Post to Medical Extended Reality

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  • Brennan Spiegel, MD, MSHS, is director of Health Services Research for Cedars-Sinai and Director of...
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  • Brennan Spiegel, MD, MSHS
    You know, within the more prescribed realm AppliedVR is a company here in LA that is going through FDA clearance right now for their their program called EaseVR. Which is for chronic pain, they have validated it for chronic lower back pain and randomized controlled trials conducted in partnership with Stanford.
  • Brennan Spiegel, MD, MSHS
    So for example, and so, you know, I wouldn't want to say like, oh, you know, you don't need any pain medicines after open heart surgery or after having your sternum cut. You probably will need some analgesics, but maybe the the dosage requirement could be lower if you think about it, something like an opioid, which can be very effective doesn't necessarily help you think differently about the pain or affect the emotional or cognitive experience of that pain.
  • Brennan Spiegel, MD, MSHS
    And so what we can do in VR rather than using it just for entertainment or games, As to change perceptions about the world around us and to change perceptions about the world within us, and to do it in a way that can hopefully recalibrate unhealthy perceptions that can drive for example, pain or anxiety or depressed.
  • Brennan Spiegel, MD, MSHS
    So I have a particular interest in certain GI conditions, particularly irritable bowel syndrome or IBS, which is one of the most common. Disorders we see in GI and anywhere in the world, it's for the most common disorders. And we know that that is a disorder of what we call gut-brain interaction. 
 So the way the brain and the gut communicate back and forth is underlies the experience of having IB. It's a complicated disease. There's many different causes of it, but, but we know for example, stress and anxiety are part of it and certainly promote the experience of IBS, make it worse. So I've been thinking about the connection between brain and body for a long time.
  • Brennan Spiegel, MD, MSHS
    We can use it for cognitive behavioral therapy so we can use it to train people with new skills that they can hopefully bring with them outside of virtual reality.
  • Brennan Spiegel, MD, MSHS
    Whereas something like VR, if it's done correctly might be able to help you think differently about that pain. Not that you think away pain by. It's much more complicated than that, but we know that the brain and the body are connected. It is one physical system.
  • Brennan Spiegel, MD, MSHS
    Mel Slater, who I mentioned earlier at the university of Barcelona. Gave me a complete out of body experience where I was in a body. And then he separated me from my body. He pulled me up into the ceiling and I looked down and I saw this vacated body down below that I had just occupied and it was motionless. 
 It wasn't moving. It was still, it was dead. And I realized, oh my God, I had, I just died. Like I literally just died and passed into some other life. And I thought to myself, oh my God, I'm thinking about death differently. Now death doesn't need to be catastrophic. The process of dying maybe could be almost spiritual or mystical. 
 And so I think about that even to this day. So I started thinking, oh my God, I died in VR, two different ways that jumped off a building. And I had an out of body experience and had totally different emotional experiences. [00:18:55
  • Brennan Spiegel, MD, MSHS
    That is a powerful opportunity and mechanism for perspective, taking and empathy taking. And that's yet another opportunity to also empathize, not just with other people, but to empathize with yourself, which you can also do in virtual reality, where you interview yourself, you put yourself in two different avatars and bounce back and forth between them, which is a very powerful technique.
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