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Episode 7 of the Healthcare Beans podcast
Virtual reality (VR) therapy can be very effective for treating pain. The key issues are the types of pain that can be treated with VR, and how we can pay for it. In early 2020, Medicare approved payments for acupuncture to help treat pain without prescribing opioids, which clearly signals the demand for different ways to treat pain.
Episode takeaways:
(1) Due to the opioid crisis, it’s very difficult to (legally) get your hands on prescription pain medication. Clinicians are reluctant to prescribe opioids for anything except severe pain. For people with substance use disorder, this is a good thing. But that also means we need other, non-addictive ways to treat or eliminate pain.
(2) Virtual reality companies like AppliedVR and XR Health are providing VR therapy to better manage acute pain, chronic pain and anxiety. VR therapy can be self-administered in your home, after receiving minimal instruction.
(3) The next step for VR therapy is getting health insurance companies to pay for it. Certain Medicare Advantage plans and commercial insurers have started covering VR therapy, but it still has a long way to go.
The benefits of virtual reality for patients are becoming clear, but what’s not clear is whether the technology will be widely adopted, or will it actually help lower the rates of opioid addiction in the United States. I’m betting it will do both.
~ James
Transcript
Hello and thanks for tuning into episode #7 of Healthcare Beans, I’m your host James Haven. This episode is inspired by a recent experience I had with my dentist (and please bear with me – this will certainly connect with the broader theme of healthcare in the United States).. So I showed up for an emergency visit on a Saturday; and I was in a lot of pain and it turned out that I needed my wisdom tooth pulled… I’m one of those types that wait till the last minute for dental care because I just hate going to the dentist.
Now, I’ve had this sort of dental work before, where after a tooth extraction, I start to experience a lot of pain, maybe around 4 hours after the surgery, when the pain medication wears off. As a matter of fact, I once ended up in the ER after dental surgery, the pain was so bad. So I describe my past experience with the dentist and I ask her for prescription pain medication (real pain medication); not high dose tylenol/ibuproferin. And she said to me (these are her exact words) – it’s not in my philosophy to prescribe opioids for a tooth extraction.
I got to say, I wasn’t expecting that, and I was a little upset. Nobody wants to hear about someone’s clinical philosophy when you’re having pain.
So I left the dentist office with a useless prescription of high-dose Tylenol and crossed my fingers for good luck. About 6 hours later, I was in serious pain. The Tylenol didn’t work, the dental office was closed, and I was pacing back-n-forth in my living room because that’s what I do when I’m not feeling well.
And then it hit me – the last time this happened (and I ended up in the ER), the emergency room physician gave me a prescription codeine; and I filled that prescription. So the codeine was somewhere in my home, I just had to find it. And that’s what I did; I frantically searched for the codeine, found it, and popped one pill. And about 20 min later, the pain was much reduced and after another 10 min, the pain was pretty much gone. Presto!
Now, the moral of the story is not that codeine is the best thing since sliced bread; I mean, it worked well, but that’s not the point. The point is that pain management is a very real problem in healthcare. Dentists and doctors are very reluctant to prescribe opioids, and there’s a very good reason for that; the opioid epidemic is killing thousands every year, and the best way to save lives, at least in the near term, is to stop prescribing opioids for anything less than 3rd degree burns (unfortunately).
And that brings us to the search for different forms of pain management. There are at least 3 broad directions where things are moving: the first is pharmaceutical companies are working to develop pain medicine that is not addictive. The second area is alternative or holistic treatments, so thinking about acupuncture and how that’s more or less effective for different types of pain.
Interestingly, Medicare now pays for acupuncture to treat lower back pain, and maybe one day that will expand to treat other types of pain (provided there’s enough data to back that up) – I wrote a post on Medicare and acupuncture a few months back, which is linked in the show notes.
And last, there’s using new technology to help us manage pain, which brings us to virtual reality. So I came across this company called AppliedVR (which I assume stands for “applied virtual reality”) – I found this through an article in Fierce Healthcare (btw, the Fierce magazine is an excellent resource on all things healthcare, I totally recommend checking it out; I put the link in the show notes.
I’ve heard of virtual reality being used in the hospital setting for childbirth and other painful procedures, but what surprised me was the amount of data that supports its use. There are a lot of medical studies reporting that patients experience much less pain (and less anxiety) before and during medical procedures.
Moreover, the next step we’re seeing in this space is how virtual reality can help people manage chronic pain in their homes. And this is exactly what AppliedVR is doing – last year this company tested the use of VR headsets at home, self-administered by patients who are suffering from back pain and/or fibromyalgia (); and according to AppliedVR, the results were positive; overall, patients experienced reduced pain.
Typically, I don’t immediately believe a private company conducting its own scientific study to validate the technology they’re selling, but since there’s a lot of previous academic studies that support the use of virtual reality for pain management, I’m inclined to believe it can work. Now, with that said, this could be a game changer in terms of weaning our country off opioid medications, especially if patients are receptive to this technology; if they’re willing to start using virtual reality headsets in their homes.
And, I think people are ready and willing to wear headsets; I own a virtual reality headset and the experience is comfortable up to 30 or 45 minutes of use, and after that it does start to feel heavy and I’ll take it off. Mind you, the therapeutic sessions for pain management can be much shorter, like 5 to 15 minutes, and they’re still effective.
Okay, so now we get to the real issue that concerns all of us, as patients – how do we pay for this? I did come across another virtual reality company called XR Health, which provides therapeutic virtual reality sessions to patients, and it looks like they’re able to bill the service to Medicare, treating it as a telehealth service.
Now, as for younger people who rely on commercial insurance carriers, there doesn’t seem to be widespread coverage for virtual reality yet. This is still pretty experimental, and both providers and insurance companies are considering the ROI for virtual reality. Is it cost effective at scale, who are the types of patients best served by this technology, will it actually reduce opioid dependence in the long run. These are still open questions, but for now, the data strongly suggests that virtual reality therapies will grow very quickly over the next few years, so stay tuned for that.
Well, that’s a wrap for today. Please check out the show notes on www.healthcarebeans.com, leave a review on Apple podcasts when you get a chance, and as always, I welcome any thoughts or suggestions you might have for future content. So thanks for listening to Healthcare Beans; I’m your host James Haven. God Bless.
