The New York Times Magazine 45part of the internal psychology,’’ Ap karian says,
‘‘a negative emotional cloud that takes hold.’’
The brain itself morphs. Patients with chron-
ic pain can show a signifi cant loss of gray mat-
ter in the pre frontal cortex, the attention and
decision- making region of the brain that sits
behind our foreheads, as well as in
the thal amus, which relays sensory
signals; both areas are important in
processing pain. Excitatory neuro-
transmitters increase, and inhibitory
ones decrease, while glial and other
immune cells drive infl ammation; the
nervous system, unbalanced, magni-
fi es and prolongs the pain. The system
goes haywire, like an alarm that keeps
blaring even when there’s no threat,
even when the pain isn’t protective
anymore. Instead, it just begets more
pain — and the longer it lasts, the more
deeply systemic it becomes and the
harder it is to resolve.
There’s a popular saying in neuro-
science that as neurons fi re together,
they begin to wire together, an exam-
ple of neuro plasticity in action. But if
our brains really are plastic, what is
shaped there can be reshaped. Ther-
apies that target the brain instead of
the aching back or the sore knee —
whether through psychology, drugs,
direct stimulation of the brain or vir-
tual reality — in theory could undo
chronic pain.
In the 1990s, Hunter Hoff man, a
cognitive psychologist at the Univer-
sity of Washington, began to use V.R.
to provide relief to burn patients who
were having their dressings changed
— an excruciating ordeal that is diffi -
cult to medicate. ‘‘Nobody was using
virtual reality to reduce the pain of
patients before us,’’ he says. In his V.R.
program, called Snow World, patients
who tumbled through the wintry
scene, chucking snowballs at pen-
guins, reported that their relief was
similar to what they got from intrave-
nous opioids. Brain scans confi rmed
these fi ndings: V.R. and opioids each
resulted in remarkable reductions in
neural activity in pain- related areas.
Unlike most drugs and surgical
procedures, V.R. has far fewer side
eff ects — mostly nausea and motion
sickness. Headsets now cost a fraction
of what they once did, and graphics
are markedly improved, resulting in
more immersive experiences and fewer poten-
tial side eff ects. What’s more, Hoff man says, ‘‘all
the major computer companies are pumping
billions of dollars into virtual reality as a kind
of internet’’ — what Mark Zuckerberg called an
‘‘embodied internet’’ when he announced last fall
that Facebook was becoming Meta. A few months
later, Microsoft unveiled plans to acquire Activi-
sion Blizzard to ‘‘provide building blocks for the
meta verse,’’ the company said. The downstream
eff ects of all this technological ferment, Hoff -
man predicts, is that V.R. therapies, powered by
private- sector investments, will swiftly develop
into a standard treatment for pain.n Aug. 8, 2016, Robert Jester, a retired high school
biology teacher in Greenport, N.Y., who was
moonlighting as a chimney sweeper — both to
support his family and to enjoy the magnifi cent
views — drove to a nearby neighborhood for a
quick job. The ladder he took was too short, but it
seemed like a simple sweep, so he decided to go
ahead with the work anyway. He climbed to the
top, the ladder slipped — and he fell to the hard
ground below. The pain in his back was so intense
that he couldn’t make out the rescue workers
bending over him; he could see only white light.
A broken spinal cord means he can’t walk
today, and his legs constantly feel as if they’re
submerged in boiling water; frequently, they also
feel as though knives are stabbing them up and
down their length. He fractured his molars from
clenching down during these episodes. The fi rst
year after his accident, the pain was so unbearable
that he almost enacted his step-by-step suicide
plan a dozen times. Opioids softened the agony,
but they also changed his mood. He stopped tell-
ing jokes. And if he no longer had his sense of
humor, he thought, what was the point of living?Before the accident, Jester got his students so
excited about biology that they wanted to work
on their science projects long after school, frus-
trating the custodians who were trying to clean
his classroom in the evening. During fi re drills,
his students would form a conga line, chanting,
‘‘D-N-A deoxyribo nucleic acid.’’ He also volun-
teered as a tutor to kids in town. One of them
had a father named Bob McInnis, whom Jester
met while cleaning the family’s chimney.
McInnis happened to have seen an internet
video about a company in Los Angeles called
Applied VR. At the time, in the spring of 2017,
Applied VR was focused on treating anxiety and
acute pain in those who had to undergo hospital
procedures, especially children. McInnis went
to the company’s website and fi lled out a general
contact form with information about Jester’s sit-
uation. ‘‘Is there anything that your device might
be able to do to help him?’’ he typed. ‘‘Just thought
I’d throw it out, given how much pain he’s in.’’ He
didn’t expect to hear back. Three hours later, an
email from Josh Sackman, one of the company’s
founders, arrived in McInnis’s inbox. A headset
soon appeared in Jester’s mail.
Sitting in a plush brown recliner, his beef
stroganoff dinner on a tray before him, Jester
tried V.R. for the fi rst time. He got so caught up
viewing a farm scene that he tried to shoo away
a cow that came over to lick him — and knocked
the noodles all over his living- room wall. He was
hooked. Next, he fl ew with the Wright broth-
ers, controlling the plane by looking in diff erent
directions. (Applied VR has stopped using this
module.) Jester realized that he was so focused
on keeping the plane upright that he was no
longer dwelling on his pain anymore. He won-
dered if he could use V.R. to distract himself and
reduce his reliance on Oxy Contin and other pain
medications — and eventually stop altogether.
He started charting his opioid use in a little blue
notebook, while continuing daily V.R. sessions.
After two months, he was off narcotic pain killers.
Now, Jester told me recently, ‘‘I use the training
right away when the pain comes on.’’ He squeezed
his eyes closed and breathed in deeply. ‘‘I can refo-
cus myself for a minute,’’ he said, imagining one
of the special V.R. plants whose bare branches
become full of leaves when his breathing is slow
and steady, as detected by a sensor on the headset.
When Sackman and his co- founder, Mat-
thew Stoudt, heard about Jester’s success with
V.R. and opioid tapering, they redesigned their
product: EaseVRx — renamed RelieVRx in Feb-
ruary — would provide therapy for chronic
pain. Beth Darnall, a psychologist and director
of Stanford’s Pain Relief Innovations Lab, is the
company’s chief science adviser. She describesIllustration by Deanne Cheuk
O
The New York Times Magazine 45