Cedars-Sinai learns from what does - and doesn't - work in therapeutic VR

By Jonah Comstock
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At the Digital and Personal Connected Health Event at HIMSS in Orlando, Cedars-Sinai Director of Health Services Research Brennan Spiegel spoke some more about his experiences using virtual reality to help alleviate patients’ pain and allow them to virtually escape the confines of the hospital during their recovery.

“We’ve now done this with well over 300 of our patients and we have been learning a lot about when it works and when it doesn’t work,” Spiegel said. “How effective is this for managing conditions like pain, managing depression, managing anxiety, even managing hypertension?”

Cedars-Sinai doesn’t have large-scale, robust efficacy data yet, although they are working on a large randomized trial that compares VR to the same content delivered via 2D video. They expect the results in six to eight months.

In a small controlled study, however, VR was able to drop patients’ average self-reported pain scores from a 5.4 to a 4.1. A 2D distraction experience in the control group only dropped that score to 4.8.

But at the conference, Speigel also talked about what his group has learned about when VR doesn’t work. Older patients were more likely to turn down the treatment, but those who did use it found it to be a more transformative, profound experience than the younger users, he said. 

Additionally, they found a number of conditions that, at least for now, excluded patients from consideration for VR, including stroke, delirium, epilepsy, nausea, and people who were too frail to physically wear the slightly bulky headset. In addition, they’ve learned to be careful what they simulate with patients with PTSD, for example, as even a fairly innocuous game in such an immersive virtual environment can trigger traumatic memories.

But not all negative data is bad. Spiegel shared a story of one woman whose chronic abdominal pain doctors had concluded was mostly psychological. But after she had no response at all to the VR therapy, it prompted them to take a second look and discover a rare, hard-to-detect physical cause for the symptoms.

“The point here is that we figured this out because she had a negative response to virtual reality,” he said. “It’s almost a diagnostic test to the degree to which the mind is guiding the experience of pain. Sometimes it’s OK if a digital health intervention fails. Let’s learn from those failures and figure out why they’re occurring.”

Finally, it’s important to listen to and respect patients who realize a novel intervention isn’t right for them. Spiegel shared one story about a woman who emphatically rejected the idea, and then died two days later.

“I was almost embarrassed that I can walk in with a toy and think it would do anything for her,” Spiegel said. “But it really made me realize: We cannot overpromise and underdeliver on digital health. It’s all wonderful, but there is a time and there is a place for these interventions.”