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Virtual reality is emerging as an unlikely tool
for solving this intractable problem. The V.R.
segment in health care alone, which according
to some estimates is already valued at billions of
dollars, is expected to grow by multiples of that in
the next few years, with researchers seeing poten-
tial for it to help with everything from anxiety and
depression to rehabilitation after strokes to sur-
geons strategizing where they will cut and stitch.
In November, the Food and Drug Administration
gave authorization for the fi rst V.R. product to be
marketed for the treatment of chronic pain.
Spiegel, who has the slim build of someone
who runs marathons (he has fi nished 18 of them),
fastened a black V.R. set onto Mon terroso’s head.
It was wired to a computer, behind whose moni-
tor sat Omer Liran, a psychiatrist and self-taughtprogrammer who created the virtual worlds for
this use. ‘‘The beauty of doing everything here is
that I can very quickly change things with patient
feedback,’’ Liran told me. ‘‘If we outsourced it, it
would be pretty much impossible,’’ he said — or
at least slow and expensive.
The week before, Spiegel and Liran started
collecting various biometric data from patients
while they were in virtual reality. Liran’s com-
puter showed what was happening to Mon-
terroso’s heart and eyes and to her cognitive
load, or mental eff ort, while a two- dimensional
version of what she was seeing in the headset
played on another screen. Mon terroso sat in a
plastic chair under fl uorescent lights, but in vir-
tual reality she stood on a footbridge in a lushforest. As she looked around at the giant trees,
she trembled, and tears suddenly started stream-
ing down her face. Her cognitive load, shown as
a pink line on the computer, started to increase.
‘‘I feel like I’m there with my son,’’ she said
in Spanish. Her 21-year-old son died in a car
accident in June. They loved visiting Yosemite
together, and in these virtual woods, she felt as
if she were hiking with him again. Spiegel reas-
sured her that such intense reactions are very
common, then leaned over to whisper to me,
‘‘She’s doing her own therapy right now.’’
As her tears dried, Mon terroso slowly moved
her head to look over a menu of choices. Selecting
a beach-scene option with her gaze, she found
herself beside a placid sea, under a brilliant blue
sky. A mandala moved toward and away fromher, syncing her breathing rates to a relaxation-
inducing tempo. Her cognitive load and heart
rate slowed, and her pupils became less dilated,
all signs of relaxation. After a while, she headed
to the mountains, where goats trotted by.
‘‘Welcome back,’’ Spiegel said as Mon terroso
removed the headset. He pulled up some of her
measurements on the computer monitor. He
explained that larger pupils, for example, indi-
cate stress. ‘‘In the forest, they’re big.’’
‘‘Because my emotions were very strong
then,’’ Mon terroso replied.
‘‘In the mountains, the pupils were smaller
because you were relaxed,’’ Spiegel continued,
his fi nger tracing a downward- sloping line on
the screen.fter an hour-and-a-half bus ride last November,
Julia Mon terroso arrived at a white Art Deco
building in West Hollywood, just opposite a
Chanel store and the Ivy, a restaurant famous
for its celebrity sightings. Mon terroso was there
to see Brennan Spiegel, a gastro enterologist and
researcher at Cedars- Sinai who runs one of the
largest academic medical initiatives studying
virtual reality as a health therapy. He started
the program in 2015 after the hospital received
a million- dollar donation from an investment
banker on its board. Spiegel saw Mon terroso in
his clinic the week before and thought he might
be able to help alleviate her symptoms.
Mon terroso is 55 and petite, with youthful
bangs and hair clipped back by tiny jeweled
barrettes. Eighteen months earlier, pain seized
her lower abdomen and never went away. After
undergoing back surgery in September to treat
a herniated disc — and after the constant ache
in her abdomen worsened — she had to stop
working as a house cleaner. Eventually, following
a series of tests that failed to reveal any clear
cause, she landed in Spiegel’s offi ce. She rated
her pain an 8 on a 10-point scale, with 10 being
the most severe.
Chronic pain is generally defi ned as pain that
has lasted three months or longer. It is one of
the leading causes of long-term disability in the
world. By some measures, 50 million Ameri-
cans live with chronic pain, in part because the
power of medicine to relieve pain remains woe-
fully inadequate. As Daniel Clauw, who runs the
Chronic Pain and Fatigue Research Center at the
University of Michigan, put it in a 2019 lecture,
there isn’t ‘‘any drug in any chronic- pain state that
works in better than one out of three people.’’ He
went on to say that non pharmacological therapy
should instead be ‘‘front and center in managing
chronic pain — rather than opioids, or for that
matter, any of our drugs.’’
A
‘I’ve tried breathing exercises before,
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