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With the risks from pharmaceuticals a real and ongoing concern, veterans living with chronic pain are often at an increased risk for suicide because it can lead to other risk factors, such as depression, anxiety and PTSD, and left to wonder what nonpharmacological alternatives are available through the Department of Veterans Affairs.
One of the most promising areas is the use of immersive technology. Immersive technology falls primarily under two categories: augmented reality (AR) and virtual reality (VR). AR is the least immersive form, in which a patient wears a headset or glasses and interacts with digital overlays in a physical environment.
VR is the most immersive form, which involves putting on a headset, no longer seeing the physical environment and being psychologically present in a virtual environment.
According to the VA, VR already has more than 40 documented indications or different applications within VA health care. Evan Davis, a VA recreational therapist and marine veteran, has been using VR to assist veteran patients with chronic pain and balance issues from brain injuries and more.
"In context of physical rehabilitation, VR has proven to be more effective than traditional therapy delivery models," said Davis.
"Typically, when you go to a physical therapy appointment, it's not the most fun. You are trying to treat a condition while co-treating chronic pain, and the exercises can be hard. With VR, I can set a patient up with a game like a virtual pinball machine. A veteran might think they are only batting around a virtual pinball, but they are working on their balance and core strength while moving side to side and the individual is immersed and focused in the virtual environment."
A veteran in acute rehabilitation recently told Davis he loved fishing and missed the enjoyment of that experience. It was not physically safe for him to go out and fish based on his current condition, but VR gave the veteran that experience safely in a way that assisted with his recovery.
Early data from VA immersive technology implementations has already shown promising results in the area of chronic pain, with participants seeing notable improvement, including a 28 percent reduction in pain intensity and anxiety. The VA is also seeing positive responses to the technology's use for postoperative pain management.
"This research and exploration of immersive technology in VA health care is incredibly important for veterans' care," said DAV Assistant National Legislative Director Jon Retzer.
"By augmenting evidence-based practices such as positive distraction, cognitive behavioral therapy, prolonged exposure and other practices with engaging modalities like VR and AR, we are starting to see an expansion of alternative therapies with increased access and improved outcomes, which is exactly what we want to see in veterans care."
Despite the promising results of immersive technology, there are hurdles to overcome -- from adoption and usage to training and education that ensures VA staff and veterans can use and maintain the technology.
To address these challenges, VA Immersive team members are working to increase access to the technology by holding in-person events, like the VA Immersive Summit, and engaging with veterans in their own communities, as they did at the 2023 DAV National Convention and will again at this year's convention in Phoenix.
"At last year's DAV national convention, I had a DAV member come to me and report how VR helped him with his vestibular [balance] issues," Davis said. "Traditional approaches had been unsuccessful, but he had in-person experience and went back to his provider to get a referral for VR, which led to a breakthrough in his recovery."
"The potential of immersive technology is limitless, but we have the responsibility to grow, test, evaluate and implement this technology appropriately," said Dr. Anne Lord Bailey, executive director of the VA's Strategic Initiatives Laboratory, which oversees all clinical implementation of immersive technology.
"The VA has the opportunity to lead in the field of immersive technology, and we need to get more heads into headsets to continue to expand our efforts."
If you are a veteran using VA health care and would like to learn more about immersive technology, please contact your primary care provider. If the technology is available at your local VA facility, you may get a consult with a VA provider who could curate a virtual experience based on your treatment needs.