The FDA approved it for the first time to treat pain. Why is VR?

How does VR occupy a place for single-disease multidisciplinary pain management?

Do you think VR can only play games?

On November 16, the FDA authorized EaseVRx, a prescription system that uses VR to reduce chronic low back pain. This is the first and only home VR treatment system approved by the FDA for chronic low back pain . It was also awarded a breakthrough device. title.

Is this a signal that indicates that the commercialization of VR has gradually moved from gaming to clinical treatment?

In fact, it has taken more than 20 years for VR to treat pain to this point. During this period, the baton of pain management has gradually been handed over from opioid painkillers. Among these players, how does VR find its place?

The FDA approved it for the first time to treat pain. Why is VR?

Pain, defined as an uncomfortable sensation in the body due to ongoing or impending tissue damage, is a very widespread phenomenon. According to data, in 2020, approximately 100 million people in the United States will suffer from chronic pain (usually defined as pain that lasts more than three months and cannot be relieved), and the national economic cost associated with chronic pain is estimated at US$56-635 billion each year. .

Looking at the world, almost everyone is at risk of chronic pain . It is likely to appear in everyone’s life with age, genetic susceptibility, as part of another chronic disease, after surgery or after injury. Low back pain, toothache, stomach pain, dysmenorrhea…As humans with advanced neurosensing, we seem to be surrounded by different degrees of pain.

But “pain” is a too ambiguous expression, such as “toothache is not a disease, it hurts to kill people”, how much pain does this describe? Camus’s description in “The Plague” explains this phenomenon well-

“What he expressed by himself was indeed what he condensed in his day-to-day thinking and pain. What he conveyed to the other party was also the scene of long-term waiting and suffering. The other party, on the contrary, thought his feelings They are all clichés, his pain is everywhere, and his melancholy is common to everyone…”

Pain is a personal experience, “Human sorrows and joys are not interlinked”——

Only we know how much we hurt.

This has also led many people and even some medical staff to believe that chronic pain is not a disease. Chronic pain is a type of disease with a very wide range of effects and a very complicated pathological mechanism. It will cause changes in the entire nervous system, and it tends to worsen over time.

Also because pain usually does not directly cause death, the treatment of pain is often regarded as a non-urgent or even non-essential thing. However, persistent pain will not only affect the quality of life of the patient. If it is not effectively relieved and improved, the pain will cause anxiety, depression, fatigue, insomnia, loss of appetite and other symptoms. These change change when the course does not directly cause people to die, but the quality of life will be greatly reduced, for individual people, but also the meaning of life left to live up.

Modern medicine has not only satisfied treatment and cure, but from a humanitarian point of view, it is also a responsibility to improve people’s living conditions and improve their quality of life.

Pain management came into being.

In the 1950s, there was the concept of “pain management”. With the development of the economy, people are pursuing the improvement of the quality of life, and pain management has become a rapidly growing market in recent years . According to Mordor’s analysis, the pain management market is valued at approximately US$65.108 billion in 2020, and revenue in 2026 is expected to be US$86.505 billion, growing at a compound annual growth rate of 4.85%.

The FDA approved it for the first time to treat pain. Why is VR?

Mordox Intelligence data

The early growth of the global pain management market mainly relied on the mature industry of painkillers as the first-line treatment. However, in recent years, as the side effects of opioid painkillers have been amplified, more and more people choose to use device-based pain management therapies. In addition, because of the relatively high prevalence of chronic pain in the elderly, the burden of global population aging is increasing, which will also promote the growth of the pain management market.

Such a hot track, of course, is indispensable for Dachang. Abbott, Medtronic, Boston Scientific, and GlaxoSmithKline are all players in the pain management market.

The WaveWriter Alpha, launched by Boston Scientific in January of this year, provides personalized treatment for patients with pain. This is a combination of spinal cord stimulator (SCS) systems that includes FAST™ that can provide patients with insensible relief of abnormal pain within minutes .

Medtronic ’s SynchroMed™ II is an intrathecal drug infusion system for chronic pain management. It uses a targeted drug delivery method with fewer side effects and lower doses.

When the big factory’s killer is still based on the innovation of traditional medical equipment, let’s take a look at how new medical technology can relieve pain.

A few months ago, when we discussed Metaverse , we found that VR technology has a mature and stable format in the medical industry. But using VR analgesia still sounds a bit like metaphysics. In terms of pain management, what superpowers does VR have?

In fact, studies have long proven that cognitive behavioral therapy, mindfulness and other methods can effectively reduce pain. Since pain usually has psychological and cognitive effects (such as anxiety, depression, etc.), interdisciplinary, biopsychosocial methods are the most promising treatment for chronic pain.

There have been a large number of studies supporting that various cognitive behavioral interventions are effective in reducing pain. The most common interventions include acceptance and commitment therapy (ACT, Acceptance and Commitment Therapy) and traditional cognitive behavioral therapy (CBT, Cognitive-behavioral Therapy) .

Pain is a complex experience that is affected by its underlying pathophysiology and personal cognition, emotion and behavior. Using CBT as a key psychological treatment method can help patients actively cope with pain.

CBT for pain consists of three components: treatment principles, coping skills training, and the application and maintenance of learned coping skills. The goal is to reduce the impact of pain on the daily life of patients, learn skills to better cope with pain, improve physical function and emotional state, reduce pain and dependence on painkillers.

CBT is a structured, time-limited, and current-focused psychotherapy. Many current technologies that use VR to relieve pain are based on CBT therapy , such as the VR system EaseVRx we mentioned at the beginning. This is a prescription therapy based on a VR system that uses CBT and other behavioral methods to help patients aged 18 and over who are diagnosed with chronic low back pain relieve pain.

EaseVRx is based on a VR contains an eight-week program, combined with bio – psycho – social ‘ll Medical science model, pain education, diaphragmatic breathing exercises, mindfulness exercises, relaxation exercises and reaction perform functions of the game, the user’s coping skills training , And at the same time cultivate new and beneficial habits, so as to reduce pain intensity and pain interference, and improve the quality of life.

AppliedVR, the developer of EaseVRx, is one of the leaders in the field of digital therapy. On November 11, the company received US$36 million in Series B financing. The company founded in 2015 has received two rounds of high financing this year. Up to $71 million in financial support has been raised.

The milestone in the use of VR technology to relieve pain is a VR application SnowWorld that began in 1997 and was developed by cognitive psychologist Hunter Hoffman to reduce the pain of burn patients during treatment.

The FDA approved it for the first time to treat pain. Why is VR?

Burn patients experience VR when changing dressings

SnowWorld is adapted from flight simulation software, using icy canyons and rivers as the background for snowmen, penguins, mammoths, fish and snowfall. When passing through the canyon, the patient will focus on throwing snowballs at objects in the canyon to distract. The snowman freezes with one blow, and shatters with two blows. The results of this study showed that SnowWorld reduced the activity of brain regions related to pain perception, and patients reported a 35-50% reduction in pain.

For many years, SnowWorld has been a research application. One of the participants, Howard Rose, later left academic research and founded Firsthand Technology, a VR technology company focused on the pain management market. Firsthand has created two VR programs, COOL! And GLOW! .

We found the experiencer in COOL! The picture seen in:

I am floating on the bank of a grassy river. In the distance are mountains, blue sky and white clouds. Along the water’s edge, a furry brown otter stood on its hind legs to greet me. I used two handheld controllers to throw fish at them. They turned over happily and the color changed to zebra stripes or flamingo pink.

Firsthand’s newly released GLOW! A camera-based system is used, a heart rate sensor is used to drive a simple meditation movement, and mindfulness skills are used to control the patient’s pain——

Lower your heart rate, close your fingertips, and call the fireflies to your side… The sensor on your fingertips transmits your heart rate to the computer, so when you relax, hundreds of fireflies fall between your hands and finally form a glowing sphere …Close your eyes and imagine this scene, as if it really relieves pain…

Firsthand said that they are researching more ergonomic helmets. In the future, biosensors and biometric technology will become more and more important, and will be integrated into the VR hardware system, driven by AI, to dynamically adjust the VR environment to achieve Personalized treatment methods.

At present, the mainstream way to relieve chronic pain is to use surgery and prescription drugs for treatment, but the health risks brought by it should not be underestimated, such as adverse side effects and drug addiction. 

In a 2010 meta-analysis on the use of opioids, it was found that although the pain intensity was reduced and the physical function improved, the mental health function was declining. There are data showing. During the course of opioid therapy for back pain, up to a quarter of patients showed abnormal medication behavior.

Opioid addiction has become a global public crisis, which also indicates that the use of VR as an adjuvant treatment to reduce the risk and side effects of drug addiction may become the best solution to alleviate chronic pain.

Some studies have shown that VR technology is expensive, mainly because researchers and game development are in demand for its development. The current state of using VR as a pain management tool is still in the early stage of development.

However, with the development of technology and the increasing demand for chronic pain, the country’s economic burden has increased. As a supplementary pain management strategy, VR is receiving attention. This technology that was once thought to only exist in games has attracted neuroscientists. , The interest of clinical researchers and pain management clinicians. Does this indicate that VR has already passed the stage where it can only play in the human world, perhaps its power has just awakened?

In view of advances in neuroscience, such as increased knowledge about brain and behavioral connectivity, pain perception and regulation, and dynamic interactions between biological and psychological factors related to pain perception, VR will become a viable first-line intervention and drug therapy Complementary therapy.

In a 2011 paper discussing VR and pain management (Virtual reality and pain management: current trends and future directions), the author wrote:

“Virtual reality will have a significant impact on acute and chronic pain management and mental and pain/physical rehabilitation in the next 5 to 10 years. As the costs associated with VR technology decrease and the flexibility/customizability of the gaming environment increases, VR It will provide multiple applications for patients suffering from a range of acute and chronic diseases.”

Ten years have passed. Does EaseVRx, which has just been authorized by the FDA, herald the future?

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