The VA is turning to VR to help vets manage chronic pain

Doctors at Veterans Health Administration (VHA) facilities will soon be offering vets a high-tech way to deal with their chronic low back pain: virtual reality-based therapy. 

Caregivers at 18 Veterans Affairs (VA) facilities will write patients a “prescription” for an FDA-authorized, eight-week VR program called RelieVRx, which was created by Los Angeles-based “immersive therapuetics” company AppliedVR. 

AppliedVR has actually been working with the Department of VA—and, by extension, the VHA—for the last two years. “The VA was one of the earliest adopters of immersive medicine,” says CEO Matthew Stoudt. “They’ve been using it to treat PTSD at 120 sites and over a thousand practitioners, so they understand the power of this.”

Stoudt says for many years chronic pain, including chronic low back pain, has been treated as if it were acute pain—that is, with drugs and surgery. Immersive VR widens the scope of the treatment to include the mental and emotional aspects of pain, which Stoudt says is crucial. “We have to treat the comorbidities of anxiety and depression, too,” he says.

AppliedVR’s program combines established pain management techniques—such as for body awareness, pain distraction, relaxation, and behavior modification—with immersive imagery and sound. In pain distraction, for example, the program has the patient throw snowballs at bears, which can have the effect of flooding the neural pathways that would normally carry pain signals, Stoudt says.

“We are right at the nexus of pain and mental health,” Stoudt says.

AppliedVR’s work with the VA was facilitated through a contract with the VHA Innovation Ecosystem, which searches for and implements new healthcare innovations for the benefit of vets. 

Once a VA doctor prescribes the VR therapy to a patient, the VA will then notify AppliedVR to send a VR headset to the patient’s home, where the patient will complete the eight-week, self-directed program. Once finished, the patient sends the headset back, and the VA reimburses AppliedVR for the expense it incurs. 

A nagging problem

Chronic pain is an all-too-common problem among veterans. The VHA provides care to more than nine million veterans, and more than half of them are affected by chronic pain. 

The VHA has relied mainly on medical procedures and surgery to treat chronic pain such as low back pain. But those approaches are costly. A 2020 study in the Journal of American Medical Association found that costs associated with lower-back and neck injury topped $134 billion, making it the highest-cost category of health spending in the country. And surgery is often only marginally or temporarily successful for back problems. 

Caregivers also use drugs, often opioids, to treat pain, and opioid addiction in the veteran community has been a very serious problem. One in 10 veterans who seek care at a VA facility meet the criteria to be diagnosed with a substance abuse disorder, according to research from The National Institute on Drug Abuse. And the same mental disorders that lead to drug abuse can also lead to suicide: veterans commit suicide at nearly twice the rate of the rest of the U.S. public.

So, new approaches to pain management are very welcome, and many in healthcare are looking to emerging technologies like VR for new ideas. 

A 2021 clinical trial showed that an eight-week therapy program using AppliedVR can result in a significant improvement in the way many patients cope with pain. And in July, AppliedVR said a follow-up study had shown that a significant number of patients continued to demonstrate a “clinically significant” improvement in dealing with pain six months after completing the VR therapy.

Those results provided some of data AppliedVR presented to the FDA before it was given the agency’s authorization to market RelieVRx. And they certainly put some science behind the VA’s interest using it to help veterans.

Stoudt say RelieVRx arms the VA with a more holistic treatment tool for chronic pain. “The VA is very squarely thinking about addressing pain that is a product of the wounds of war, and the mental health side of the [healing] process.”

“Our wounded warriors are heroes,” he adds. “They deserve the world’s best healthcare, and that includes our most advanced technology.”