4.7 Virtual Reality for Orofacial Pain: Unlocking Its Potential in Pain Management

 

By GianCarlo Colloca, MEd, MS, and Luana Colloca, MD, PhD, MS (USA)

Virtual reality (VR) is sparking interest as a pain management tool. Although its role in pain treatment is being explored, its potential in orofacial pain is still untapped. VR transports you beyond your surroundings, even embodying a new environment. This blend of technology and experience enhances pain tolerance and can notably reduce acute and chronic pain in real-world settings.

What is intriguing is that VR pain relief works at the bedside or at home, expanding its benefits. Custom VR rehabilitation aids movement-impaired individuals, while also enabling health care practitioners to gain hands-on training. The future holds the promise of more wide-ranging VR applications beyond medicine, and robust research is becoming increasingly available.

VR reveals a pain-managing future, offering a sneak peek. Through careful investigation and development, VR has the potential to revolutionize the experience, management, and treatment of pain.

People who experience jaw pain, known as temporomandibular disorders (TMDs), often have trouble finding the right help for their ongoing pain. TMDs affect about 5% to 12% of people in general, and it causes a great deal of difficulty for individuals and society. Sadly, it is not easy for individuals with TMD to find treatments that do not involve taking pills. In part, this is because there is no agreed-upon best care protocol for individuals with TMDs, nor is there much knowledge about how much therapies that consider both the body and the mind can help with TMDs and related issues. Moreover, to make the situation even tougher, there are not enough health care providers who know how to treat this condition.

VR could help with ongoing pain, whether it is lasting or just comes on suddenly. Although there is a great deal of detailed research about how exactly this works in acute and chronic pain, more research is needed especially for people with orofacial pain and TMDs.

Unlocking the Magic of Virtual Reality. VR is a computer-generated technology that creates immersive, three-dimensional environments or simulations. It is designed to simulate a user’s physical presence in hear, feel, and even expect. There is still much more to learn. We need to figure out how our thoughts and feelings affect how VR helps with pain.

Understanding How Virtual Reality Helps with Pain. The Colloca research group (USA) performed a study to investigate how VR affects how we feel pain and whether we can increase the ability to tolerate pain through VR.  Study participants included healthy individuals, and the study investigated how their bodies and minds reacted to VR when they experienced a painful stimulus. Specifically, a painful stimulation was delivered through a thermode that became increasingly warm and that the study participants were able to control with a remote. The VR headset was mounted and displayed some jellyfish, nature, music, and relaxing ocean scenes. This was one of the first studies of VR that included appropriate controls for VR contexts (immersive vs nonimmersive) and multiple objective and subjective outcomes.

We wanted to determine whether VR could change how much thermal pain individuals could handle in a laboratory setting. We also investigated whether the painful stimulus made them feel different emotions, such as being in a better or worse mood or feeling anxious, when they were in the VR world. We even measured how their bodies reacted by measuring how their skin responded to pain and how their body’s vagal nervous system was working.

The study results indicated that, when people used VR, they tolerated a higher level of painful thermal stimulations, and yet their bodies showed that they were more relaxed, even if they could tolerate more pain under VR conditions. It was as if their bodies were saying, “I’m okay, even though I’m feeling pain.” The VR environment might have created such a state of relaxation that it allowed study participants to handle more self-administered pain while relaxing and experiencing mood improvements. Some of these results are presented in Figure 4-4, which shows that VR users exhibited increases in pain tolerance, reductions in pain unpleasantness, improvements in mood, and reductions in anxiety.

Figure 4-4. VR-induced pain tolerance and psychological well-being, as shown by plots of (A) pain tolerance, (B) pain unpleasantness, (C) mood improvements, and (D) anxiety reduction for control VR versus immersive VR. These results collectively suggest that VR not only enhances pain tolerance but also promotes a state of relaxation, improved mood, and reduced anxiety. These findings are statistically significant.

We also tested different variables, such as having people do a memory task to contrast the effects on pain tolerance of distraction versus VR. This trial indicated that simply being distracted by VR did not fully explain why pain was experienced less intensely. Also, the memory task did not help with relaxation. Instead, people became more nervous during the memory task. On the contrary, it seemed that feeling relaxed in the body played a significant part in how VR helped with pain.

In short, we found that VR can help people increase experimental pain tolerance and improve their mood and anxiety. We also saw that the type of VR world matters. For example, being in a VR ocean scene rather than a violent opera (The Clemency of Titus, Mozart), which we created ad hoc for the VR headset, seemed to help the most, allowing study participants to tolerate more pain and feel better overall. The VR world appeared to provide people with a break from painful stimulations and help them relax. Moreover, the more an individual liked a VR world (e.g., the ocean vs the violent opera), the better they felt emotionally, and the less their pain bothered them. This means that how much someone enjoys a VR world can change how much it helps with both the experience of pain and general mood. It is as if the VR created a sort of multisensory experience that made thermal painful stimulations feel less intense.

Potential Mechanisms of Virtual Reality. Researchers have been investigating how VR might help reduce pain. Imagine being in a computer-made world that feels so real that you feel like you are actually there. VR can use features such as what we see and hear and even how we are feeling emotionally to help reduce pain. It is more like a distraction that our brain pays attention to instead of the pain. Our thoughts and expectations might also play a role in how well VR works for our experience of pain.

Scientists are studying this question in detail to determine exactly how VR affects pain and whether it can provide a helpful means of managing pain as an adjunct to medications or in the place of high-dose medications. Researchers want to know if different aspects of VR, such as what we see and hear and even how much we enjoy it, can change how much pain we feel. It is like solving a puzzle to make VR work the best way possible for people who are in pain. This is all still being researched, so there is much more to learn about how VR can help with pain relief.

Real-World Benefits of Virtual Reality in Hospitals. Researchers have been investigating how VR can help with pain relief, for example, for those who are staying in the hospital. This is pretty exciting because it is a new way to help in-patients feel better when they are experiencing excruciating surgery- or trauma-related pain. We have seen how VR can actually make a difference for patients at the bedside in the hospital.

One study used VR in a special way to help in-patients manage their acute pain.  In this study, patients were given VR headsets with an assortment of different experiences to choose from, such as being underwater or in a peaceful garden. The researchers then compared the experiences of these patients with others who just watched a regular television program about health and wellness. What they found was that the patients who used VR reported less pain than those who watched television.

Another study considered in-patients with injuries, including head injuries.  In this case, two types of VR experiences were tested, one of which was relaxing, while the other was neutral. The VR experiences were also compared with use of a tablet with no immersion in VR contexts. The patients who experienced the relaxing VR reported less pain compared than those who used a tablet. The VR experience also seemed to make the body relax, which is good for healing. Even though the difference in anxiety levels was minimal, the patients felt that the relaxing VR helped them the most. Interestingly, a reduction was observed in the need for opioid intake to relieve pain. This result seems to be extremely meaningful in the effort to reduce opioid side effects and, potentially, to minimize the burden of overuse, abuse, and addiction resulting from the opioid epidemic. Interestingly, it was found that in-patients who liked the relaxing VR used less pain-relieving medicine, such as opioids, after a VR session. This suggests that VR might help reduce the need for strong pain medications while still making in-patients feel better.

Both of these studies demonstrate that VR can be used in hospitals to help patients manage their pain and feel more comfortable when handling severe traumatic and surgery-related acute pain, thus opening up a new and exciting way to improve in-patients’ experiences while in the hospital.

Advancements in Virtual Reality for Chronic Pain Relief. Researchers have investigated how VR can make a difference for people dealing with long-lasting pain. The efficacy of VR in terms of clinical pain reduction has already been examined for a variety of clinical conditions, including burning wound care pain, dental examination, and vaccination, as well as chronic pain. Individuals with chronic pain have also found relief through VR. One study used VR for just 5 minutes and found that participants felt much less pain during the VR session. In another study, participants used VR for 21 days at home, and after a couple of weeks, they reported starting to feel better and being able to manage their pain more effectively. Also, exciting is that in the U.S. the Food and Drug Administration (FDA) has approved a prescription VR headset device for managing chronic lower back.

In the United Kingdom, researchers explored using VR for chronic low back pain. They found that participants who used VR therapy reported reduced fear of movement and overall improvement in their condition. This shows that VR can offer relief and positive changes for those living with chronic pain.

These studies are paving the way for a new approach to managing chronic pain through VR. As technology continues to improve, we can expect even more innovative solutions for people dealing with persistent pain

Accessing VR for Pain Management. Patients interested in utilizing VR for pain relief have a few options for obtaining this technology. Some health care providers and pain management specialists may prescribe VR as part of a comprehensive pain management plan. Patients can inquire with their health care team about the possibility of using VR as a part of their pain management strategy. Insurance coverage for VR-based pain management may vary. Although some insurance plans do cover the cost of VR therapy when prescribed by a health care professional, others may not. Patients should contact their insurance provider to understand their specific coverage and reimbursement options. Importantly, there are various affordable or free VR programs and apps available. These can be accessed through VR headsets or even smartphone-based VR experiences. Some of these apps are designed specifically for pain management and relaxation (i.e., mindfulness). Although they may not offer the same level of customization and medical supervision as prescription-based options, they can still provide valuable help for pain relief. Patients can explore app stores and online platforms to discover free or low-cost VR programs that suit their needs.

The Colloca group at the University of Maryland School of Nursing (USA) has now enrolled more than 150 individuals with TMDs in VR treatment, and we have not observed any adverse events related to VR use in patients experiencing orofacial pain. Although we acknowledge the potential for facial sensitivity, we also emphasize that, with proper adjustments, such as lighter devices, additional padding, strap loosening, and shorter initial sessions, many individuals with facial pain may find VR to be a valuable tool for relaxation and improvement of pain outcomes. We encourage open dialogue between patients and their health care providers to ensure a tailored and comfortable VR experience that complements their unique needs and preferences.

Uncharted Territories and Future Research. As technology rockets forward, new doors swing open for the potential use of VR in fields such as education and medicine. In the realm of mental health, VR is making group therapy more accessible and inclusive. In education, VR classrooms immerse students in a dynamic learning environment, keeping distractions at bay and engagement high. Researchers are pushing the boundaries even further. By combining VR with eye-tracking technology, they are delving into the intricacies of human behavior such as monitoring patients for nonverbal expressions of pain sensation. This combination allows for the study of behaviors such as attention to cues, providing a peek into how our minds work in real-life situations. VR is also stepping onto the stage of art and creativity. Virtual galleries and exhibitions are bringing vibrant experiences to the public, offering an entirely new way to interact with art and culture. In the world of health care, VR is taking solid steps toward becoming a tangible tool. Its applications in clinical settings are no longer just theoretical but are now being put to the test.

Researchers have been busy exploring VR’s potential in various aspects of health care, from therapy to pain management. This surge of activity has brought forth a wave of new ideas, products, and scientific insights. As VR continues to grow, we can anticipate even more breakthroughs, pushing the boundaries of what we thought was possible. The journey has just begun, and the road ahead is full of exciting twists and turns.

IN AUSTRALIA

Medical providers across Australia implement VR tools through two distinct therapeutic methods:

• Neurological Pain Distraction: Immersive environments flood the brain’s visual and auditory cortex. This sensory saturation isolates the brain from registering the acute trigeminal nerve signals responsible for head, face, and jaw pain.
• Pain Science Education & Neurorehabilitation: Instead of just distracting the user, Australian-designed software teaches patients how the brain constructs chronic pain. This approach de-threatens painful sensations, decreases fear-avoidant jaw movement, and fosters active muscle rehabilitation.

Key Australian Clinical Providers & Platforms

Australia hosts several cutting-edge clinical providers and medical tech platforms using VR specifically for acute or chronic pain rehabilitation:

1. Clinical Software Developers

• Reality Health: Headquartered in Sydney, this pioneering organisation created a specialised, clinician-led chronic pain management VR platform. Developed alongside renowned Australian pain expert Prof. G. Lorimer Moseley, it pairs immersive interactive learning with behavioral neuroscience.

2. Virtual Healthcare Providers

• XRHealth Australia: A prominent national telehealth provider offering registered clinicians (such as physiotherapists and occupational therapists) who conduct remote, home-based VR pain management therapy sessions. They deliver the headset directly to your door, guiding you through tailored software tracking facial muscle stress, physical rehabilitation, and nervous system calming.

3. Allied Health Networks

• EXPHYS Better Pain VR Program: This nationwide mobile exercise physiology provider runs a dedicated 6-session, 10-week pain science program utilizing advanced VR kits. Their physical specialists travel to patients’ homes to manage nerve, head, and face pain using structured VR tracking.
• Kinetic Medicine: Utilizing the Reality Health ecosystem, their allied health clinics use VR for intensive neurological and physical rehabilitation. This system transforms pain management from passive pharmaceutical reliance to active, brain-retraining recovery.

4. Hospital & Academic Interventions

• St Vincent’s Hospital Sydney: Collaborating with the UNSW 3D Visualisation Aesthetics Lab, St Vincent’s Pain Medicine team pioneered custom 3D VR simulation games designed to lower patient opioid dependency.