Patients at safety net hospitals are often unable to access or use technology like virtual reality, as the tool might not be available in their preferred language or might require a certain level of health literacy to navigate, the University of California, San Francisco's Urmimala Sarkar, M.D., said. (AppliedVR)

There's a growing number of healthcare companies trying to tackle chronic pain with digital solutions, and the use of virtual reality, in particular, is gaining momentum.

Studies have shown that VR can be an effective treatment for opioid-sparing pain management, but the majority of these studies were conducted among primarily White, relatively advantaged populations and in well-resourced settings, according to a research team from AppliedVR and S.O.L.V.E. Health Tech, a health equity incubation partner embedded within the University of California, San Francisco (UCSF).

The researchers set out to examine how providers can get new innovations like VR into the hands of underserved patients. Through a collaborative research project, UCSF and AppliedVR found that providers treating Medicaid patients can integrate VR as a scalable, low-risk alternative for treating chronic pain, with the potential for high patient satisfaction and engagement.

However, significant barriers exist to expand access to less-served and more diverse patient populations, according to the team's research published in the Journal of Medical Internet Research.

Healthcare providers, including users and non-users of VR, identified a lack of reimbursement for the technology as one of the biggest barriers for adoption, the UCSF-AppliedVR research found. More payers that support underserved populations will need to adopt reimbursement pathways to ensure VR can be prescribed by a provider and paid for by a payer, according to the researchers.

“There is a tremendous unmet need in the U.S. to deliver evidence-based digital therapeutics to the broader population, and virtual reality for pain management holds significant interest for front-line pain management clinicians and leadership in safety-net health settings,” said Urmimala Sarkar, M.D., UCSF professor of medicine and co-founder of S.O.L.V.E. Health Tech. “But, it will require collaboration across industries to overcome the hurdles that stand in the way of wider adoption, including commitments from payers for more reimbursement and adapted content that tailors to the needs of diverse populations.”

Policymakers also should assess VR for reimbursement as a pain management approach so patients do not have to bear the cost of use, Sarkar said.

There is a huge supply issue with non-pharmacologic options for chronic pain sufferers, Josh Sackman, AppliedVR co-founder and president, told Fierce Healthcare.

"While cognitive behavioral therapy, biofeedback and other evidence-based approaches are recommended for chronic pain patients, the reality is that most patients either don't have sufficient health insurance coverage for those options, or they don't have enough supply of trained professionals in their area," he said. "Chronic pain impacts such a large population—an estimated 100 million in the U.S.—and we think self-administered technology available in the home can make a huge leap forward toward advancing health equity in chronic pain care."

AppliedVR's platform has been used by more than 30,000 patients in more than 240 of the top health systems globally. The company recently received breakthrough-device designation from the FDA for its EaseVRx solution.

The Los Angeles-based company's VR platform—which uses goggles and headsets to create an immersive, 3D virtual world—has been aimed at alleviating everything from labor pains during childbirth to the pain from burns to discomfort experienced undergoing infusions for cancer treatment.

The company is engaged in multiple studies with payers for determining reimbursement, Sackman said, and also is investing heavily in evidence development to continue demonstrating strong health outcomes and addressing the cost-effectiveness of its digital solution.

VR content needs to be more culturally relevant, personalized

Healthcare providers that use VR cited positive patient feedback, the study found, but safety net stakeholders indicated that existing VR content may need to be more relevant or appealing to a more diverse patient population.

"The patients I care for at the Richard Fine People’s clinic, a publicly funded, safety net hospital, are interested in using technology to manage their health. However, they are often unable to access or use it, as the tool might not be available in their preferred language, or perhaps requires a certain level of health literacy to navigate, for example," Sarkar told Fierce Healthcare.

Digital health is often designed without input from racially and ethnically diverse patients, low-income populations, older adults, patients experiencing homelessness or people who speak languages other than English, Sarkar said.

"If we do not focus on including patients like mine in research of digital health tools like VR, we actually threaten to widen health disparities by excluding them from tools that can improve their health," he said.

Moving forward, Sarkar said he plans to test VR’s usability for patients who are often underrepresented in clinical trials.

The research findings highlight that digital health companies should include marginalized and minoritized patients in the design of their products to make sure they work for a wide range of users, Sarkar said.

"They can also collaborate with health systems and healthcare workers to help align their product with existing clinical workflows, rather than taking a standalone approach. What works in a well-resourced health system will not successfully translate to the safety net without significant adaptation incorporating input from front-line workers," he said.

Sackman said AppliedVR is currently working with medical technology advocacy organizations like AdvaMed and Digital Therapeutics Alliance as well as the patient advocacy group American Chronic Pain Association to help bring awareness and help shape policy in the healthcare VR space.

“The COVID-19 pandemic put on full display the health inequities that have existed in our country for years, so digital medicine shouldn’t be the latest innovation to fall into the same trap. What good does billions of investment dollars flowing into digital health do if very little of it reaches the people who need it most?" he said.