After 10-year-old Blaine Baxter injured his arm in a go-kart accident last year, painful daily dressing changes at the hospital made him so anxious that he had to be sedated.
Then came virtual reality.
Two weeks into his stay at Lucile Packard Children's Hospital Stanford, a team of pain management specialists recommended he try playing games using the . They were such an effective distraction that he didn't need sedation anymore. He went from being scared anytime the doctor approached his room to happily embarking on deep sea adventures and zapping burgers in outer space with VR.
"It was a total flip," says his mom, Tamara Baxter. "He was on so many medications as it was. It was one less thing that we had to pump into his system."
Packard Children's use of VR was spearheaded by the hospital's Chariot program, short for Childhood Anxiety Reduction through Innovation and Technology. The team works with developers to create games like Pebbles the Penguin, in which a luging penguin collects (you guessed it) pebbles, and Spaceburgers, in which players zap flying objects, including burgers, by staring them down.
VR has been hyped as one of the next big trends in technology, potentially changing the way we communicate and interact with video games and films. But despite the backing of major players like Facebook, Samsung and Google, the masses haven't adopted the technology, which is largely seen as a gimmick.
That's not so for the medical community, where VR has been used for decades to help people overcome phobias and anxiety disorders. Sleeker and cheaper products have made it easier to roll VR out in more health care settings, from training medical students and midwives to helping stroke victims regain motor function.
Now more researchers and hospitals are also finding that VR can reduce anxiety and pain perception during things like dressing changes, IV placement or epidural administration. It can also help patients relax before or after a procedure.
A Cedars-Sinai study from last March involving 100 hospitalized patients found that those who watched calming videos on a VR headset reported a 24 percent drop in pain scores. The other 50 patients who watched a standard, 2D nature video with relaxing scenes on a nearby screen experienced only a 13.2 percent reduction in pain.
Brennan Spiegel, director of health services research at Cedars-Sinai in Los Angeles, says they're still not exactly sure why VR is so effective at reducing pain.
"The brain is so complex that it's hard to tease out precisely how something like virtual reality is working," Spiegel said. But simple distraction is believed to be at play: The brain is so busy processing signals from VR that it has a hard time processing other signals, like pain.
"If the science shows that it works, then it would be a fantastic application of VR," says Global Data analyst Avi Greengart. "It may be that over the next 18 months, we find that VR rigs are prevalent in health care, even if they aren't in your living room."
Cedars-Sinai uses Samsung Gear VR through a partnership with Los Angeles-based content provider AppliedVR. In addition to games, patients can choose from content that virtually transports them to places like Big Sur or London.
"It literally tricks your brain into thinking that you're somewhere totally different," says 34-year-old Harmon Clarke, a patient at Cedars-Sinai with ulcerative colitis. "It takes you from the hospital to Yosemite. I can smell the trees and feel the sun on my face and really get to be there."
Clarke is afraid of needles. It once took eight different nurses to get an IV line in him. Since he started using VR, he hasn't had any issues. "Every time I come to the hospital, I call them to make sure I can get the VR kit," he says. "It's that important."
From the lab to the front lines
Cedars-Sinai and Packard Children's certainly aren't the first to discover the power of VR for pain relief. Researchers like Hunter Hoffman at the University of Washington's Human Interface Technology Laboratory have studied its effects on patients such as burn victims for decades. But the equipment Hoffman uses costs several thousand dollars.
"All we've done is taken the latest and greatest hardware and software, like the Samsung Gear VR or AppliedVR software, and walked it into the hospital," says Spiegel. "Up to this point, it's been happening quietly in elite laboratories and psychology departments around the world."
Nearly 2,500 patients at Cedars-Sinai have used VR therapy since the hospital began rolling it out in 2015. Spiegel said it could be a game changer in areas like orthopedics, where patients who undergo surgery are often placed on -- and stay on -- opioids.
"We're sowing the seeds of dependency in the hospital by giving out opioids so freely," he said. "Let's at least give [patients] the opportunity to reach for something like virtual reality or other kinds of technologies that can non-pharmacologically reduce pain."
In AppliedVR's most recent clinical study, which hasn't been published yet, patients who used VR had a 52 percent reduction in pain. CEO Matthew Stoudt says that reduction is on par with what we'd expect to see from taking opioids.
Although VR isn't going to completely replace opioids and painkillers, he says, the evidence suggests it's worth trying before jumping to prescription drugs.
Baking it in
Dr. Sam Rodriguez, a pediatric anesthesiologist, says many commercial games don't work in a hospital setting because they're either too violent or end when a character dies. That can be problematic if a patient is about to get punctured by a needle but is suddenly stuck on a menu screen.
That's why Chariot, the program he co-founded, works with developers like Weightless Studio, which creates VR content specifically designed for patients undergoing painful experiences. Developers can customize the content to work just as well when patients can't move their heads as much and are lying down, so that they're not just looking up at a virtual sky. The games also don't have any bloody scenes or levels so the experience doesn't end at a key moment.
Fighting the spread of infection is a major challenge of implementing VR in a hospital, Rodriguez says. Phones have to be thoroughly wiped down between patient use, and things like goggle head straps need to be occasionally replaced.
Spiegel says it's also challenging to figure out how to bake VR into the process of care so that a physician could, for example, "prescribe" virtual reality to a patient through the electronic health record. They could select visualizations based on a patient's condition and decide when VR should be used, perhaps as an option before employing opioids.
The goal isn't to keep people on VR forever, he adds, but to train them to call up pain distraction techniques even when they don't have a VR headset.
Researchers are also exploring VR's potential to impact chronic pain. At Packard Children's, for example, Chariot is working to design software that would help kids with chronic lower extremity pain do their physical therapy in a virtual environment.
"Chronic pain is a huge issue because we don't really have great treatment," Rodriguez said. "We're hoping that for certain kids, this will really make a difference."
It's already made a difference in the lives of patients like Baxter, who ended up buying his own Samsung Gear VR kit after his three-week stay at Packard Children's.
"Sometimes when I get home," he says, "the dressing changes are actually kind of exciting because I get to use my VR."
Words his mom never thought she'd hear.
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