Samsung has used its virtual reality (VR) solutions for mental health diagnosis, therapy for cancer patients, and most recently as a magnification tool for the vision-impaired. Now the company has partnered with St Vincent’s Hospital in Sydney for a clinical trial that will investigate the use of VR for pain management.
The trial, which will be undertaken at the hospital’s Department of Pain Medicine, will make use of Samsung smartphones and Gear VR and explore their potential as a treatment method for acute pain, taking into account potential side effects, cost-efficiency, and the ability to reduce the risk of opioid dependency.
Announced at the Samsung’s first Healthcare smart summit in Sydney last week, the upcoming trial has been touted as the largest clinical trial of its kind in Australia. It will offer a variety of virtual scenarios for patients experiencing chronic pain from a variety of medical conditions, as well as those undergoing rehabilitation post surgery.
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Speaking to TechRepublic at the summit, the hospital’s director of Rehabilitation and Pain Medicine professor Steven Faux said that software for the trial is currently in development and is expected to be complete in six months.
“We’re going to give [the patient] a VR episode three or four times a day, like a scheduled drug, and we will be looking at outcomes like how quickly they move, how soon they might be out of hospital, whether they develop any complications, and of course all the side effects of VR, so are they getting cyber-sick, are they bored, do they not like the data.”
The partnership is looking to develop two types of age-specific software for the VR experiences.
“We’re looking at they’re going to have two cohorts, it going to be the elderly who operations from falls and there’s going to be the young who have operations from trauma,” Faux said. “Those two are generally the two peaks of pain management and acute pain, although it can happen any age. So we’re going to have to develop two products.”
Rather than simply being a welcome distraction from pain, the VR experience will be capable of having a biological effect on the patient, which will in turn reduce the reliance on narcotics to manage pain.
The advantage of VR over other types of treatment is the reduction of side effects, Faux said, although there are still some factors that the hospital has to careful of when developing the software. According to Faux, there will be a fine balance between creating a scenario that is both engaging for the patient but not too challenging that it causes stress.
“The thing about VR is you don’t get diarrhoea with it like a tablet, and you don’t get terrible side effects. The only problems we’ve seen with it is if movement is too fast they will get cyber-sickness, so we’re very careful about the speeds; we’ve tested a few speeds. The second thing is that [the experience] can get too real.
“I’ve seen a single case where a woman put her partner’s headsets on and I think there was an arachnophobia thing that they were trying to teach the person and it was an old lady, and she put a headset on without knowing what was going on, there was a spider there, she jumped backwards, fell off her chair and broke her arm. So it’s not without some risks, we’ve got to just be careful about how it’s presented.”
St Vincent’s hospital had previously completed studies of the impact on VR for stroke education before Samsung approached the hospital over a partnership. This differed from the upcoming pain management trial; rather than using VR as a rehabilitation tool, the headset offered a more interactive way of explaining how a stroke came about, and how to reduce the likelihood of reoccurrence. A stroke patient at the hospital can now put on the VR headset and be presented with a CGI representation of the inside of a blood vessel that leads to the brain.
“It’s a bit like a Raiders of the Lost Ark,” Faux said. “You see these tunnels, because blood vessels are tunnels, and you’re walking up and you see stuff coming through the tunnels, some of it is normal, like blood vessels, blood cells, which we explain to them. Sometimes it’s abnormal, like a clot coming from the heart.
“We can say, ‘This is what we think occurred to you at the time you had your stroke’. And then we say ‘This is your blood vessel, you’re 15 years old, and now we’re going to show you what happened to your blood vessel between the ages of 15 and 71’, and all the cholesterol starts to come up, and all this rubbish starts forming on the inside of the cell, and we show them how narrow the vessel is, we watch how blood cells can get stuck and not go through and we watch a clot develop on the side of the wall … the wall cracks open, it’s a bit like watching geology in time-lapse photography.”
Faux said that there are “heaps” of different applications for VR in hospitals, not just in treatment and rehabilitation, but also staff training. It’s also a more approachable way to teach young Australians how to be healthier.
“All the psychological tests that we give patients are based on people having enough education up to the age of 14”, Faux said. “But there are very few who have that level of knowledge about their own anatomy so many of them didn’t even know that blood vessels have something to do with a stroke. And we think we’ll face exactly the same things with the pain [trials]; we have to accept that people know very little about that.
“I think Australians take up information technology and innovation much faster than many other societies, and I think we are underplaying what we could do; maybe we’re hamstrung by some of the infrastructure of hospitals, but I think if we created little environments within hospitals where you could experiment without wrecking the hospital, we would see incredible things.”
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Samsung’s key speaker at the summit, chief medical officer and head of Healthcare and Fitness at Samsung Electronics America David Rhew, explained that VR’s capability to reduce pain, stress, and anxiety is now backed up by clinical trials and studies, one of which has demonstrated how pain can be reduced as much as 24 percent, and anxiety by as much as 60 percent with the use of a VR experience.
Rhew cited a University of Washington study that took fMRI scans before and after a patient had a VR experience. Areas of the brain that were affected by pain had been reduced after the experience; even after patients took the VR headset off, some experienced sustained pain relief for up to 48 hours in some cases, Rhew said. The upshot of this is a reduced reliance on narcotics, which is cheaper, more natural, and reduces potentially harmful side effects.
“In the US we have a major problem: there is an overuse of opiates. In fact it’s considered an epidemic. Many organisations right now are seeing people die from opiate overdose every single day. We recognise that we need to have better ways to address the pain. We’re starting to recognise that virtual reality can be used to do that.
“We have seen children with sickle cell pancreatitis, which invariably requires hospitalisation, it requires narcotics, and if we see a know sickler come into ER, it’s a pretty much a shoo-in that they get admitted and the next thing you know you’re starting them on IV narcotics and medicines. We’ve seen kids in the ER receive the VR treatment and sent home with no pain meds.”
In other cases, individuals going in for major adnominal surgery are being given a 50 percent reduced dose of narcotics after using VR, Rhew said. In another study, a sample of paraplegics experienced improved muscle control thanks to a 12-month training course that involved VR; as many as half of those patients had their condition upgraded. “We’ve seen a woman deliver a baby with a virtual reality in her epidural,” Rhew added.
“When we think of virtual reality, we sometimes think ‘oh it’s a great entertainment tool, it’ll help my patients because they’re bored or maybe we need to distract them before we actually give an injection or take off a cast, or maybe we’ll train our clinicians’. And these are all great use cases. But what we didn’t expect was that virtual reality could be used to treat medical conditions.
“In the past five to 10 years, VR headsets have got smaller, the quality has improved, they’re more affordable, and they’re mobile. Because of that, there’s been an explosion in the amount of research clinicians are doing in this space; we’re starting to see more and more clinical trials of how VR can be used in new and exciting areas.”
VR has been used by range of Australian startups and is increasingly being rolled out to hospitals across the country for several different conditions. In December 2016, Australian health insurer Medibank launched an immersive VR experience for Australian hospitals on Google Daydream, in collaboration with a group of neuropsychologists at Melbourne-based VR developers Liminal.
The “Joy” experience, which was designed entirely in 3D using Google’s Tilt Brush, provides hospital patients with a virtual experience to attempt to relieve loneliness and isolation, particularly for long-stay patients with restricted mobility.
Victorian startup Build VR also launched its Solis VR unit, a Gear VR handset that features video scenarios to trigger positive emotions for dementia patients, even for those in the later stages who are barely responsive.
Solis VR users start in a computer generated atrium in front of a wall with five paintings, with each one reflecting a VR experience. When the user looks at a painting, a 360-degree video begins, which could be of anything ranging from scuba diving, canoeing, or a trip to Bali. The experiences offer a distraction when dementia patients are experiencing boredom or displaying repetitive behaviour.
Last year, Relax VR also launched its VR mobile application compatible featuring a range of calming virtual scenarios and compatible with Gear VR and Google’s Cardboard and Daydream. Relax VR brings their solution to high-pressure corporate environments to relieve occupational stress, which in turn can reduce mental and physical illness.