Think Outside the Pill: New Approaches to Pain Management
You’re in the hospital recovering from surgery. The pain is excruciating. Instead of giving you Vicodin, your doctor straps you into a VR…
You’re in the hospital recovering from surgery. The pain is excruciating. Instead of giving you Vicodin, your doctor straps you into a VR headset. Suddenly you’re exploring Icelandic fjords, Hawaiian beaches — from the comfort of your hospital bed.
Then your doctor writes you a prescription for marijuana. Not to get you high, but because it’s the safest treatment for pain relief.
What sounds like a pothead’s fantasy may be a glimpse into healthcare’s future. Cannabis and VR therapy represent a new approach to pain management. They have the potential to reduce opioid addiction and save lives.
Pain and Gain
Six years ago I tore my ACL playing soccer on Roosevelt Island. After ACL reconstruction surgery the doctor sent me home with a Vicodin prescription. I stopped taking the meds when the pain subsided a week later.
I remember the last time I popped a Vicodin. I felt something different now that my pain had diminished — I began to feel a mild euphoria. Like I was floating on a warm, bubbly wave. I watched “Puss in Boots” on my iPad and giggled like a little kid. I got a sense for how addictive the drugs can be.
Since then I’ve advised healthcare and technology companies developing alternatives to opioids. I’ve gotten a first-hand look at new approaches to mitigating opioid addiction — the biggest public health crisis of our time.
More deaths than AIDS
How serious is the opioid crisis? Every day, 100 people in the US die from opioid overdoses.
Drug overdoses — from heroin and fentanyl in particular — claimed more American lives last year than were lost in the entire Vietnam War. Opioids kill more people each year than the peak year of AIDS and cause far more fatalities than car crashes.
Opioids are expected to kill another 52,000 Americans this year alone — and up to half a million in the next decade.
The story of how this happened hardly needs retelling. Pharma companies in the 1990s developed powerful new drugs like Oxycontin and Vicodin and promoted them aggressively. Healthcare systems, under pressure to process patients more rapidly, started writing more opioid prescriptions.
People got hooked. It’s been estimated that half of patients become addicted to Vicodin when doctors prescribe it after surgery.
When the FDA cracked down on overprescribing MDs, opioid addicts turned to street drugs like heroin and fentanyl — the drug that killed Prince.
It’s an epidemic with no easy cures. But experts see hope in new therapeutics and emerging research on the mind-body connections underlying pain and addiction.
“Why the pain?”
What causes addiction? I listened to a fascinating podcast with Dr. Gabor Maté, a physician, neurologist and author of the award-winning “In the Realm of Hungry Ghosts: Close Encounters with Addiction.”
Dr. Maté believes addiction isn’t something that’s inherited from genetics, but is rooted in emotional pain. This could be the pain of having been an abused or neglected child. Or simply the pain of social isolation, feeling disconnected — an endemic problem in US society today.
The addiction isn’t just to alcohol or drugs. It can be gambling, sex, work, shopping, food — anything that mitigates the pain and makes the disconnection easier to bear. The deeper the pain, the more intense the addiction.
Instead of asking “Why the addiction?” Dr. Maté believes we should ask, “Why the pain?”
He thinks current approaches to treating addiction are too limited and reactive. On average, 40 to 60 percent of people who get rehab treatment will slide back into addiction.
Dr. Maté thinks overcoming addiction is about reconnecting with yourself physically and emotionally. Traditional therapies like yoga can help people regain a sense of connection with their body. New mobile apps like reSET let addicts connect with each other and engage in recovery processes from the comfort of their home.
How to make sure people don’t get addicted in the first place? For the 25 million Americans afflicted by chronic pain, there’s a huge need for non-addictive alternatives. Virtual reality (VR) might soon be one of them.
Therapeutic VR
I first learned about VR’s therapeutic potential last fall. I was advising a startup creating custom VR experiences to ease the pain of cancer patients in chemotherapy wards.
Since then I’ve interviewed dozens of VR experts to understand the technology’s potential for health & wellness.
I started following Dr. Brennan Spiegel, Director of Health Services Research at Cedars-Sinai. Dr. Spiegel believes therapeutic VR can help patients escape the “biopsychosocial jail cell” that it feels like to be in a hospital room.
This approach reflects the emerging view of chronic pain as a condition caused not only by biological factors but by psychological and social factors as well, like stress and anxiety.
In one randomized controlled trial, patients reported a 24 percent drop in pain scores after a 15-minute VR intervention.
The “spotlight theory” of the mind explains why VR might reduce the experience of pain. Just as shining a spotlight into the sky makes you focus on the light and ignore the darkness around it, VR overwhelms the brain with feedback, making it harder to focus on peripheral things like physical pain.
The pain-mitigating effects of therapeutic VR have been shown to last for hours or days after the VR experience is over. Just as in mindfulness meditation, the brain is effectively rebooted to a new, calmer level.
Not all VR experiences work as well on each patient. Dr. Spiegel’s team at Cedars-Sinai is working to psychometrically profile individual patients so they can map the right experiences to the right patient. The end goal is creating a “VR pharmacy” with different experiences tailored to each patient.
Cannabis
I went to a talk by Dr. Jeffrey Chen, Director of the UCLA Cannabis Research Initiative. He said we’re just beginning to understand the medical benefits of cannabis: “Pot was once viewed as a gateway drug. Now medical experts see cannabis as a ‘gateway herb.’”
One of the plant’s most important extracts is Cannabidiol, or CBD. Using CBD is very different from using marijuana — it doesn’t lead to altered perception and cognition. Even though it’s non-psychoactive, it’s believed that CBD may have beneficial effects on the brain.
In California and other states where marijuana has been legalized, health food stores are adding CBD to juices for a few dollars a pop, touting the extract’s anti-inflammatory and anti-anxiety properties.
Dr. Chen believes cannabis could play a role in alleviating the opioid epidemic. The plant’s “opioid-sparing” properties can decrease the level of opioids someone in pain needs by a factor of 10.
Yasmin Hurd, a neuroscientist who directs the Addiction Institute at the Mount Sinai School of Medicine, is leading a clinical trial to explore whether CBD might help prevent relapse in opioid abusers by reducing craving for the drug.
Pharmaceutical companies are betting on cannabis, too. One of the biggest US manufacturers of narcotics was my client last year. They’re shifting R&D investment away from opioids and into cannabis-based medications.
Cannabis research faces massive barriers. Right now the only way to fund cannabis research is philanthropy. Its status as a Schedule 1 drug restricts access to federal research and funding.
The goal of Dr. Chen’s lab is to study cannabis use in opioid dependence and, ultimately, get cannabis rescheduled as a Schedule 2 drug. This would legalize it for specific use cases, like people in pain trying to get off opioids. As Dr. Chen said, “It would open up the floodgates for federal funding.”
Beyond the Pill
I’m not pro pot. I don’t think kids should be smoking it. As with any new medication, more research is needed to fully understand the risks and benefits.
There will always be those who demonize marijuana or dismiss VR as an overhyped gimmick. Yet with opioids killing thousands of Americans each year, we need radical new solutions. We should support research on medical cannabis, therapeutic VR and other new pain treatments that have the potential to save lives.
Originally published at www.thriveglobal.com.