AppliedVR science chief talks pain psychology and virtual reality

Axios interviewed the chief science advisor of AppliedVR, a California provider of prescription virtual reality pain management treatments.

Why it matters: The discussion follows the S-1 filing of venture-backed Hinge Health, a virtual physical therapy provider poised to break the digital health IPO drought.

Context: AppliedVR has raised $77 million from investors including SVB Financial and F-Prime Capital, and while their offering is not as broad as what Hinge offers patients, its approach to virtual pain management is somewhat similar.

• The below conversation with AppliedVR chief science advisor Beth Darnall at Axios' Prognosis for America's Pain Management event has been edited and condensed.

How does AppliedVR see itself fitting into the available business landscape? How does it compare to a Hinge Health, for example?

• "We've married this virtual reality technology with basic pain management skills, so a person can put on a headset and enter an immersive world, and we're able to teach people how to regulate the central nervous system using visual displays, there's auditory input, there's biofeedback technology.
• "We've developed a proprietary program using our device, which is a prescription device, that's 56 days long, 3-6 minutes a day.
• "These accessible and autonomous VR treatments fit very nicely within this concept of a broader dedicated company such as a Hinge; they can just slot right in."

What aspects of psychology are important in managing emotional and physical pain?

• "Once we realize that pain is a product of the central nervous system, that's the opportunity for us to directly modulate the central nervous system so that we can gain relief. It's more of an integrated approach.
• "Our bodies know how to escape pain. And when we experience pain and it's distressing, it creates a neurobiological cascade that prepares us to escape it. But say you have a diagnosis of fibromyalgia or migraines. You can't just run away from that pain.
• "It's this disconnect between how our neurobiology is preparing us and our capacity in the moment, and all that simply requires is that we apply skillsets to be able to calm the central nervous system and move ourselves towards relief."

Are there circumstances in which medications like opioids should be incorporated in a treatment plan?

• "Absolutely there's a place for opioids. I mean, for some people, those are essential. What we need to do is truly characterize the whole person that is having pain, to identify their unique targets to be able to gain relief.
• "Nowadays, people living in rural areas don't have enough access to trained psychologists or other clinicians to apply more conservative approaches, and insurance will only cover medications, so doctors are left with few choices. This sort of backs people into riskier options because we haven't made some of these better options available."

Are there other approaches that don't involve technology like AppliedVR's headset?

• "I developed an intervention called Empowered Relief that is a one-session intervention, and it rapidly equips individuals with effective pain relief skills. It basically takes what's normally accomplished with 16 hours of cognitive behavioral therapy or some of these other evidence-based treatments compressed down to a single session.
• "I knew as a psychologist that very few people could come back for multiple sessions, but most people could attend one. Now we offer it online, and we can have 100 people in a single two-hour class, and people learn three core pain management skills."

Can you give me some examples?

• "When we calm the central nervous system, that communicates safety; it communicates wellness. Once we have ongoing pain, it's absolutely essential that we continuously communicate safety to our central nervous system. That actually dampens pain processing in the brain.
• "Our brain and body move into a defensive position when we experience pain. You may notice a contraction in your muscles. Our mind is attuned to it. We can become vigilant. We can change how our body is moving. Our heart rate increases, our respiratory rate increases, our blood vessels constrict. This is all automatic, and it's in response to pain.
• "If we calm the central nervous system, we move ourselves into an incompatible state. The mind is calmed. The muscles relax. Our mind and body move into that state of safety, and when we do this regularly over time, that's what steers our neurobiology towards relief. "