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Off Deadline: Management of pain may be new frontier for 'virtual reality'

Stanford University researcher's work 'is getting to the root causes' of types of pain

Virtual reality — the creation of a seemingly real environment via computers and headsets — has been floating around for decades, especially on the Midpeninsula where some key originators resided.

But when Jaron Lanier, then of Menlo Park, came up with the term "virtual reality," he may have been focused more on the experiential aspects of the sensation such as, say, riding a banana into outer space. Similarly with local resident Doug Engelbart, an early explorer of virtual reality, sans banana but with a clear scientific-exploratory bent.

Yet an entirely new world, virtually speaking, may be opening up at Stanford University as a multidisciplinary team moves further into exploring how virtual reality (commonly known just as VR) can help reduce or eliminate what is commonly considered as physical pain: real, physical pain, so-called, even if sometimes based on a psychological or perceptual foundation.

When NBC nationally broadcast a short account of the Stanford study last month, a surge of inquiries flooded in, according to two of those cited in the news report: researchers Kim Bullock, M.D., and Andrea Stevenson Won, Ph.D. Both are working with a multidisciplinary team within Stanford's Division of Pain Management, directed by Dr. Sean Mackey, to explore how using virtual reality can relieve types of chronic pain.

Bullock as an undergraduate studied with V.S. Ramachandran, best known for his research on treating "phantom pain" of people with amputated limbs and using mirror-illusions to affect the brain's perceptions of pain — a rudimentary form of virtual reality.

"Yes, it's really sad," Bullock said of the flood of inquiries following the NBC national report. Her sadness was because many of those who called about being part of the Stanford research studies using VR couldn't be helped, either because they didn't fit current study guidelines or their pain was not treatable through virtual reality. For instance, VR doesn't work for pain from an actual injury, such as a broken leg, she said.

She said people interested in being part of research studies should be going through a pain clinic or a psychiatrist or psychologist. The highly regarded Stanford Pain Clinic contact number for patients and referrals is 650-723-6238.

Bullock had one correction to the NBC segment: She does not consider herself a "pain specialist."

"I don't really treat pain. I'm a neuropsychiatrist. I treat mental illness and research the psychosomatic bodily symptoms that sometimes go along with pain," she said in a joint telephone interview with Won.

Bullock is the founder and director of Stanford's Neurobehavioral and Virtual Reality clinics and laboratories. Her primary research is creating "novel clinical trials using virtual immersive technologies and somatic symptom-related disorders," according to the Stanford Medical Center website.

Inspired by her early studies with Ramachandran, she said she "discovered some wonderful things that Andrea is doing" and wanted to "apply virtual reality to treat pain in people with neurological symptoms.

"What Kim is doing is really novel," Won interjected, noting that Bullock will be collaborating with Mackey this summer on research called the "Complex Regional Pain Syndrome Study."

Bullock credited Won with bringing advanced VR technology into an office environment so it is accessible to researchers and patients in the study.

"One thing that's really exciting about what Kim's doing is that it's starting to get at the idea of what is it about virtual reality that can can help with different kinds of pain," Won said. She said it has long been known that distractions can help with managing pain levels, and there's no better distraction today than through the world of virtual reality.

Bullock's work "is getting to the root causes" of types of pain, she said.

Both agreed that the use of virtual reality is akin in some ways to the use of hypnosis in treatment of pain.

"It's a prosthetic for our imagination," Bullock said of VR. "It may have a lot of biological correlates to hypnosis, and we have known for a long time that pain can be alleviated by distraction."

VR also can help provide skill training, enhance learning and teach mindfulness or distraction for individuals involved, she said.

An important process in the rehabilitation of some patients, such as stroke victims and those experiencing phantom-limb pain, is "remapping the brain" in terms of how it responds to sensory perceptions. That's also called "cortical remapping" and involves one area of the brain being turned off and replaced.

Bullock cited an example of such remapping: When one experiences pain, "the body is telling you, 'Let's slow down — don't move that arm.'" That creates a feedback loop in which the brain thinks if a limb is not moving it is a really serious matter so one better not move the painful area.

The use of VR can often break that cycle.

"We go to a virtual cycle rather than a vicious cycle," she said.

Former Weekly Editor Jay Thorwaldson can be emailed at jaythor@well.com.

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