participants using the therapy reporting substantial improvements after treatment: an average 42% reduction in pain intensity and less disruption to life 49%, 52% less sleep disturbance, and 56% less emotional disturbance.

In addition to chronic low back pain, VR digital therapy can also relieve many pain symptoms. Take AppliedVR, for example, which is developing pipelines for symptoms such as maternal pain, pediatric peripheral venous catheter pain, rheumatic pain, and emergency room pain management.

In addition to AppliedVR, there are other XR digital therapy companies around the world developing products for pain symptoms. Examples include XR Health’s digital therapy for chronic pain, and Rocket VR Health’s products for pain relief in oncology patients.

It is not difficult to understand that digital pain therapy is gradually gaining momentum around the world. In the United States alone, 20.4% of adults suffered from chronic pain in 2016, and 8% of adults suffered from high-grade chronic pain. In addition to being excruciatingly painful for patients, chronic pain over the years can also come at a high cost—most notably the opioid epidemic in the United States. Additionally, a Johns Hopkins study published in The Journal of Pain found that the cumulative cost of chronic pain could be as high as $635 billion a year, more than the annual costs of cancer, heart disease and diabetes combined .

However, due to the relatively low level of attention and differences in cognition. This type of digital therapy has yet to be developed in China. At present, the domestic Aomei Intelligent is also developing XR pain digital therapy, but it has not yet been certified. Because pain is not directly life-threatening like other diseases, it always lingers out of the public eye, and patients’ concept of analgesia is backward. In addition, the complex causes and pathogenesis of chronic pain lead to the unsatisfactory efficacy of many treatments.

However, this does not imply a lack of demand. According to the “Report on the Development of Pain Medicine in China (2020)”, there are more than 300 million chronic pain patients in my country, and the number is growing rapidly at a rate of 10-20 million per year. As age is an important factor affecting chronic pain, with the deepening of social aging in our country, this potential huge demand needs to be met urgently.

In addition, in 2018, WHO revised the International Classification of Diseases (ICD-11), which for the first time assigned pain as an independent disease to coding and classification. Although it will take some time, as ICD-11 continues to advance globally in the future, the notion that chronic pain is a disease will inevitably become known.

What this means for digital therapy businesses is self-evident.

What are the shortcomings of XR in full swing?

Although XR digital therapy is increasingly favored by the industry, it is still a type of digital therapy, so the problems faced by the development of digital therapy, such as payment and commercialization, are also inevitable. Since we have discussed such issues many times, this article will not elaborate on them.

Different from other digital therapy, the treatment principle and effect of XR digital therapy are closely related to the virtual reality effect created. XR technologies including VR, AR and MR are still in their early stages of development. Therefore, from a technical point of view, there is still a lot of room for improvement in XR digital therapy.

Yang Guilong (nickname: Uncle Ka), a VR industry expert who has been working in the VR industry for many years, now works in a leading manufacturer in the industry believes that due to technical limitations, the current bottlenecks for VR equipment used in medical care lie in several points. One is the display effect. ; The second is performance; the third is wearing experience.

The first is the display effect. At present, the display effect of VR equipment, whether it is the display resolution or the clarity, is still a certain distance from the ideal. Take pixel density, a key indicator that determines the clarity of VR display. At least 6K resolution per eye is required to achieve an ideal immersion, but currently few devices can achieve it.

Performance is another bottleneck that VR devices are currently facing. For example, one of the potential side effects of any VR-based application is 3D vertigo, and one of the main causes of this vertigo is the visual vertigo created by the VR device itself.

Visual vertigo refers to the dizziness caused by the visual system, which is mainly caused by the high display delay caused by the insufficient performance of the VR device. To put it simply, the user rotates the head 90 degrees to the right in 0.5 seconds. However, due to the performance limitations of the current VR device, the rendering time in virtual reality is longer due to the rendering delay, which leads to high screen delay. . At this point, the user will immediately have a strong sense of dizziness.

“In fact, even if the performance is sufficient to eliminate the delay, dizziness cannot be completely avoided. The occurrence of dizziness is also related to the individual and requires a certain amount of adaptation, which cannot be completely solved by technology. Just like motion sickness, some people do not get motion sickness at all. , Some people have serious motion sickness, and some people who have been motion sick before can no longer get motion sickness through long-term exercise.” Yang Guilong introduced to Arterial Network.

The last is user experience. Yang Guilong said that the current mainstream VR devices in the all-in-one mode are generally bulky and heavy due to technical limitations, and the center of gravity is quite forward, resulting in poor wearing experience. In addition, the existing VR equipment needs to rely on the handle for operation, which is not immersive, and is not friendly to middle-aged and elderly people who are slow to accept new things.

Undoubtedly, the advancement of these technologies requires significant resources and time. The continued popularity of the Metaverse may help speed up this technological advance.

write at the end

Although still in the early stages of development, XR digital therapy has shown great potential for development and is also a very popular branch of digital therapy. In addition to mental disorder treatment, disease rehabilitation, ophthalmology and pain, the industry is constantly exploring more directions, such as sleep and children’s attention training.

The continued popularity of the Metaverse will not only bring a strong follow-up impetus to XR digital therapy, but also drive more people’s understanding and recognition of this type of digital therapy.Kang Cheng, CEO of Virtual Reality Technology , said in an interview with Arterial.com that digital therapy and the Metaverse will begin to merge in 2022, which will greatly improve the popularity of digital therapy.

What makes us particularly happy is that the application of XR digital therapy in China has not fallen behind, and even has a certain lead. With the help of the world’s leading digital basic capabilities and the open concept of digital technology, it is not a dream to create a digital therapy ecosystem with international influence. China’s digital therapy technology will also have the opportunity to affect the world’s medical care more.

*References

Iain Martin ,Forbes.com:FDA Grants Breakthrough Device Designation To VR Mental Illness Treatment

IDC: 2016 VR Industry Report

Sohn Ji-young,the Korea Herald: Korea sets guidelines for medical devices employing VR, AR technologies

McKinsey: Value Creation in the Metaverse

Globalnewswire.com:Virtual Reality (VR) in Healthcare Market Size Expected to Attain USD 40.98 Bn by 2026, Global Forecast from Facts & Factors

Freeman D, Lambe S, Kabir T, Lancet Psychiatry:Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis (gameChange): a multicentre, parallel-group, single-blind, randomised, controlled trial in England with mediation and moderation analyses.

Modrego-Alarcón M, López-Del-Hoyo Y, García-Campayo J,Behav Res Ther:Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trial.

Malloy KM, Milling LS. Clin Psychol Rev:The effectiveness of virtual reality distraction for pain reduction: a systematic review.

Garcia LM, Birckhead BJ, Krishnamurthy P,J Pain :Three-Month Follow-Up Results of a Double-Blind, Randomized Placebo-Controlled Trial of 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality (VR) for Chronic Low Back Pain.

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Fan Bifa, Tsinghua University Press: “Report on the Development of Pain Medicine in China (2020)”

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