TRANSCRIPT:

Voice-over: Welcome to Spotlight on Migraine, hosted by the Association of Migraine Disorders. Join us for fresh perspectives by medical experts and advocates as we explore the spectrum of migraine and dig deeper into this complex disease.

This episode is brought to you by our generous sponsor, Impel NeuroPharma. 

Could virtual reality be an at-home treatment for migraine? Dr. Laura Garcia, with AppliedVR, explains how virtual reality can help adjust cognitive, emotional, and physical responses to chronic pain.

Laura Garcia: Hi, everyone. Welcome. I’m Laura Garcia. I am the director of research, design, and product innovation at AppliedVR, and I’m honored to join you today to discuss a topic I’m very passionate about — that is, the use of virtual reality in the treatment of chronic pain. 

Today, I will be providing a very brief background on a holistic perspective of chronic pain. I will then describe how behavioral medicine addresses pain, including migraines, and I will share about the use of EaseVRx, a virtual-reality therapeutic in the treatment of pain. Lastly, I will discuss the implications of this research for the treatment of migraines.

Taking a holistic perspective on pain means that you consider all the different factors that may impact the experience of pain. These factors include biological processes like digestion, circulation, even physical conditions. And we can also consider psychological factors. This may mean increases in stress or focusing your attention on pain or beliefs that impact your perceptions of your pain. We also have to consider the social, cultural, spiritual, and financial factors that impact pain, including an inability to gain support from a community or have access to different treatments. 

Given that so many individuals experience migraines and that they can be debilitating if they’re experienced on a regular basis, it’s important to understand how do we deal with pain from a complex perspective so that we can develop treatments that are more effective?

Behavioral medicine attempts to address some of the psychological and social factors that are often missed with pharmacological treatments. Psychotherapies like cognitive behavioral therapy, biofeedback, relaxation training, mindfulness training, and also stress management have all been shown to reduce the experience of pain and the distress related to chronic pain, including migraines. These therapies often help people understand more about their pain. They help people gain a state of deep relaxation, focus their attention on things outside of their pain, learn how to listen to their bodies with self-compassion, and it empowers people with different tools to cope with their pain on a day-to-day basis. These programs typically involve 8 to 12 sessions with a provider, either in individual or group settings, and individuals often get the sessions in hospitals or community centers or clinics.

These programs are very beneficial for people. However, there are a lot of barriers to receive behavioral medicine. Some of those barriers include lack of transportation, lack of availability of providers, higher costs, and even just lack of awareness about these programs. 

A potential solution to these barriers is the use of virtual reality as a delivery method for integrated treatments. While immersing individuals, virtual reality can shape and activate networks associated with pain, downregulating the pain response in this way. It also engages the different learning centers in a way, so it accelerates the learning of coping skills for pain. It can address major barriers by being cost-effective, scalable, on demand. And, most importantly, it can be delivered in the home.

So how do we know that VR has potential? Take EaseVRx. EaseVRx is the first neurobehavioral treatment for chronic pain. It’s an eight-week self-administered program to be used at home, and it’s currently seeking approval from the FDA as a pain treatment. This program was designed in collaboration by Beth Darnell — a world-renowned pain psychologist — and our team at AppliedVR. 

EaseVRx trains individuals on recognizing and adjusting their cognitive, emotional, and physical responses to pain. Individuals engage in one session per day for 56 days, sessions of about seven minutes long. And, during the sessions, individuals can learn about their pain through animations. They can also practice breathing, mindfulness, distractions, and gain deep relaxation. 

And, in this video, we showcase the different experiences that individuals in our program go through. As you can see, there are educational experiences, breathing experiences, environments that change with your breathing, and that change with the increased sense of relaxation. We also have beautiful sceneries and landscapes, and we have some distraction games to help people focus their attention.

A recent randomized controlled trial tested the efficacy of EaseVRx in treating chronic lower back pain. The data I share with you today is data from 168 participants in our study. These participants were randomized to one of two conditions. One condition received EaseVRx, the program that I just described, and another condition received a VR headset with a non-immersive, very neutral program with nature videos and [inaudible] sounds. The reason why we have this comparison is because we wanted to make sure that if people were experiencing benefits from our program, it wasn’t due just to the novelty of the technology. 

In our study, we asked our participants to rate their experience of pain before and after their treatment. We asked them to rate their pain on a scale from 1 to 10, 10 being the most unbearable pain that you would have and 1 being no pain at all. What we found was that, on average, individuals in the EaseVRx group were reporting pain reductions of 41 percent.

So what does that mean? That would mean that someone who reported a level of 10 in the beginning of the treatment — so pain that was completely unbearable — by the end of the treatment, they were reporting a number of 6, or a level of 6, which is still manageable pain. And these benefits extended to how their pain was interfering with their activity, with their sleep, with their mood, and with their stress. 

So reductions in pain are great, but how many people benefited from using this program? And what we found is that about 87 percent of our participants reported reductions in pain from the moment they got the headset to the moment they shipped the headset back. And, out of those people, 46 people reported reductions of 50 percent or greater in their pain experience. So imagine someone who went from a 10, unbearable pain, to a 5, bearable pain, by the end of those two months of treatment. Most relevantly, some people went from 10 to a 3 after only two months of treatment. 

And what is best? This pain reduction, this pain benefit, lasted for at least six months post-treatment. So imagine taking a course of medicine for two months that provides you with benefits up to six months or even more after you are done with the treatment. This is why VR is so powerful. 

And VR is powerful because the experience is great. People are engaged with the content, they complete the majority of the sessions, and they’re highly satisfied. To an extent, they’re learning how to cope with their pain, but also in a fun way. 

So, in summary, given that pain is a biopsychosocial issue, VR therapies like EaseVRx can reduce pain intensity and interference with activity, sleep, mood, and stress — all that while being engaging and fun. Our future work will examine this program with other conditions, including migraine.

You may be asking yourself, “Could virtual reality work for migraines?” Most importantly, “Could virtual reality work for my migraines?” And I’m here to address common concerns that people like you may have regarding this new technology, one of them being cybersickness. A lot of people who are sensitive to motion sickness — and I am — we fear that with the headset, we are not going to be able to use the program because we’re going to have these side effects. 

What I have to say to you is that companies like AppliedVR and other companies doing these pain treatments in virtual reality, they’re ensuring that the content is so well designed so that it’s short. You have daily experiences that have very little perception of movement so that you’re less likely to experience cybersickness. Another main concern is that this headset may trigger migraines for you. Now, if it did, you can stop at any time and you don’t have any impacts or consequences of using virtual reality, even once. 

In terms of efficacy, there’s still not a lot of research in the treatment of migraines while using virtual reality, but I can say to you that more research and development is in the horizon. 

Now, virtual reality is costly right now. Even just a headset is very costly. Now, currently, it is an alternative treatment, so you probably don’t have access to it now. But with time and the possibility of getting this treatment reimbursed by payers, you would go to your doctor, and in the same way in which you receive prescribed medications, you may also receive prescribed virtual-reality headsets.

So this is what’s up, what’s coming in the future. I hope that you found this presentation helpful, interesting, and that you are just as excited as I am about the possibility of using virtual reality in the future for the treatment of pain and migraines.

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Voice-over: Thank you for tuning in to Spotlight on Migraine. For more information on migraine disease, please visit MigraineDisorders.org.

*The contents of this podcast are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The speaker does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.