The New York Times Magazine 43‘‘I’ve tried breathing exercises before,’’ she
said, ‘‘but this is much more relaxing.’’ She
rubbed her abdomen. ‘‘I don’t have pain in my
stomach now.’’
Next, Mon terroso entered another virtual
environment that Liran built specifi cally for
patients with chronic gastro intestinal symp-
toms. In this setting, unlike the previous one,
Mon terroso used hand controls. Inside a virtual
clinic, a robot named Maia — short for ‘‘mixed-
reality artifi cial- intelligence assistant’’ — guided
her to a young blond woman, who expressed
frustration with abdominal symptoms. Mon-
terroso examined the patient with her virtual
hands, placing a stethoscope on her stomach to
listen to the sounds of digestion. Maia explained
how the brain and the gut work together. As she
spoke, an image of a brain popped up, connected
to intestines by a yellow fl ashing line. When the
brain became stressed, it turned fuchsia in color,
and the yellow line to the gut meta morphosed
into a stream of fi re. A pounding heart appeared.
Because the program is in English, Spiegel trans-
lated Maia’s speech into Spanish: ‘‘When you
have a lot of stress, the heart beats faster, the
intestines can move faster and oxygen in the body
goes to the brain, away from your intestines.’’
‘‘This really helped me to understand how the
brain and the intestines work together, because
after the accident of my son, I’ve been very sad,’’
Mon terroso told Spiegel after her V.R. session.
She looked around the room, seemingly sur-
prised to see everyone. ‘‘I didn’t even notice the
people here,’’ she said.
‘‘That’s because people can’t live in two real-
ities at once,’’ Spiegel said. He was describing
V.R.’s ‘‘unique ability to convey a sense of just
‘being there,’ wherever there happens to be,’’ as
he puts it in his book ‘‘VRx: How Virtual Thera-
peutics Will Revolutionize Medicine.’’ ‘‘All of its
revolutionary potential tumbles out of its ability
to compel a person’s brain and body to react to
a diff erent reality.’’ Humans may use roughly 50
percent of our brains in visual processing, Spiegel
writes, so ‘‘bombard the eyes with spectacular
and dynamic visions, and next thing you know,
those three billion neuronal fi rings per second
will ricochet through half the brain to process the
overwhelming load of visual data.’’ In this reality,
Mon terroso no longer experienced pain.
‘‘What we saw today with Julia was like a
‘cyber delic,’ as if she took psilo cybin,’’ Spiegeltold me, referring to the hallucinogen. ‘‘She
had explosive insights into how to modify her
own life.’’ Her amyg dala was ‘‘on fi re,’’ he added,
referring to the almond- shaped structure in the
brain that processes emotions. The real-time
bio data helped her connect the dots between
brain and body, while Maia taught her how she
could potentially turn the pain off. Even though
Spiegel tried to explain all this to her the week
before, she did not grasp it until she tried V.R.
‘‘I almost don’t even care what the mecha-
nism is of how it’s working,’’ Spiegel told me.
And indeed, its impact on chronic pain still isn’t
fully understood. What really matters to him
is the answer to his question: ‘‘Is it clinically
working or not?’’I BEGAN LOOKING into novel treatments for
chronic pain because, as an emergency- room
doctor, I’ve long grappled with caring for
patients at the extremes of persistent suff ering.
I’ve seen what happens when our medical treat-
ments turn deadly. Years after telling a man that
his son had died of an opioid overdose — which
resulted from an addiction to prescription pain-
killers following foot surgery — I can still hear
his wails, and recall how they brought my hos-
pital’s bustling E.R. to near silence.
The opioid epidemic, an American tragedy,
has no clear end in sight. Drug- overdose deaths,
most of them from opioids, rose 30 percent
during the fi rst year of the pandemic. While
illicit fentanyl is largely to blame, the health care
system is also complicit in this harrowing statis-
tic: At one point, 80 percent of those who wereusing heroin fi rst misused prescription opioids.
Patient- rated pain scores in siren red used to be
a regular feature on my E.R.’s dashboard, having
gained the same importance as other vital signs
like oxygen levels and blood pressure — until
they quickly disappeared after Purdue Pharma
became implicated in the unethical marketing
of opioids. The health care system, confronted
with evidence that these drugs were being over-
prescribed and even harming some patients,
then began cutting them off abruptly in some
cases instead of tapering their use or off ering
alternative treatments.
The patients who haunt me nearly as much as
those who have succumbed to the opioid crisis
are the ones I send away, often in as much painbut this is much more relaxing.
I don’t have pain in my stomach now.’
The New York Times Magazine 43