The New York Times Magazine 47says, he doesn’t earn money from Applied VR,
but he occasionally advises the company, and
he uses its products in some of his federally
funded research. He says that is mainly because
there is ‘‘nothing better right now’’ for chronic
pain. (Cedars- Sinai itself, which fi rst invested in
Applied VR six years ago through the hospital’s
tech incubator, may someday opt to commer-
cialize its own V.R. eff orts.)
Still, Spiegel recognizes the value of start-up
funding and the freedom that comes with it.
The initial $1 million directed toward some of
his work helps him and Liran take V.R. to the
bedsides of hospital patients. That sort of fund-
ing, Spiegel says, gives his group ‘‘extra support
and fl exibility to be innovative’’ — including the
creation of their own V.R. programs and making
them available without cost.
I met one of these hospitalized patients,
Misty Williams. A 38-year-old chef who has long
suff ered debilitating pain episodes caused bysickle- cell disease, Williams relies on Dilaudid,
a strong narcotic — but not while she’s cater-
ing, because ‘‘if anything happens on the job,
they’re going to ask you what you’re taking, and
so I don’t,’’ she says. After her inpatient V.R. ses-
sion, she concluded that the headset was bet-
ter than Dilaudid. What would be most helpful,
she pointed out, would be using V.R. during her
breaks at work. Spiegel’s program helped her
during her hospitalization, but it won’t do so
after she goes home.pplied VR is considered the pioneer and the
company that is most likely ‘‘furthest along in
getting devices to patients,’’ according to Aman-
da Di Trolio, a health care technology analyst at
CB Insights, but several other companies are
also closing in. Karuna Labs, a start-up based
in San Francisco, has created a hybrid model
that mixes V.R. with aspects of tele health. ‘‘We’re
neuro science people’’ with ‘‘whiz-bang technol-
ogy,’’ says Lincoln Nguyen, its founder. He is
reluctant, however, to call his fi rm a V.R. com-
pany, because he considers coaching sessions
to be central to what Karuna does.
Patients are paired with a pain coach, who
makes weekly video calls to supplement the self-
guided V.R. modules that patients go through
daily for three months. Jon Weinberg, Karuna’s
chief operating offi cer, emphasizes that the
human engagement is essential. The coaching
curriculum falls under the purview of Howard
Schubiner, director of the Mind Body Medicine
Center at Ascension Providence Hospital in
Michigan and a clinical professor at Michigan
State University’s College of Human Medicine,
and Kristine Beebe, Karuna’s lead pain coach
and physical therapist. Schubiner is a protégé of
the late John Sarno, a controversial pain doctor
who taught patients that their pain was caused
by repressed emotions. Schubiner recognizes
the limitations of Sarno’s work and what he
got wrong — being angry at your mother about
your childhood isn’t likely to cut off blood fl ow
to your back — but he maintains that treating
chronic pain requires a rewiring of the brain,
which can involve recognizing emotions and
diffi cult life events. ‘‘Not some kind of woo-woo
New Age thing,’’ Schubiner told me. ‘‘This is just
straight neuro science.’’
Schubiner, who is not involved in the V.R.
aspect of Karuna’s program, instructs the patientsin his own clinic in Michigan to imagine that they
are taking part in activities without experienc-
ing pain — like the athlete visualizing the perfect
shot — so that they engage the corresponding but
dysfunctional neurons. Karuna tries do the same
thing by using V.R. instead of requiring patients
to rely on their imagination. In an interactive
virtual setting — Karuna’s head sensors and
hand controls determine how the body moves
— patients with back pain, say, might be asked to
bend as far as they can without discomfort, then
make both their body and their avatar gradually
increase their spinal fl exion. Archery games help
patients recover movement in their back (as they
pick up arrows) or their shoulders (as they draw
back the bowstring). In other modules, designed
to facilitate the resumption of routine tasks,
patients push around a virtual vacuum that cleans
up colorful stars. The patients’ performance is
transmitted to their coach.
Karuna is based on existing chronic- pain
treatments, though some of the company’s
explanations for how V.R. trains the brain are
more heuristic than settled science. ‘‘We don’t
have any hypotheses born in V.R.,’’ Weinberg
says. According to Nguyen, the brain, trans-
ported to a diff erent world in V.R., learns to stop
associating routine motions with the usual pain.
‘‘I’ve seen the body moving in V.R. in ways that it
can’t move in real life,’’ he told me. ‘‘You’re trick-
ing your brain, using the visual system to move
more, so that we have bottom- up, top-down syn-
ergistic eff ects that can help people to change.’’
If you can vacuum in virtual reality, then maybe
you can vacuum in your living room too.
Karuna also uses mirror therapy to trick the
brain; this is how Nguyen fi rst became interest-
ed in V.R. and chronic pain. Nguyen discovered
it as an adolescent when he was looking for rem-
edies for his father, who was in extreme pain
after two debilitating strokes. The therapy was
invented in the 1990s by V. S. Rama chandran,
a neurologist, to treat phantom- limb pain, a
phenomenon in which someone who has lost
a leg or an arm still feels pain in the missing
limb because the brain continues to perceive
it as being present but also in an abnormal
state. Rama chandran would place the arm of
an amputee — or a stroke patient, in the case of
someone like Nguyen’s father — into an open
box with a mirror down the middle so that the
suff erer, peering down through the top, saw the
refl ection of an intact, functioning arm on the
aff ected side. Eventually, the thinking goes, the
visually dominated brain sees a normal, healthy
limb and reduces the pain signals — a crude
form of virtual reality.that can help people to change.’
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