How Virtual Reality Can Help Chronic Back Pain

Chronic back pain is one of the most common conditions people in the US and around the world experience. As such, there is a plethora of treatment options, from resting to open surgery and a ton of therapies in between. Back pain is so tricky, though, that not all treatments will work for all patients, and some won’t find relief from anything they try.

So, spine specialists are turning to alternative methods to treat chronic back pain. One solution gaining traction is cognitive behavior therapy delivered via virtual reality (VR).

FDA Approves Virtual Reality System Back Pain Treatment

In November 2021, the U.S. Food and Drug Administration (FDA) gave the green light to a new immersive 3-D virtual reality system called RelieVRx (formerly EaseVRx) that uses cognitive behavioral therapy to help patients with chronic lower back pain. In a clinical study involving 179 participants, those using the RelieVRx system reported a 42% reduction in pain intensity, 56% reduction in mood interference, and 57% reduction in stress compared to the control group.

“Pain reduction is a crucial component of living with chronic lower back pain. Today’s authorization offers a treatment option for pain reduction that does not include opioid pain medications when used alongside other treatment methods for chronic lower back pain,” said Christopher M. Loftus, M.D., acting director of the Office of Neurological and Physical Medicine Devices in the FDA’s Center for Devices and Radiological Health, in an FDA release.

How Cognitive Behavior Therapy Helps Chronic Back Pain

The use of cognitive-behavioral therapy (CBT) to alleviate chronic lower back pain is not a new idea. CBT is a psychotherapy that uses the power of positive thinking to help a patient manage pain. Working with a therapist, the patient is coached to clear their mind of negative thoughts and attitudes and direct their focus on positive, healthy living.

CBT aims to get a patient to manage their pain by changing their narrative, which in turn changes the way the body responds physically to pain. For example, instead of thinking “I can’t” because they feel limited by their back pain, they change their thinking to “I can.”

A study by the Group Health Research Institute in Seattle looked at the effectiveness of CBT in treating back pain. The study involved adults between ages 20 and 70 who had back pain for more than three months without knowing the cause of the pain. After six months, 58% of those receiving CBT treatment experienced an improvement in their back pain.

VR Evolving in Spine Treatment

Spine specialists have also found benefits to incorporating virtual reality in their treatment of patients. If you play video games, you’re probably familiar with VR. When you slip on the VR goggles, you become immersed in an interactive, three-dimensional world. Now doctors are using the tool to take patients on a trip to the inner workings of their bodies so they can see and understand more clearly their diagnosis and treatment.

Jeremy Steinberger, M.D., director of minimally invasive spine surgery for Mount Sinai Health System’s Department of Neurosurgery in New York City, has been using VR in his practice since 2017. At first, Dr. Steinberger used VR for brain surgeries, but he’s been using it more for his spine patients in recent years.

Today, Dr. Steinberger has fully incorporated the use of VR in his outpatient practice. The VR products he uses are Surgical Theater and one from DeGen Medical, which is still under development.

“It used to be I would say it took too much time, and it was just too much fiddle factor, but now, we have it down,” Dr. Steinberger said. “We have a VR headset for patients to use, and it's just become part of our routine.”

When patients come into Dr. Steinberger’s office for a herniated disc or other spinal stenosis, a VR consultation is incorporated into the initial consultation. The patient puts on VR goggles and then views visual 3-D models of their condition. The VR consultation goes over what stenosis is, what a herniated disc is, what the surgery to fix it looks like, and the risks of surgery, Dr. Steinberger said.

“They can kind of see what they're going to undergo,” he said. “Ultimately, patients want to be engaged. Once you form a connection with patients, they walk away with a lot better understanding of the surgeon, the surgeon’s plan, and the risks of surgery. They get it. We call it their ‘aha’ moment.”

Patients who gain a better understanding of their diagnosis and treatment through VR are less likely to seek a second opinion, Dr. Steinberger said.

Dr. Steinberger is also using VR for training medical residents and students. The VR system provides students with a rehearsal of surgical cases before getting on the surgery floor.

How RelieVRx Works

The RelieVRx system takes VR one step further to provide cognitive behavioral therapy and other behavioral methods to help patients with chronic back pain. The system, which is prescribed for use by a physician, includes a VR headset and controller as well as a “breathing amplifier” which attaches to the headset for use in deep breathing exercises.

During RelieVRx’s daily eight-week treatment plan, users have access to 56 VR sessions, which are between two and 16 minutes long. The sessions include breathing and relaxation techniques, mindfulness exercises, and games to educate users on managing their pain. The system is designed to be used with other treatments such as physical therapy.

There are other answers to addressing chronic lower back pain even if you feel you’ve run out of options. Advances in medical technology have shown that VR and cognitive behavior therapy can help patients manage their pain and lead healthier, happier lives.