Game your way out of pain: Pain management
By Lety Laurel
Have you ever donned headphones while exercising, with the goal of making the time go by faster and minimizing the discomfort? Or given a child an electronic device during a vaccination so he won’t focus on the pain and fear? What seems at first like simple distraction techniques may hold the key to pain management.
Maureen Simmonds, Ph.D., PT, is exploring the effect of computer games and virtual reality on the perception of pain.
“Our brains have limited attentional capacity, so if we focus on something else, we can’t focus as much on the pain,” said Dr. Simmonds, a professor of physical therapy and research chair. “If you create games or have people do things that they would like to do anyway, and the decrease in pain is the secondary effect, it works well. You can have a positive effect on pain and it lasts beyond playing the game.”
Using a blend of sophisticated virtual reality equipment and simple physical and cognitive tests, Dr. Simmonds is working to understand the links between pain, mind and movement across conditions to better manage the impact of illness and injury.
Pain is one of the primary reasons patients see a doctor, and often they’re treated with prescription painkillers. Yet there’s a dark side to those drugs. It is estimated that 91 Americans die each day from an opioid overdose, according to the Centers for Disease Control and Prevention. More than 100 Bexar County residents died of an opioid-related overdose in 2015.
“We don’t understand a lot about pain and its complexity, and the fact that in many chronic conditions, pain becomes the disease,” she said. “It’s not a symptom of something else.”
Understanding that leads to better treatment options and outcomes for patients, she said.
“Most people don’t like pain. It’s unpleasant. But it’s not just a sensory experience, it’s also an emotional experience,” she said. “It has meaning for us in terms of ‘Am I going to end up in a wheelchair?’ or ‘Someone has just had brain cancer and I have a headache. Do I have cancer too?’ The way we think about that pain, the cognitive part, also influences the total pain experience. So it’s a multidimensional experience, not just a sensation.”
This biological, psychological and social phenomenon sometimes makes the brain the body’s worst enemy—or its best asset.
When people are injured or sick, they slow down. Patients fear movements they believe will be painful, and mentally link an increase in movement with a spike in pain.
Often, the anticipated pain is worse than the reality, Dr. Simmonds said. Overcoming the fear of pain becomes critical, because the path to recovery involves regaining normal motion and function. And the benefits stretch beyond physiological. The ability to function leads to better moods and better cognition.
“So the way we think is influenced by chronic pain, and likewise chronic pain is influenced by what we think and the way we think,” she said.
Dr. Simmonds’ lab is taking this mind-pain link and turning it on its ear. By manipulating the environment, they want to spur the body into movement, fooling the brain into recovery.
“This manipulation of the environment gives you the illusion of something that is not actually there, but you can have an effect on the mind and movement,” she said. “And because you also have this distraction that is going on, you lose some of the attentional capacity for focusing on pain.”
Small environmental tweaks have led to large discoveries. Patients walking on treadmills walk faster if the virtual reality environment around them, such as a hallway of pillars or a country road surrounded by trees, slows down.
“The slower the pillars move on the screen, the faster the person moves. And the faster it goes, the slower they walk,” Dr. Simmonds said. “So you can manipulate how fast something is moving and the person adjusts accordingly. And they don’t know because it’s quite subtle.”
The body responds similarly with auditory cues. Increasing or decreasing the speed of footsteps causes people to speed up or slow down their pace to walk in sync with the sound.
“They are speeding up without understanding it and it is not aggravating their pain. They don’t even know they are doing it,” she said. “By adjusting that preferred speed, they recalibrate. And when they are walking off the treadmill, they can maintain the increase in movement. It is quite fascinating.”
Dr. Simmonds’ lab is also exploring the use of avatars in pain management. Patients create an avatar and use that virtual body to identify regions of pain that echo their own. They then practice diminishing the pain on their avatar.
Just as human bodies are complex and unique, pain is a complicated, personal experience. And it’s invisible. Beyond the avatar or a pain scale, there is no way to demonstrate one’s level of pain. Similarly, there is not one way to treat pain.
“There is no panacea. It’s a very complex system, and there has been a lot of misdirected problem-solving from patients, caregivers, practitioners and policymakers,” she said. “I think it’s trying to understand that in a more holistic way that addresses the person with pain as opposed to just the pain itself.”
Medication may be appropriate for temporary use after surgery or during a spike in pain, but managing chronic pain is key, she said.
“With any chronic disease, you don’t expect to cure it. You have to learn to manage and live with it,” she said. “But if patients still expect to be cured of pain and for the pain to go away totally, and health care practitioners—be they physicians, nurses or physical therapists—think of pain as acute that should be cured and go away, then the expectations of both in terms of an outcome of treatment are going to be violated. It ain’t going to happen.”
Dr. Simmonds has experienced pain from both sides of the hospital bed. When she was 19, she broke her back and pelvis in a horseback riding accident. Since then, she’s had about 10 surgeries and has spent nearly 400 days in hospitals around the world. Rehabilitation has been a continuous part of her life, both as patient and as therapist.
It has impacted her research from the beginning, and continues to inform her work as an educator.
“I came to the realization that therapy is not what you do, it’s who you are. You’re the therapy,” she said. “By creating that therapeutic self in yourself and others, you can understand and empathize [with patients]. And if you legitimize the suffering and the misery that can sometimes come along with some days and you demonstrate a belief in the person and the difficulties they’re experiencing—if you make people feel better, they will do better.”