Last updated
Re-Engaging Veterans in Pain through Extended Reality (VIPER): Virtual Reality
Share PrintOne in five, or about 50 million Americans suffer from some form of chronic pain, which accounts for an estimated $560 billion each year in direct medical costs, lost productivity, and disability programs (CDC 2018). Chronic pain is more prevalent and of greater intensity in Veterans than in the general population. VHA has provided unparalleled resources for Pain Management and Opioid Safety, but Specialists in Pain Management are scarce. The Clinical Resource Hub (CRH) TelePain Service employed Immersive technology to fill this gap and provide access to the Biopsychosocial model of Pain Management for our Veterans. This Virtual Reality Tool, through TeleHealth, empowers and re-engages our Veterans with the Soonest and Best Care offered by VHA.
Origin:
November 2023, VISN-12
Adoptions:
1 successful
Awards and Recognition:
VHA Clinical Resource Hub Strong Practice - 2024, Virtual reality for Veteran TelePain management - VA News, VHA Shark Tank Finalist: 2024
Partners:
Diffusion of Excellence, Office of Connected Care, Pain Management and Opioid Safety, Specialty Care, VA Immersive, XR Network
Recent Updates
Overview
Problem
Veterans suffer from Chronic Pain at a higher rate and of greater intensity than non-Veterans. Moreover, the prevalence of pain is increasing at a higher rate in Veterans than in non-Veterans. Untreated, persistent chronic pain can contribute to depression, anxiety, post-traumatic stress disorder (PTSD) poor sleep patterns, decreased quality of life, substan
...
Veterans suffer from Chronic Pain at a higher rate and of greater intensity than non-Veterans. Moreover, the prevalence of pain is increasing at a higher rate in Veterans than in non-Veterans. Untreated, persistent chronic pain can contribute to depression, anxiety, post-traumatic stress disorder (PTSD) poor sleep patterns, decreased quality of life, substance use disorders and is also a risk factor for suicide.
Despite the availability of safer and more effective pain management modalities, opioids are often prescribed. Of the nearly 5 million VA patients, rural Veterans were prescribed 30% more opioids than their urban counterparts. Healthcare disparities such as this likely contribute to Veterans dying from opioid-related overdoses at roughly twice the rate of the general population. These statistics may additionally be attributed to barriers to access and engagement with safer, more effective and innovative pain management modalities for Veterans (Military Medicine, Dec. 1, 2019).
Although VHA is committed to and provides unparalleled resources for Pain Management, Opioid Safety and Suicide Prevention with published VA/DoD guidelines and oversight, Pain Specialists are not consistently accessible to provide all Veterans, particularly rural Veterans, with the Evidence Based Stepped Care Model and Biopsychosocial Model for Pain management. Oftentimes, pain interventions and other modalities utilized are costly and ineffective for long term functional gains.
The costs of Pain, Physical Therapy, Complementary Integrative Health (CIH) related referrals to community care were $300 million, $300 million and $200 million respectively in FY23. The average cost of a Pain Management Referral to the Community was $2380 per Unique Veteran. Preventative care through Virtual Reality Self-Care Tools, Empowerment and Education for Pain Management help reduce these costs, leaving funding available for Sooner and Better Care through other VA programming.
It is imperative to reach our Veterans in underserved areas and in VAMCs without Pain Specialist access, by embracing innovative TeleHealth and Immersive technology and provide Veterans with safe and effective Specialty Care Pain Management Resources. See more
Despite the availability of safer and more effective pain management modalities, opioids are often prescribed. Of the nearly 5 million VA patients, rural Veterans were prescribed 30% more opioids than their urban counterparts. Healthcare disparities such as this likely contribute to Veterans dying from opioid-related overdoses at roughly twice the rate of the general population. These statistics may additionally be attributed to barriers to access and engagement with safer, more effective and innovative pain management modalities for Veterans (Military Medicine, Dec. 1, 2019).
Although VHA is committed to and provides unparalleled resources for Pain Management, Opioid Safety and Suicide Prevention with published VA/DoD guidelines and oversight, Pain Specialists are not consistently accessible to provide all Veterans, particularly rural Veterans, with the Evidence Based Stepped Care Model and Biopsychosocial Model for Pain management. Oftentimes, pain interventions and other modalities utilized are costly and ineffective for long term functional gains.
The costs of Pain, Physical Therapy, Complementary Integrative Health (CIH) related referrals to community care were $300 million, $300 million and $200 million respectively in FY23. The average cost of a Pain Management Referral to the Community was $2380 per Unique Veteran. Preventative care through Virtual Reality Self-Care Tools, Empowerment and Education for Pain Management help reduce these costs, leaving funding available for Sooner and Better Care through other VA programming.
It is imperative to reach our Veterans in underserved areas and in VAMCs without Pain Specialist access, by embracing innovative TeleHealth and Immersive technology and provide Veterans with safe and effective Specialty Care Pain Management Resources. See more
Videos
VA Clinical Resource Hub TelePain Program Veteran Testimonial
- Clinical Resource Hub Sharepoint Clinical Resource Hub (CRH) Sharepoint
Files
Links
Solution
To address these barriers to the Soonest and Best Care VHA provides for our Veterans, the VISN12 Clinical Resource Hub TelePain Service has:
1. Re-Engaged our Veterans and brought the Biopsychosocial Model for Pain Management directly to the Veteran’s home through CRH TelePain Management and Immersive Technology.
Virtual Reality for Pain Mana ... To address these barriers to the Soonest and Best Care VHA provides for our Veterans, the VISN12 Clinical Resource Hub TelePain Service has:
1. Re-Engaged our Veterans and brought the Biopsychosocial Model for Pain Management directly to the Veteran’s home through CRH TelePain Management and Immersive Technology.
Virtual Reality for Pain Management Empowers our Veterans through structured treatment addressing all facets of their complex chronic pain. Through meditation, mindfulness, Cognitive Behavioral therapy, and relaxation, Veterans control both sensory and emotional aspects of Pain Processing.
2. Removed Barriers For Rural Veterans and Veterans who have difficulty traveling short distances due to pain and/or anxiety, through collaboration with Physical Therapy, Prosthetics departments and vendor, to replace in-person trials with at-home trials for VR for Pain Management.
3. Provided Trust, Value and Satisfaction for Veterans by integrating VA Whole Health and Physical Therapy modalities through regular TeleHealth visits, and setting SMART goals throughout the 8 week duration of the VR programming and 3 months post-therapy.
4. Employed VR as a cost effective and safe modality for Pain management for our Veterans. See more
1. Re-Engaged our Veterans and brought the Biopsychosocial Model for Pain Management directly to the Veteran’s home through CRH TelePain Management and Immersive Technology.
Virtual Reality for Pain Mana ... To address these barriers to the Soonest and Best Care VHA provides for our Veterans, the VISN12 Clinical Resource Hub TelePain Service has:
1. Re-Engaged our Veterans and brought the Biopsychosocial Model for Pain Management directly to the Veteran’s home through CRH TelePain Management and Immersive Technology.
Virtual Reality for Pain Management Empowers our Veterans through structured treatment addressing all facets of their complex chronic pain. Through meditation, mindfulness, Cognitive Behavioral therapy, and relaxation, Veterans control both sensory and emotional aspects of Pain Processing.
2. Removed Barriers For Rural Veterans and Veterans who have difficulty traveling short distances due to pain and/or anxiety, through collaboration with Physical Therapy, Prosthetics departments and vendor, to replace in-person trials with at-home trials for VR for Pain Management.
3. Provided Trust, Value and Satisfaction for Veterans by integrating VA Whole Health and Physical Therapy modalities through regular TeleHealth visits, and setting SMART goals throughout the 8 week duration of the VR programming and 3 months post-therapy.
4. Employed VR as a cost effective and safe modality for Pain management for our Veterans. See more
- Veteran Engagement with VA resources through VR equates to Improved Outcomes, Opioid Safety and Decreased Community Care Costs. Community Care for Pain Management can cost $1500 to $3000 per Unique Veteran. 56 session program's average cost is $50 per treatment with effects lasting 24 months post treatment; averages about $4 a day over the 24 month time period. RelievRx 8 week Virtual Reality Program for Pain Management
- VA clinicians’ at-home virtual approach for chronic pain Virtual Reality for Veteran TelePain Management
- XR presentation on CRH TelePain Reengagement of Veterans in Pain through Immersive Technology: Virtual Reality Reengagement of Veterans through Immersive Technology: Virtual Reality
- Learn more about VA Immersive here: VA Immersive: Home
Files
Links
Results
Throughout the course of this Immersive 8- Week Virtual Reality Program and thereafter, 100% of our Veterans Engaged in VA programs for Pain Management including Physical Therapy, Whole Health, MOVE for weight loss, Nutrition, Acupuncture, Hypnosis, Cognitive Behavioral Therapy for Chronic Pain, Chair Yoga, Recreation Therapy, Anti-Inflammatory Diet, Aquathe
...
Throughout the course of this Immersive 8- Week Virtual Reality Program and thereafter, 100% of our Veterans Engaged in VA programs for Pain Management including Physical Therapy, Whole Health, MOVE for weight loss, Nutrition, Acupuncture, Hypnosis, Cognitive Behavioral Therapy for Chronic Pain, Chair Yoga, Recreation Therapy, Anti-Inflammatory Diet, Aquatherapy, Massage Therapy, Primary Care Mental Health Integration (PCMHI) and more.
Veterans had a reduction in their Pain Intensity and Interference with Enjoyment of Life and General Activity Scores. Additionally, Veterans experienced an improvement in Sleep and Mood.
No Veterans required an increase or initiation of Opioid Therapy during this VR course. In fact, 3 Veterans reduced their opioid consumption after completion of this VR program for Pain management.
No Veterans required Community Care for Pain Management and Re-Engaged with the Soonest and Best Care: The average cost of a Pain Management Referral to the Community was $2380 per Unique Veteran in FY23. See more
Veterans had a reduction in their Pain Intensity and Interference with Enjoyment of Life and General Activity Scores. Additionally, Veterans experienced an improvement in Sleep and Mood.
No Veterans required an increase or initiation of Opioid Therapy during this VR course. In fact, 3 Veterans reduced their opioid consumption after completion of this VR program for Pain management.
No Veterans required Community Care for Pain Management and Re-Engaged with the Soonest and Best Care: The average cost of a Pain Management Referral to the Community was $2380 per Unique Veteran in FY23. See more
Images
Decrease in Pain Intensity Scores and Reduction in Pain Interference with Enjoyment of Life and General Activity with VR
Improvement in Pain, Enjoyment of Life, General Activity (PEG), Sleep and Mood Scores with VR for Pain Management
Improved Participation with PT Integration with Virtual Reality
Veteran Engagement, Reduction in Community Care, Opioid Safety, Veteran Participation with Physical Therapy Integration with VR
Metrics
- Veteran Engagement with VA resources through VR equates to Improved Outcomes, Opioid Safety and Decreased Community Care Costs. Community Care for Pain Management can cost $1500 to $3000 per Unique Veteran.
- Over 800 Virtual Reality Sessions were completed during this program
- No Veterans required Community Care for Pain Management: The average cost of a Pain Management Referral to the Community was $2380 per Unique Veteran.
- 95% of Veterans who used Virtual Reality for Pain management had an improvement in Pain Scores
- Veterans did not require an increase or initiation of Opioids during course of Virtual Reality
- Participation increased from 50% to 93% with Engagement/Integration of Physical Therapist throughout course of Virtual Reality
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
Ask me how you can trial this Immersive Technology: Please email Nadia.hussain@va.gov
Implementation
Timeline
-
1 - 2 Months
Resource Allocation/Mapping/Clinic Set UpProsthetics Standard Operating Procedure and Vendor Order Set-UpPhysical Therapy Training for Telehealth, Engagement and MeasuresEducation and Training for PACT and Pain Specialists: Veteran Selection -
3 - 6 Months
Veteran Selection and Initiation of TherapyPhysical Therapist Engagement and Pain Metrics at 1 week, 4 weeks, 8 weeks
Departments
- Logistics
- Education and training
- Telehealth
- Pain management
- Physical therapy, occupational therapy and kinesiothology
- Primary care
- Rehabilitation and prosthetics
- Whole health
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Optional Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
TOOLS |
|
Support Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
Risks and mitigations
| Risk | Mitigation |
|---|---|
| Time required for developing Implementation Documents, tools and workflow | Our team will provide resources, support and consultation to facilitate smooth implementation of Re-Engaging Veterans In Pain through Extended Reality (VIPER) |
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email nadia.hussain@va.gov with questions about this innovation.
About
Origin story
The VISN12 Clinical Resource Hub TelePain Service provides all Veterans with access to unparalleled VHA Pain Management resources. Recognizing the need to provide the Soonest and Best Care for rural Veterans, we employed an 8-Week structured, Evidence-Based, Biopsychosocial Model for Pain through Virtual Reality with positive outcomes and Veteran Satisfactio
...
The VISN12 Clinical Resource Hub TelePain Service provides all Veterans with access to unparalleled VHA Pain Management resources. Recognizing the need to provide the Soonest and Best Care for rural Veterans, we employed an 8-Week structured, Evidence-Based, Biopsychosocial Model for Pain through Virtual Reality with positive outcomes and Veteran Satisfaction:
Incorporating a Virtual Physical Therapist's touch throughout this 8-week, structured Virtual Reality course to continue to motivate, engage and empower Veterans further enhanced Veteran Engagement and Trust in VA.
"None of my private pain doctors have ever offered something like this to me. I am happy to hear the VA is coming up with new ways to help Veterans with their pain. It shows me they care."
This alternative to high risk opioid therapy offers a safe, effective and cost-efficient Biopsychosocial Pain Management Model of Care, while Pain Management Specialists are scarce.
Original team
Nadia Hussain, MD
VISN12 Clinical Resource Hub Specialty Chief/TelePain Management Chief
Shoba Rajamannar-Underhill, PT
VISN12 Clinical Resource Hub Physical Therapist
great work for our Veterans,. thank you