Accelerate Virtual Reality for Clinical Care (Accelerate Health Podcast)

answer just that question. As he speaks with Dr. Brennan Spiegel, Director of health services research at Cedars Sinai and author of the upcoming book, how virtual therapeutics are revolutionized medicine. Over to you, john.

made a mark. But what we've learned over the years long before I became involved, was that virtual reality has this tremendous ability to alter consciousness, our experiences of the world, but the world around us And the world within us. And if we use it, effectively, then we can use it to promote positive cognitions, about the world around us in the

world within us. So the idea of using VR for healthcare is something that has been tested now for decades in psychology laboratories around the world and elite universities. But until recently, we haven't had low cost, highly effective headsets that we could clean and reuse and bring to the front

lines of health care. Really, that's where, you know, doctors like me step in is, we've taken all these years of research that have been hard fought by a lot of other investigators over many years and taken these new headsets that have been created, and brought them up to the clinic, or into the hospital, and tested to see how it may be useful for a wide range of conditions. And we can talk about all those different use cases.

And of course, some of the most famous research has come out of the University of Washington with hunter Hoffman and his team using virtual reality and in victims of severe burn injuries.

And you know, this is one of the most severe experiences pain experiences a human can sustain, going, having a, you know, advanced burns, and then having to go through a bandage change, for example, and he and his team have shown over the years that virtual reality can reduce the perceived pain during a bandage change among people with severe burn injuries, and even demonstrated that in a randomized control trial, and what he shown is not only does it reduce the physical

experience of pain, but also the emotional experience of pain, and the cognitive experience of pain. So it seems like virtual reality works by tamping down both the physical and emotional pain circuits in the brain and he showed that even with functional MRI scans of the brain Have people first without VR and then with VR. And so as a result, you know, it's been studied in a number of different

acute pain conditions. Our group has looked at this and hospitalized patients and found benefits in a randomized trial. We also recently looked at this in labor and delivery, women undergoing childbirth, were randomized to experience a Lamaze style VR treatment, compared to no VR and recorded less pain. So there's a wide variety everywhere from dentistry to physical rehab, and lots of pain syndromes where VR seems to work quite well.

it's just a platform. What matters is the software that we're using, what software are we using for which patients What are people seeing and hearing and feeling and experiencing? So the first challenge is getting the right headsets, getting the right software. And then you know, there's a whole issue of making sure we can clean these headsets, decontaminate them, which was always important even before pandemic, but COVID just

puts a point on that. So we've developed a number of protocols, which include UVC, exposure, UV light exposure, and specialized boxes, and topical, surface decontamination and so on. And then there's other challenges, like just explaining it to patients so that they're, you know, understanding what it is that we're doing. And when we first started doing this, some patients were a bit hesitant to use VR as part of their

treatment. Over time, those more people become familiar with the technology, we don't see as many barriers on that level. But that's just a sampling. There's, you know, a number of other challenges, but we've been largely able to overcome them.

And similarly, you know, we think about digit cuticles, whether it's VR or otherwise, we need to pick the right digit suitable for the right patient at the right time. And when for VR, ideally, we would have a library of, you know, 10s, if not hundreds, of different evidence based therapeutic programs that are specifically designed for different conditions. So you know, VR, for example, has been used for stroke rehabilitation, the totally different experience than somebody using it for pain

management. And even within pain management, it's very different. If somebody's going through, you know, childbirth, compared to somebody undergoing a spinal tap. Lots of big differences there. We have to think about everything from what people are seeing and experiencing the how much mobility Do they have at the time that they're undergoing VR? So that's the idea of having a VR pharmacy.

patients? Do you think it's something that should be prescribed at home, for instance, as well as in the hospital and clinic.

address now. And, you know, we need more science, there's always a need for more science, but there's, you know, there's over 5000 studies now, and I've written a whole book about this about, you know, the research supporting VR, I just to be clear, you know, VR isn't some miracle, it's, it's a way to, to modify our consciousness, using basic principles, to move people from unhealthy perceptions to healthy perceptions, or to promote certain behaviors or certain motions, physical

motions, for example, in rehab, it's not a magic wand, and ideas that should be used to augment traditional therapies. So what that requires is that we have some kind of a service that supports traditional medical therapies, we call this the virtual list. And the virtual list is, you know, the clinician whose job it is to, you know, use the VR in partnership with other doctors, and that will, over time require a VR type

clinic. So at Cedars Sinai, we're currently working on developing such a clinic, where outside of research, people can go to receive VR treatments, both on the outpatient side answer that question, and on the inpatient side. And, you know, we're also working with insurance companies to educate them about this therapy, you think about all the things insurance pays for that far exceed, you know, the direct costs required to use a VR headset, and it's just no

comparison. You know, think about like a robotic surgery for prostate cancer. You know, these are these are multimillion dollar robots that provide a tiny bit of benefit over a traditional hand-sewn prostatectomy, but insurance will cover it. And you know, what we're talking about here are a couple hundred dollar

headsets and software. And, you know, the business model around that I don't think is all that challenging, as long as we can get insurance companies to recognize the benefits of VR, which is just requiring somebody read through the science. So these are the things we're working on now is how do we implement this at scale? throughout both inpatient and outpatient environments?

And so we're doing research right now supported by the NIH, for example, looking at different forms of virtual reality, for chronic lower back pain, and monitoring people not for just hours, or even days, but for up to up to three months to see if there's sustained differences in the pain experience, stratified by different types of virtual reality. So you know, the goal, of course, is to reduce opioid use, as well as reducing pain.

There is some evidence already that VR is similar to opioids in reducing acute pain in terms of the effect size that it achieves. A number of studies have shown that now, including one head to head study against a vikan. But we don't have long term evidence yet that it can reduce opioids. That's one of the studies we're doing with NIH. And hopefully we'll have more information to record over the coming years as well others as they continue to explore this possibility.

body are connected. And you know, how can we use it as a legitimate tool within Western medicine to advance Mind Body medicine across a wide range of different conditions, some of which we've talked about today, others, including, you know, everything from Post Traumatic Stress Disorder to eating disorders to dementia and schizophrenia, and many other

conditions. So the book tells the frontline stories of patients, and doctors and researchers who are using medical extended reality on the frontlines of care and that term medical extended reality comes from the FDA. And that kind of answers your question about what's next is the FDA now recognizes this really, as a new field of medicine is the way I think about it, they call it m

xR, medical extended reality. So you know that when the FDA is looking at it seriously, and thinking about the regulatory landscape around this, this field, that it's starting to become a real codified, you know, field of medicine, not just an area of research within psychology laboratories, which is created the foundation for what we're doing, but now a true

clinical discipline. And my hope is, in the next, you know, five years, certainly 10 years that we're going to see this field expand, that we'll start to see virtual lists, who are really learning how to use this

technology. And in the last chapter of the book, I, I sort of spell out what this might look like and what everyday life in the hospital might look like, and in the clinics with the availability of really high quality mixed reality technology to expand our capabilities beyond what we currently can do as doctors and clinicians.