By Elissa Bass
Christine Chiappone was a fit and active 45-year-old single mother of two young girls when she began feeling pain in her right arm. Eventually, a neurologist diagnosed her with a pinched nerve in her neck, and surgery was scheduled. During surgery it was discovered that she had a benign tumor that had wrapped itself around several bones in her neck. Doctors removed the tumor, but Christine was left with severe pain.
Fifteen years and multiple surgeries later, Christine lived with agonizing chronic neck pain that often radiated into her shoulders and arms. She had to stop working, struggled with taking care of her daughters, stopped exercising, stopped caring. “I had given up,” she recalls. “I was in bed most of the time, and I just kept thinking, ‘I don’t know how to live my life in so much pain.’ It changed me. It changed my personality. I just wanted to be alone all the time, I withdrew from everything. I was very angry.”
She was taking dilaudid, a morphine-derivative prescription painkiller used to help relieve severe pain. Hydromorphone belongs to a class of drugs known as opioid (narcotic) analgesics. Christine would often take two pills a day, and still find little to no relief.
Two years ago, her pain management physician, Hartford HealthCare Ayer Neuroscience Institute’s Dr. Adrian Hamburger, asked her to try a new treatment, using virtual reality (VR) technology for non-narcotic pain management.
“I thought, ‘That’s going to get rid of this pain?’ ” Christine recalls. “It looked like the video games I played with my nephew. But at this point I was willing to try anything.”
Two weekly treatments lasting about 20 minutes each — with Christine donning a VR headset in an exam room outfitted with computer hardware and sensors. After about a half-dozen visits, “It was working,” Christine says. “I didn’t understand why it was working but it was working.” Pain that had been at an 8-10 level was around a 2-3 level, and she found herself becoming more active. As her visits added up, the effects would last longer. And if she had a pain flare up, Christine could visualize her VR world, and help herself relax and change her focus from the pain to something else.
“I have pain-free days now,” she says, noting that she has reduced her intake of dilaudid to only a few times a month, and then only a fraction of a dose. “My daughters are now 29 and 23, and for so long I had pushed them away because of the pain. But now I am back, and we do things, and go places. I live my life again. The VR has been a true blessing.”
A chance visit to Best Buy
Dr. Hamburger walked into a Best Buy store one day a few years ago and saw a VR demonstration. He was familiar with VR technology, both as a gaming environment and as a training tool for the military and the airline industry. He had seen research published about its use in pediatric burn units to distract patients as they went through painful wound care procedures. Doctors saw a significant reduction in the need for pain medications and in patient anxiety when VR was utilized. He began to think about ways he might use the technology in his pain management practice.
“VR is an immersive environment, and it provides 360 degree-range of motion,” he says. “It’s interactive. You can see all around you, and with hand devices we can transfer your movements into the VR.
“We are using Virtual Reality in two ways for the pain population now,” he continues, “biofeedback for coping training, and for rehab. We see that it can help patients slow down their heart rate and breathing, and it can help patients learn to relax. We are using the game environment to retrain the brain. From a rehabilitation point of view, the patient uses the affected body part to improve range of motion and get over whatever fear of motion they might have.”
Various Virtual Reality “worlds” that Dr. Hamburger uses include Christine’s treatment, in which she travels down a river shooting bubbles at otters that are on the banks. This is her coping training, and Christine says that now, when she feels pain, she closes her eyes and pictures her VR world, and she can calm herself and help regulate her pain level. Patients using the treatment for rehab might be throwing a ball to a virtual dog (shoulder), shooting a crossbow at targets (back and torso), or catching a soccer ball (range of motion of the upper extremities).
Dr. Hamburger sees VR having a solid place within a treatment strategy that could also include therapeutic injections, massage, acupuncture, and physical therapy. “With the current concerns about the opioid epidemic, and the significant societal and patient risks associated with their use, adding VR to the mix certainly makes sense.”
Hartford HealthCare Mystic HealthCenter to include VR
Hartford HealthCare’s new 47,000-square-foot HealthCenter scheduled to open late winter 2020 will include a pain management clinic with a dedicated Virtual Reality treatment facility. Dr. Hamburger will be using that space for his patients.
With patients like Christine who suffer from chronic pain, “we typically don’t anticipate a cure,” Dr. Hamburger says. “But we want to provide the patient with the tools to feel better and to be more active in life. With chronic pain sufferers we need to develop a strategy to minimize the impact on their life and decrease the number of flare-ups, as well as decrease the need for prescription help. We’ve seen such discontent (in the medical world) with narcotic pain management; this is a pretty cool alternative.”
Dr. Hamburger has had close to 50 patients experience the VR treatment. One challenge he faces is that not all insurances cover the treatment, an issue he hopes will be resolved as more data is compiled on its effectiveness. With the new treatment facility in Mystic, he will be able to gather data from his patients more efficiently.
The typical VR patient will undergo six weeks of treatments, twice a week for 20-30 minutes per session. Then they do an assessment to determine the overall pain reduction, coping mechanism improvement, and overall pain management level. “We’ve seen a low drop-out rate,” Dr. Hamburger notes.
Dr. Hamburger is one of a handful of doctors on the East Coast using VR as a regular treatment method for pain management. “As there is more and more data coming out I expect there will be more VR available,” he says. “And I eventually see the day when the technology advances so that doctors can write a prescription for a headset and the patient can treat at home.”