An estimated 3.2 million adults suffer from chronic pain in Australia. It is often debilitating, restricting the activities that those affected can undertake as well as the work that they can do. As testament to this, 40 per cent of early retirements in Australia are due to chronic pain. Further, the wide-ranging impacts of chronic pain are disproportionately experienced by vulnerable societal groups, including women, the elderly, or low socioeconomic individuals.
Despite this immense burden, chronic pain is widely misunderstood by the general public, and modern scientific understandings are rarely translated effectively into healthcare settings. To discuss this, I sat down with USyd alumna Nigel Cowan, Director of Reality Health (which produces chronic pain management tools for clinicians), and one of the clinicians who have been utilising these tools, Adelaide-based physiotherapist Leander Pronk.
The key idea that Cowan stressed was that pain is a real sensation, and it is never just “in your head”; But, it is always “in your brain”.
Traditional pain management has focused on the idea of causation — pain in your back or neck is because of an injury to that area. But sometimes you may continue to experience pain even after the injury has seemingly healed, leading you to experience restricted movement due to a fear of ‘aggravating’ the site. This conceptualisation of pain is much more likely to lead patients towards unnecessary, invasive surgeries and procedures. By attempting to treat the harm instead of the hurt, such solutions may also only give mild relief.
However, what we see here is an overinflation of hurt (pain) to mean harm (damage to the body). Our central nervous system equips us with a “pain alarm” that is designed to protect us from danger (think when you avoid walking on a sprained ankle). And, just like most alarms, sometimes the signals that our bodies send us are false, causing us to experience pain when there is no danger. A great example of this is the muscle soreness you feel the morning after a particularly gruelling sprint to class — the pain is real, but that alarm doesn’t signal danger. And, when you’re running late for class the next time, you might even find it a little easier. This is the modern understanding of chronic pain.
Just like muscle soreness, with chronic pain, the hurt is no longer signalling danger. That very real, very unpleasant pain may be an overprotective response left over from when our bodies were once in danger. Unfortunately, the anxiety developed trying to avoid this pain actively impedes recovery. Every time we stop ourselves from making that sprint gradually causes a loss of muscle mass, reduction in quality of life (now you’re late to class), and reinforces the faulty alarm.
Why such a long preface you may wonder?
Congratulations. Reconceptualising the pain you experience is a precursor to successful rehabilitation. This is not to say that awareness is a cure all. It is far from it. However, chronic pain is a disorder of the Central Nervous System, meaning that it has “sensory, emotional, cognitive, and behavioural elements” which can be treated through pharmacological and psychological interventions. This is where VR comes in.
Cowen discussed the extensive clinical trials occurring throughout Europe, utilising VR technology to essentially ‘re-calibrate’ body perception of the affected area, reversing maladaptive brain plasticity and thus ‘correcting’ the faulty pain alarm.
Though Australia’s technology is not quite there yet, Cowen’s company Reality Health utilises the immersive experience of VR to provide patients with a more compelling understanding of pain than the one I provided above. Sensory experiences, such as that of vertigo from looking over a cliff ledge, are used to explain pain management and the principles of neuroplasticity. He presented the immersive education provided through VR as an underutilised way to start the rehabilitation journey of those experiencing chronic pain. It is available in select practices, and they are hoping to expand in the future.
Cowen also described their utilisation of the VR embodiment phenomenon discussed in a previous article. Patients suffering from chronic pain can be immersed in a VR game that distracts their sensory system. Whilst this occurs, a table or chair is gradually shifted to increase the patients’ range of motion. When shown a video of themself playing the game, the patient’s confidence in their bodies increases.
Leander Pronk has been using this VR tool in his physiotherapy practice for over a year, and describes how it encourages patients to engage in physical rehabilitation. The fun, interactive nature of the content allowed for white coat anxiety to be bypassed. When asked to pinpoint the difference that VR education made, Pronk noted how it had changed the delivery of information to his patients.
“It’s not just me talking to them,” he said. “VR is compelling.” Rather than the overwhelming cacophany of medical jargon that inundates those with chronic pain, VR shows users through interactive experiences.
Even though it’s not helpful with all forms of chronic pain, from his experiences so far it shows great promise as an adjunct treatment. He described the reassurance that some hurt won’t cause harm as being the most important educational message provided by the VR experience, as this can often be enough to “encourage patients to try even just light chores around the house” — helping to gradually increase mobility and quality of life. Of course, it is largely helpful in conjunction with physical activity and other personalised treatments.
Regardless of limits to its application, Pronk is a dedicated advocate of chronic pain education in Australia. If there’s one thing that I want to stress in this article, it is that chronic pain is both a common and a complex condition. So, as much as you’re certainly not alone, your experiences are entirely individual, and virtual reality offers one way to equip yourself with the knowledge to navigate the terrain of chronic pain.