Episode 60 - Conquer Pain with Virtual Reality
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Episode Summary
When we think of virtual reality, we usually think about its most obvious uses: gaming, socializing, or even shopping.
But researchers and doctors are also experimenting with VR in the healthcare field. Harvard MedTech has found that VR has unique properties that help the brain address pain and return to homeostasis in a holistic way.
In the Vx Therapy program, clinicians work alongside VR to help guide anyone from surgical patients to hospice patients and veterans toward relief from their pain.
Using a biopsychosocial approach, practitioners there have found that creating acute distractions during a VR therapy session leads to pain relief that lasts hours, the equivalent of a pharmacological option like painkillers. That activity also encourages neuroplasticity and has helped patients achieve long-term relief and even sleep improvement.
“We're tapping into the human brain in a way that we've never really been able to do before,” says Gerry Stanley, MD, Senior Vice President and Chief Medical Officer at Harvard MedTech. “We always treated it with drugs, we would treat it with injections, we would do different things, but now we're leaning into the brain's natural ability to find homeostasis and heal itself.”
In this episode of Back Talk Doc, host Dr. Sanjiv Lakhia sat down with Dr. Stanley to discuss Harvard MedTech’s Vx Therapy program, why VR therapy works, and how it can revolutionize medicine as we know it.
Featured Expert
Name: Dr. Gerry Stanley
What he does: As Senior Vice President and Chief Medical Officer at Harvard MedTech, Dr. Stanely leads the company’s tech and VR solutions to help combat the opioid epidemic and mental health crisis in the United States. He is also a consultant and business leader providing guidance to healthy systems on healthcare solutions.
Company: Harvard MedTech
Words of wisdom: “If we treat people holistically, we give them a tool to engage them biopsychosocially — look at the savings on the backend for the carriers. Look at the happiness of the patients […] That’s the holy grail.”
Connect: Website | LinkedIn
Anchor Points
Top takeaways from this Back Talk Doc episode
VR therapy helps the brain heal itself. Harvard MedTech has found that VR can create acute distractions to shift the brain’s attention centers away from pain to focus on visual and audio stimuli, a technique that encourages neuroplasticity and a return to homeostasis. The pain relief lasts for three hours — a homeopathic treatment equivalent to the effect of taking medication.
Guidance is necessary when using VR for therapy. For people with anxiety, depression, PTSD, and other conditions, VR can be a saving grace or a dangerous rabbit hole. Dr. Stanley calls the former the “Alice in Wonderland effect,” in which patients begin to use it as an escape and may become isolated
In the long run, VR could even help lower healthcare costs. Financial research through Vx Therapy has found that it has an immediate return on investment and can bring huge savings to healthcare organizations. What’s more, it’s helping patients heal and keeping providers happy.
Episode Insights
[02:56] What is Vx Therapy?: Today’s guest, Dr. Gerry Stanley, leads Harvard MedTech’s Vx Therapy program. He explains how Harvard MedTech is using virtual reality to give patients a more immersive and effective teletherapy experience — and why it works.
[09:05] Helping the brain heal itself: VR therapy’s effectiveness has to do with neuroplasticity — helping guide the brain toward new neural pathways toward homeostasis.
[12:12] The “Alice in Wonderland” effect: Dr. Stanley walks us through Vx Therapy’s guided 30-day program and the risks that come with VR treatment for mental health patients if not administered properly.
[15:17] Biopsychosocial vs biomedical: The effectiveness of VR therapy has to do with the biopsychosocial model of healing first raised by Geroge Engel in 1977. It means treating someone holistically — both physically and psychologically — to treat everything from pain to insomnia.
[21:35] No ideal candidate: There’s no ideal patient or condition for VR therapy; it’s used in everything from perioperative and post-surgical care to hospice. “It's really those patients who need a little bit of extra TLC,” says Dr. Stanley. “It's the patients who have something in their life that's working against them healing.”
[24:54] Dealing with veterans: Harvard MedTech often works with veterans who suffer from repetitive microtrauma, a population ideal for treatments like Vx Therapy.
[26:40] Lower costs: Financial research on VR therapy shows that it can bring huge savings to healthcare organizations and has an immediate return on investment.
Subscribe & Contact
If you enjoyed this episode of Back Talk Doc, check out our recent episode Hip vs. Back pain with Dr. Puneet Aggarwal
Enroll in Dr. Lakhia’s 6 week course to lower inflammation:
https://www.drlakhia.com/offers/WanLnrxk
Apply for an Integrative Medicine consult with Dr. Lakhia (NC/SC residents only)
https://www.drlakhia.com/apply
For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.
Subscribe in your favorite podcast app.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
When we think of virtual reality, we usually think about its most obvious uses: gaming, socializing, or even shopping.
But researchers and doctors are also experimenting with VR in the healthcare field. Harvard MedTech has found that VR has unique properties that help the brain address pain and return to homeostasis in a holistic way.
In the Vx Therapy program, clinicians work alongside VR to help guide anyone from surgical patients to hospice patients and veterans toward relief from their pain.
Using a biopsychosocial approach, practitioners there have found that creating acute distractions during a VR therapy session leads to pain relief that lasts hours, the equivalent of a pharmacological option like painkillers. That activity also encourages neuroplasticity and has helped patients achieve long-term relief and even sleep improvement.
“We're tapping into the human brain in a way that we've never really been able to do before,” says Gerry Stanley, MD, Senior Vice President and Chief Medical Officer at Harvard MedTech. “We always treated it with drugs, we would treat it with injections, we would do different things, but now we're leaning into the brain's natural ability to find homeostasis and heal itself.”
In this episode of Back Talk Doc, host Dr. Sanjiv Lakhia sat down with Dr. Stanley to discuss Harvard MedTech’s Vx Therapy program, why VR therapy works, and how it can revolutionize medicine as we know it.
Featured Expert
Name: Dr. Gerry Stanley
What he does: As Senior Vice President and Chief Medical Officer at Harvard MedTech, Dr. Stanely leads the company’s tech and VR solutions to help combat the opioid epidemic and mental health crisis in the United States. He is also a consultant and business leader providing guidance to healthy systems on healthcare solutions.
Company: Harvard MedTech
Words of wisdom: “If we treat people holistically, we give them a tool to engage them biopsychosocially — look at the savings on the backend for the carriers. Look at the happiness of the patients […] That’s the holy grail.”
Connect: Website | LinkedIn
Anchor Points
Top takeaways from this Back Talk Doc episode
VR therapy helps the brain heal itself. Harvard MedTech has found that VR can create acute distractions to shift the brain’s attention centers away from pain to focus on visual and audio stimuli, a technique that encourages neuroplasticity and a return to homeostasis. The pain relief lasts for three hours — a homeopathic treatment equivalent to the effect of taking medication.
Guidance is necessary when using VR for therapy. For people with anxiety, depression, PTSD, and other conditions, VR can be a saving grace or a dangerous rabbit hole. Dr. Stanley calls the former the “Alice in Wonderland effect,” in which patients begin to use it as an escape and may become isolated
In the long run, VR could even help lower healthcare costs. Financial research through Vx Therapy has found that it has an immediate return on investment and can bring huge savings to healthcare organizations. What’s more, it’s helping patients heal and keeping providers happy.
Episode Insights
[02:56] What is Vx Therapy?: Today’s guest, Dr. Gerry Stanley, leads Harvard MedTech’s Vx Therapy program. He explains how Harvard MedTech is using virtual reality to give patients a more immersive and effective teletherapy experience — and why it works.
[09:05] Helping the brain heal itself: VR therapy’s effectiveness has to do with neuroplasticity — helping guide the brain toward new neural pathways toward homeostasis.
[12:12] The “Alice in Wonderland” effect: Dr. Stanley walks us through Vx Therapy’s guided 30-day program and the risks that come with VR treatment for mental health patients if not administered properly.
[15:17] Biopsychosocial vs biomedical: The effectiveness of VR therapy has to do with the biopsychosocial model of healing first raised by Geroge Engel in 1977. It means treating someone holistically — both physically and psychologically — to treat everything from pain to insomnia.
[21:35] No ideal candidate: There’s no ideal patient or condition for VR therapy; it’s used in everything from perioperative and post-surgical care to hospice. “It's really those patients who need a little bit of extra TLC,” says Dr. Stanley. “It's the patients who have something in their life that's working against them healing.”
[24:54] Dealing with veterans: Harvard MedTech often works with veterans who suffer from repetitive microtrauma, a population ideal for treatments like Vx Therapy.
[26:40] Lower costs: Financial research on VR therapy shows that it can bring huge savings to healthcare organizations and has an immediate return on investment.
Subscribe & Contact
If you enjoyed this episode of Back Talk Doc, check out our recent episode Hip vs. Back pain with Dr. Puneet Aggarwal
Enroll in Dr. Lakhia’s 6 week course to lower inflammation:
https://www.drlakhia.com/offers/WanLnrxk
Apply for an Integrative Medicine consult with Dr. Lakhia (NC/SC residents only)
https://www.drlakhia.com/apply
For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.
Subscribe in your favorite podcast app.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Voiceover (00:01):
Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery & Spine Associates, where cutting edge nationally recognized care is delivered through a compassionate approach. This podcast is for informational purposes only and not intended to be used as personalized medical advice. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia (00:38):
Those of you who have been following the podcast now know that I love, I really just love exploring topics in the field of pain, spine care that involve treatments that aren't toxic, that are holistic, that encompass the mind body connection. And today we're going to dive into one that I'm really, really excited about and that is the use of virtual technology, virtual reality technology for people suffering with pain. And to help me dive into that, I'm going to welcome Dr. Gerry Stanley to the show. Welcome to the show, Gerry.
Gerry Stanley (01:19):
Hey, thanks for the invitation.
Sanjiv Lakhia (01:20):
All right, friends, let me introduce Gerry to you. He's going to help me lead this conversation. He's a senior vice president and chief medical officer for Harvard MedTech and he's had a passion for healthcare transformation for many years. He's a family doc by training, but really has gone well beyond that, into entrepreneurship, into business, healthcare IT, population health management, and is excited about Harvard MedTech and their VX therapy virtual reality program to help combat and find a solution for the growing opioid epidemic and mental health crisis in the United States. I'm so excited about this. Full disclosure, I'm personally supporting the company because I so believe in the mission and I'm excited that Gerry's able to talk with us today.
(02:07):
Gerry received his undergraduate degree from Creighton University studying classical and near eastern civilizations where he graduated magna cum laude. He then attended the Creighton University of School of Medicine where he served as a class president for three years and graduated with clinical honors and receive the university's highest honor, the spirit of Creighton Award. Upon graduation, he completed his residency at the Northern Colorado Family Medicine program with a focus on rural and surgical family medicine. And then he practiced clinical medicine for over 10 years in a variety of settings. Group and hospital leadership positions were held as well. And then he went to the Kellogg School of Management at Northwestern University and graduated from the physician CEO program. That's a lot of accolades in a short period of time, my friend.
Gerry Stanley (02:54):
I hope my mom got to hear that.
Sanjiv Lakhia (02:56):
Yeah, exactly. All right, so let's jump into the topic of today. And that is the use of virtual reality that is the Harvard MedTech VX therapy program. In short, it involves patients who are suffering with pain, utilizing on a routine basis, evidence-based virtual reality combined with therapy, working with a clinical therapist. And before we get into the nuts and bolts of the program, can you help listeners who are not familiar with VR, kind of what is it and how does it work? How does it affect our brain?
Gerry Stanley (03:34):
Absolutely. So for folks who aren't familiar with VR, I like to think of it as it's an immersive way to experience audio and video. So if we think of just a traditional listening to a radio versus watching a television versus adding surround sound versus IMAX theaters, virtual reality is putting you in a place where you're completely immersed in 360 degrees. You look up, you look down, you look behind you everywhere that you are, you're really in the middle of what you're experiencing. So it's a great way to immerse people. And why that's really important is the immersion that's really driving so much of the benefit as we're treating some of these symptoms that patients are dealing with. Going back a few steps, virtual reality has really been around since the 60s. It really grew up, cut its teeth in the military with flight training, but it was in the early 2000s that people started using virtual reality in burn units while they were doing bedside wound debridement.
(04:28):
And in doing those debridements, they found they needed much less periprocedural anesthesia, that they didn't need to use as much fentanyl, they didn't need to use things for those debridements because patients were distracted. Fast-forward, really in the last two to three years, what's happened is the price point of this technology has come down to a place to where now we can acquire that technology and put our proprietary software in it and send it into patient's homes to where instead of having the patient go to where the therapy is, we're now bringing the therapeutic tool, the virtual reality headset to the patient's home. Does that make sense?
Sanjiv Lakhia (05:06):
Yeah. So it's combining, it's almost like a telemedicine or tele platform, very convenient and something that people can use in the comfort of their own homes. Now, when I was preparing to talk with you and learning more about this technology, I was looking through the medical literature, trying to figure out what are the mechanisms behind how this works? And not to get too geeked out on neurochemistry and neurobiology, my understanding about virtual reality, and you mentioned one of them, is that number one, there's a distraction component to it that literally can shift the attention centers in your brain away from the pain and into something more pleasant. And then secondly, my understanding is that the VR, and particularly some of the programs that we use here through the VX therapy program, work on the emotional centers of the brain, like the amygdala, [inaudible 00:06:02]. And when you create more pleasant sensations emotionally, there are direct connections, neural networks between the emotional centers of the brain and the pain pathways in the body. So what part of what I just said resonates as somewhat accurate to you, or can you elaborate on that?
Gerry Stanley (06:17):
Well, I think you're spot on in all counts. It's really an application of the gate control theory of pain. We're all very familiar with going to the dentist and they shake your gum. Well, what we're doing with the virtual reality is using very high order signals, the audio and the visual stimuli, which are far superior to pain, to vibration. I mean really even the maladaptive signals of depression, anxiety, PTSD, it's more important than, are you hungry? Are you tired? It supersedes all of those signals. So that creates that acute distraction. Okay. What we've been able to find is that by using the acute distraction in a guided and thoughtful manner, actually promotes permanent neuro plastic change within the brain where the brain, essentially deprioritizes more noxious signals. Now in the middle of all that, you're absolutely right that having the hippocampus and the amygdala activated by increasing dopamine levels, by just increasing endorphins in people because they're experiencing something that's pleasant, something that's fun, is having a direct relationship on what's going on with the pain.
(07:28):
So very much the applied gate control theory of pain, very much everything that you're talking about with regards to neurotransmitters within the brain. But we've also done some functional MRI studies and what we've seen is that when a patient is experiencing pain, we know all of that pain moves through the thalamus. That's where that central processing, where the brain's processing what's going on. When we look at what happens with virtual reality, about 50% of the thalamic activity is then rerouted to focus on the visual and the audio cues. So the brain is no longer processing at such a high rate, all of those pain signals. And that's where as we think about this in a perioperative or in a periprocedural standpoint, people are seeing a 50% reduction in pain immediately in a non-pharmacologic way just by really changing how their brain is perceiving the signals.
(08:19):
And it's lasting anywhere for two to three hours. So I always liken that. That's the equivalency I'd say, of taking a Vicodin or a Percocet, right? You're getting 50% reduction in pain the last three hours, but it's completely non-pharmacologic, and it's really aligning that person holistically so that their brain can then start to impact the sensations that they're feeling, whether again, it's pain, depression, anxiety, symptoms of PTSD. I think that's really what I'm super excited about, is we're tapping into the human brain in a way that we've never really been able to do before. And we always treated it with drugs, we would treat it with injections, we would do different things, but now we're leaning into the brain's natural ability to find homeostasis and heal itself.
Sanjiv Lakhia (09:05):
You mentioned a word neuroplasticity. For people listening who have not heard that before or don't fully understand it, can you give them a high level definition of that and how it relates to what you're trying to accomplish?
Gerry Stanley (09:19):
Oh, absolutely. So neuroplasticity, if we think about it in its most basic form, is your body's natural tendency to want to find homeostasis. And we've seen neuro plastic changes, almost all of us in our professional life or in our personal life when we've seen folks rebound from a stroke where they're learning to use a hand, they're learning to eat or drink or talk, where they've lost some of that ability and the brain knows, golly, I really want to use my left hand, but I've had a stroke and now I can't. So when the occupational therapist working with that patient, the brain is trying to find a new neural pathway in order to achieve that result. The ability for the brain to form that new neural pathway is referred to as neuroplasticity.
Sanjiv Lakhia (10:04):
Yeah, and I'm glad you mentioned that because I was thinking about my experience in residency doing stroke rehabilitation where the therapies, the physical therapy, all of these were designed to promote neuroplasticity and develop new neural networks, new neural patterns to help people rehabilitate. And another example that's somewhat similar, when I was learning about the VR technology, it made me reflect on when I used to do back in the day, some work in the prosthetic amputee clinic and this idea of phantom limb pain, and then the kind of novel development of these mirror box therapies where patients could have their unaffected limb put in a box that has a mirror reflection, so it looks like they have two healthy limbs.
(10:52):
And lo and behold, even just visualizing that and doing some physical therapy movements with that could turn down some of the brain hyperactivity centers that were responsible for the nerve pain. And I feel like VR is just that concept taken to the 10th degree, utilizing the brain's capacity to really help the body heal itself. I mean, I think that's so exciting about this and is packaged in a product that up until now, really, it's just like for PlayStation's and for gamers, and lo and behold, it can really have massively positive effects on your health.
Gerry Stanley (11:28):
Yeah. We all have our opinions about what we think of with Facebook and meta and technology and some of the addictive forces that I think we see, especially in our younger kids with phones. All of those principles that draw people into that technology we're applying, but in a very different direction. So we're applying it, I say, for the forces of good in a way that allows us to allow the body to heal itself, that drives homeostasis in a very holistic way. So again, these are concepts that feel very grandiose, yet we're surrounded by them every day in a variety of different aspects in our life. We're just choosing to apply them in a way that's very thoughtful and very directed to allow the body to heal itself.
Sanjiv Lakhia (12:12):
I want to get your thoughts on the what's called the psychosocial model of addressing pain. And as you do that, or maybe before you do that, go ahead, I outlined a little bit earlier, but go ahead and tell the folks listening exactly what the VX therapy program is from Harvard MedTech, how it works, what are the components, and then maybe you can roll that into an explanation as to why it's built around this sort of model.
Gerry Stanley (12:41):
Oh, absolutely. So VX therapy is the application of virtual reality that is guided by a behavioral health clinician. Why this is so important is if you're taking a patient who's experiencing pain or is depressed or anxious, if you give somebody a virtual reality tool, but you let them be unguided, you have a very high likelihood of giving that person the perfect rabbit hole to crawl into. I always kind of referred to that as the Alice in Wonderland effect, where you've now given somebody who may be withdrawn and isolated, now they're isolated in their home actually giving them an entire new world to go crawl into. So it's very important that with virtual reality, you're guiding the patient through it in a very programmatic way. So it's not to create an addiction of virtual reality or to create a place where patients go and hide. So what VX therapy is, it's a 90-day program and the patients are matched up with a personal clinician, and that personal clinician is a master's level behavioral health clinician. Okay.
(13:39):
All of these folks are having calls and once a week they take a call with the patient to see how are they doing, what goals are they setting, how are they sleeping? Really looking at this person in a very holistic way. We're not focusing on one specific diagnosis. We're not focusing on what's broken about them. We're focusing on what they can do, what they want to do, what they love to do, what is their joie de vivre, what brings joy to their life. And that's what we want to focus on. So we may be working with the patient and helping them do a little bit of virtual reality before bed to help them sleep. We may be having them do some games through the course of the day to keep the thalamic activity down. We'll have them go walk on the shores of Majorca or hang glide over the [inaudible 00:14:24]. We'll let them go explore different things.
(14:25):
But then we've got knowledge and educational content built in where we're educating them about good sleep hygiene, about what causes pain, about depression versus anxiety and what's going on in their body and what these neurochemicals that doctors talk about. But it's the way that we do it holistically. So that behavioral health clinician is very much like a chef. And what we're doing with the virtual reality is very much that chef's pantry, so that the chef can customize whatever they're making to the patient, because we all know no two patients are exactly alike, and there's no one therapy that fits everybody. So we're taking this virtual reality therapy, coupling it with a behavioral health clinician so that they're getting some cognitive behavioral therapy, they're getting some dialectical therapy, they're getting acceptance compliance, they're doing motivational interviewing, whatever is the vehicle to help that patient progress into and out of the program is what the behavioral health clinician is doing.
(15:17):
So really the secret is that behavioral health clinician who's customizing the therapy to the patient. Now, to go back to your original point around the biopsychosocial model, I believe it was 1977 at Rochester University when George Engel brought up this concept of the biopsychosocial model in contrast to the biomedical model that had really been at the forefront of all of medicine for years, where we were focused on the disease, the disease state, and the body. His construct was that's absolutely important, but people are also social animals. People are psychological animals. They're very complex in their makeup. And that if we just address one leg of that stool, we're not really treating the person holistically. And what Engel propose and what I'm a firm believer in is yes, we can talk about treating the patient's biologic needs. That's what you're doing every day. That's what we're doing with that headset, keeping the thalamus down, but layering in the components of a behavioral health clinician to help guide them, asking them how are they doing?
(16:20):
You may be dealing with pain and maybe you've got really bad rheumatoid arthritis and that's driving your pain. Okay, that's real pain. That's a biologic issue. But if you're a concert pianist and you can no longer play piano and do what you love and what gives you joy, you're dealing with an entirely different type of pain that's not biologic in nature, it's psychologic, it's social. What are those interactions that are not happening in a person's life that they're missing? So we've really designed this program to be the application of the biopsychosocial model, but done in a patient's home. So they have access to this 24/7, they get to talk to their clinician. The program is being changed and constantly adjusted to meet them. So whatever is driving their pain, their depression, their anxiety, their fear, their sleep issues, whatever those symptoms of the traumatic event that they've endured, we're addressing the biologic needs, the psychologic needs, and the social needs.
Sanjiv Lakhia (17:21):
And there's, thank you for that. And there's level A evidence, particularly with cognitive behavioral therapy for its effectiveness with chronic pain. And honestly, it's that component of this program that really has me almost as excited as the VR part. I've gone through integrative medicine training in addition to my physiatry training, Gerry, and as part of that, I've learned in terms of history taking at times, it's important to shift our question from asking what's the matter to what matters? And when you do that with people, you can get a whole new pathway towards helping them heal.
(18:02):
For example, just even this week, asking some of my patients, and I'll often ask them, well, why do you think this is happening now? Or what's your intuition around what's really going on behind your pain? And you get all sorts of answers ranging from anywhere from grieving to the loss of a loved one, to feeling overburdened by work or family. And all of that stuff is magnified for people who live with chronic physical pain. And when all we do is treat the physical component but don't address the social aspects, the emotional aspects, the recovery of the healing is just incomplete. So this technology, which is so cool, offers both sides of that coin to people who are suffering. So that to me, I think that's what really makes this such a dynamic package.
Gerry Stanley (18:57):
Couldn't agree more. I feel like it's a really neat time in the healthcare industry where we're needing to focus more on people than on disease states or just codes.
Sanjiv Lakhia (19:06):
Now, I was able to get my hands on a headset, and I had it for a while, and I was going through the programs. The programs are really well done. They're immersive. I really enjoyed doing the hang gliding one. It kind of reminded me a little bit. I told my wife, if you've ever been to Disney World and you sit through at Epcot, the ride Soarin, where you're up front and center and it takes you through all these beautiful landscapes and you just kind of forget about the world. And doing that with the headset on for 20 minutes, it changes your state in the moment.
(19:37):
And what's interesting is it really appears through the data that when you do that consistently, it can have long-term changes as well referring to the neuro plastic changes you described. So that's really cool. The other part that I like, I'm really big into mind body medicine. I do meditation. I do some yoga pranayama, I enjoy dabbling a little bit of Qi gong and Tai chi, but that's not for everyone. But I'll tell you, Gerry, people are used to watching screens, and VR is very passive. You literally just put it on and you sit down and you don't do anything other than engage that immersive experience. So I think this makes it very accessible to people. There's very few barriers from being able to use this technology.
Gerry Stanley (20:23):
That's really very much how we designed it was irregardless of your age or educational level, your socioeconomic status, you take this out of the box and you put it on and you're transported someplace, and you immediately begin that process of healing. And one of the things that I think in healthcare we don't often spend enough time talking about, and what we are seeing is just tremendous improvement in the quality and the duration of people sleeping. The most recent dataset I looked at was 90% of our patients were sleeping at least an hour more at night.
(20:56):
Well, I think we would all agree that if you can get patients sleeping a little bit better, they're going to be in a better place the next day. And we know the direct correlation between sleep and pain and sleep and depression and anxiety. We know the patients that aren't sleeping have far worse symptoms of PTSD, but it's helping people who are in that fear of voidance cycle of pain where I'm scared of the pain, so I'm nervous about it, and I'm so nervous the pain is worse. It's allowing patients to sleep so that we can break that cycle and give them a sense of hope for tomorrow. So like you said, it allows them to focus on what matters, not just what's the matter with their pain.
Sanjiv Lakhia (21:35):
That sleep component is so critical. Sleep is literally, and I've said before in my podcast, it's literally the only time during our day where our body can rebuild and repair. The rest of the day we're kind of breaking down. You have to get enough deep sleep, REM sleep. It's so important in terms of cognition, memory, and you're absolutely right. There's direct correlations in the medical literature between sleep and mood and sleep and pain. It's the same neural networks, the same neural chemicals that are involved. So that's a terrific utility for the product. Now, if someone's listening and they're saying, wow, this is really exciting. I've been struggling. This sounds like something new. Who would be an ideal candidate? What types of people, patients, problems, respond well to VX therapy that you would hope to try and get this in the hands of?
Gerry Stanley (22:28):
I wish I could give you a really solid, here's the one patient archetype that's its a home run in, but what we're seeing is we're having a lot of luck in perioperative care where it's part of somebody's operative procedure plans, Hey, they're having a multi-level spine surgery. We start taking care of that person a few weeks before their surgery, and then we take care of them for three months after. If it's a patient who may be a non-surgical patient, we're saying, we really don't have anything objective that we can operate on. We're doing a really good tool in those patients as far as being a resource or essentially a new arrow in the doctor's quiver to say, Hey, there's nothing I can offer operatively, but we can offer this so that we can reframe how they're dealing with those symptoms. But a lot of times, I'll tell people, it's really the patients who are dealing with psychosocial determinants of health.
(23:18):
They've got some unknown risk factor, whether it's psychologic or whether it's social in their homes, social in their life, adverse childhood events, whatever is driving those patients. Those are the ones that instinctively, we know as doctors, Hey, I've done a good surgery. Why is this patient not getting better? And there's usually something driving this that for the most part, as physicians, we're so busy and we're asked to do so much every day in the care of our patients, that it's hard for us to have the time to stop, slow down and one, identify what's going on. But then two, have the resources to be able to treat it.
(23:55):
We really have tried to step in and say, Hey, let us be that resource. Let us help you. If you've got the patient or the hair on the back of your neck stands up. Or you know that somebody's got some psychosocial risk factors, those are the patients that we want to love, we want to hold, want to work with through that journey so that we can give them that holistic care so that all of the biological medicine and everything is happening on the other side of the equation, we're driving to ensure success. To date, we've taken care of teenagers with anxiety. We've done hospice, surgical, behavioral health support, surgical avoidance, avoiding interventional pain procedures. And we've really treated a wide variety of patients. But I think at the core, it's really those patients who need a little bit of extra TLC. It's the patients who have something in their life that's working against them healing. So those are the patients that we love to lean in on. I hope that answers the question.
Sanjiv Lakhia (24:54):
Yeah, no, exactly. And I know Harvard MedTech also has done a lot of work with this offering through with veterans. Can you share a little bit about that?
Gerry Stanley (25:04):
Yeah. Taking care of the veterans is absolutely one of my passion projects because this is a cohort of people that they go to sea, they go overseas, they go away from their family to protect us so that we can all be back here and doing these things. And in that military community, a lot of times these folks are dealing with think of it as repetitive microtrauma or death by a 1000 paper cuts, as some people like to say, where they're doing a lot and they're tough and they're hardened and their seasoned and they know exactly what's going on, but it's just repetitive trauma that they're dealing with. And the ability to say, there may not have been one single event, but allowing these operators, these veterans, the ability to heal themselves, to give them a resource that they can do in their home.
(25:52):
They don't need to go see a counselor. We're doing this over the phone. We're guiding them through this program so that whatever is triggering this, it's really trauma-informed care. Whatever has triggered that traumatic event or those series of traumatic events, you're able to then go from that simple distraction principle to getting them sleeping, to really driving that permanent neuro plastic change and deprioritizing that signal. So you may not be able to make the signal go away completely, but if it's something that bothers them and it's a thunderous noise in their life, if that can just go down to a simple rumble or a little white noise or a background noise, that's really the goal. And in that community, we're really seeing a lot of opportunity to lean in and give support in just really novel places for patient care.
Sanjiv Lakhia (26:40):
Yeah. No, that's excellent. And I totally agree that's a group of people who need all the support and love they can get. Shifting gears just a little bit as we kind of come towards the end, certainly this is a tool that sounds like could be critical for helping to lower healthcare costs when treating pain and injury. From an insurance side, have you guys seen, have you collected data on kind of cost reductions for systems that are implementing and providing coverage for VX therapy?
Gerry Stanley (27:10):
Yep. That's part of what we're doing right now and part of my role is gathering that data so that we can go and have these discussions on the ROI to the payers. Now obviously, if we're talking about cost avoidance, that's fuzzy math at best. It's hard to calculate something that didn't happen, but we're getting letters back from insurance companies and adjusters saying, we saw huge savings because suddenly they were able to move, they were able to get them up. We were able to close a claim. We were able to basically get somebody back up into existing to say, look, tomorrow's going to be different. That doesn't mean it's going to be bad, but it's going to be different. So let's move towards our tomorrow purposefully. We're also working with ODG okay, and looking at that data, and there's really strong data to say that, and I think they've reviewed 20 million closed workers' compensation claims looking at, if you don't address psychosocial issues or you don't address opioids, or you just let opioids run rampant, that's a four to five times multiplier of the cost of care.
(28:13):
So if we can lean in and give people that holistic care, let them feel special, let them know that there's somebody that cares about them as they're moving through this journey. There's an almost immediate ROI that you can see just on cost avoidance, looking at not even the really high cost surgeries, even some of the lower cost surgeries or the lower cost therapeutics by allowing people to start healing themself. And there's lots of data and lots of evidence in that space. That's probably sort of my inner geeky nerd part, is moving into those financial discussions to be able to say, look, here's what we can do. If we treat people holistically, we give them a tool to engage them, biopsychosocially, look at the savings on the backend for the carriers, look at the happiness of the patients. We've got tremendous net promoter scores.
(29:04):
Look at the happiness of the patients. The providers like it because they've now got happy patients who are getting better. That's really the triple aim or the quadruple aim. That's the holy grail. Right. Where we've got better clinical outcomes, we've got a better patient experience, we've got lower financial cost, and as clinicians, we have a happy way to engage our patients. And so those are the use cases, and those are the conversations that I'm having right now with the payers and it's really exciting to be able to line up all four pieces of the quadruple aim and then show proof point saying, here, look at this. And at the heart of it is a patient that's getting better.
Sanjiv Lakhia (29:40):
Well, the work has to be done because at the end, accessibility also is important. We could have the greatest technology, but if it can't get it into the hands of the people that need it, then that's a challenge and a problem. So hopefully as time evolves, we're going to continue to have good data to show, and it's going to gain a lot of momentum. If someone's listening right now, Gerry, and let's say they're on maybe a prospective patient or even someone on the insurance side and they want to learn more, reach out to you or learn more about the product, what would you recommend they do?
Gerry Stanley (30:12):
You're welcome to come to our webpage. It's www.harvardmedtech.com, just one word, M-E-D-T-E-C-H. We've got contact information on there. If you've got questions, if you're a prescriber, if you're a potential patient, we're more than happy to help you with that journey as far as take this form to your doctor, here's what you need, here are the questions you can ask, and what can we do to be a part of that patient's journey? So that's probably the easiest and most direct way is just to engage us there.
Sanjiv Lakhia (30:41):
Awesome. And we'll link to that in the show notes. I love the ease of implementation from the patient side, the convenience from the patient side. I'm really thrilled about the scientific data behind using behavioral therapy with VR. I mean, there's just a lot of good sound science behind it, and I think it is really positioned into an area that needs help from a physician side, helping patients with challenging pain issues continues to be of top importance in this country for sure. So I'm real excited and hopeful for the future for Harvard MedTech and the VX therapy program. And again, if you're interested and you're listening, go and check out the website. We'll link to that. I'd also encourage anyone who wants to learn more, Harvard MedTech has a nice YouTube channel with several really cool testimonials put together, and then some videos on more of the science behind it. So there's a lot of information to be had.
Gerry Stanley (31:40):
Yeah. Thank you for the opportunity to be on your show. I appreciate it.
Sanjiv Lakhia (31:42):
Yeah, thank you. And I look forward to catching up with you again soon. And again, thanks for your time, Gerry.
Gerry Stanley (31:48):
Hey, my privilege.
Voiceover (31:50):
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
Top quotes from the episode:
[8:47] Gerry Stanley: “We're tapping into the human brain in a way that we've never really been able to do before. We always treated it with drugs, we would treat it with injections, we would do different things, but now we're leaning into the brain's natural ability to find homeostasis and heal itself.”
[14:57]: Gerry Stanley: “We're taking this virtual reality therapy, coupling it with a behavioral health clinician so that they're getting some cognitive behavioral therapy, they're getting some dialectical therapy, they're getting acceptance compliance, they're doing motivational interviewing — whatever is the vehicle to help that patient progress into and out of the program is what the behavioral health clinician is doing. So really the secret is that behavioral health clinician who's customizing the therapy to the patient.”
[17:49]: Sanjiv Lakhia: “It's important to shift our question from asking, what's the matter to what matters? And when you do that with people, you can get a whole new pathway towards helping them heal.”
[8:47] Gerry Stanley: “We're tapping into the human brain in a way that we've never really been able to do before. We always treated it with drugs, we would treat it with injections, we would do different things, but now we're leaning into the brain's natural ability to find homeostasis and heal itself.”
[14:57]: Gerry Stanley: “We're taking this virtual reality therapy, coupling it with a behavioral health clinician so that they're getting some cognitive behavioral therapy, they're getting some dialectical therapy, they're getting acceptance compliance, they're doing motivational interviewing — whatever is the vehicle to help that patient progress into and out of the program is what the behavioral health clinician is doing. So really the secret is that behavioral health clinician who's customizing the therapy to the patient.”
[17:49]: Sanjiv Lakhia: “It's important to shift our question from asking, what's the matter to what matters? And when you do that with people, you can get a whole new pathway towards helping them heal.”
