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Pain Management

How Virtual Reality is Changing the Way We Treat Chronic Pain

A significant number of patients report reduced pain after only 15 minutes of virtual reality immersion.
By: | May 17, 2018 • 4 min read

Virtual reality isn’t just for computer games anymore. Increasingly, the medical community — and insurers — are taking notice of its effectiveness to distract an individual from pain.

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At Cedars-Sinai in Los Angeles, Calif., Dr. Brennan Spiegel has already found virtual reality (VR) therapy, which uses wearable technology to manage pain, effective in the hospital setting. Now he’s teaming up with Travelers, Samsung Electronics America, Bayer and appliedVR, which has developed a virtual reality platform specifically for use in the health care industry.

Dr. Melissa Burke, the national pharmacy director at Travelers, said she was “blown away” after speaking with Spiegel about his success with the technology and the pain reduction in his first study in the inpatient setting and at that point began to brainstorm how the Travelers population could benefit as well.

“We continue to look for alternatives to treat the root of chronic pain,” she said. “The use of VR is all about the perception of pain and it’s about taking injured employees out of the space that they’re in. Once they become immersed in the experience, the idea is that the pain melts away.”

Melissa Burke, national pharmacy director, Travelers

Spiegel’s initial study included 100 patients who reported pain scores of greater than three on the Numeric Pain Rating Scale, which has a high of 10. Half of the patients received a 15-minute virtual reality session using VR goggles that immersed them in scenes of flying over Iceland or swimming in the ocean with whales, and nearly a quarter reported a drop in their pain scores after the treatment.

In the current study, participants who have recently suffered an orthopedic injury and report pain scores of 3 or greater will receive a digital pain-reduction kit, including a Samsung virtual reality headset, content including the Iceland experience and other peaceful simulations, as well as a transcutaneous electrical nerve stimulation (TENS) device to further treat lower back pain and muscle aches.

“The digital pain-reduction kit has the potential not only to become a first-line opiate-sparing pain management treatment option for workers’ compensation, but it could potentially be used more broadly to help battle the opiate epidemic.” — Dr. David Rhew, chief medical officer, head of Health Care and Fitness, Samsung Electronics

Each participant’s day-to-day activity, productivity and use of pain medication will be monitored via a wearable device. Dr. David Rhew, chief medical officer and head of health care and fitness for Samsung Electronics, is involved in the new study. He said if the kit reduces pain, shortens time to return to work and lowers costs, then it should be considered a first-line reimbursable treatment option for injured workers with severe and persistent pain.

“Today we have very few options for injured workers with severe, persistent pain, and opiates remain a core component of most treatment plans,” Rhew said.

“The digital pain-reduction kit has the potential not only to become a first-line opiate-sparing pain management treatment option for workers’ compensation, but it could potentially be used more broadly to help battle the opiate epidemic.”

Many Hurdles Remain for Virtual Reality

Dr. Teresa Bartlett, senior vice president, senior medical officer for Sedgwick Claims Management Services, said the use of virtual reality with biofeedback has taken off in the medical community as a means to help patients with chronic pain.

Teresa Bartlett, SVP, senior medical officer, Sedgwick Claims Management Services

“It’s something that helps individuals heighten their awareness of their body, their breath, their response to pain,” she said. “Using virtual reality could potentially help them mitigate some of those negative effects on the body … it helps them escape that pain and gives them coping skills.”

However, questions remain about whether VR therapy will be adopted even if it is shown to be a success. Bartlett noted there is currently no billing mechanism in place for virtual reality/biofeedback therapy and much will need to be done to educate the public.

“I think that employers may be a little bit suspicious when something could appear like a virtual reality game,” she said. Also the price point will be important for employers to understand.

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Bartlett said she is hopeful that the study yields positive results.

“I think any time we can give individuals coping skills that help them deal with pain without medication, it will lead to a better outcome on a claim,” she said. “I definitely think this will have a positive impact if the study is successful.”

Burke is optimistic participants in the study will experience pain relief like those in Spiegel’s first study, who only had a 15-minute VR session.

“In the future, we may have a pharmacy of virtual reality treatments available as an alternative [to opioids],” she said. &

Angela Childers is a Chicago-based writer specializing in health care and business management. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

High Net Worth

High Net Worth Clients Live in CAT Zones. Here’s What Their Resiliency Plan Should Include

Having a resiliency plan and practicing it can make all the difference in a disaster.
By: | September 14, 2018 • 7 min read

Packed with state-of-the-art electronics, priceless collections and high-end furnishings, and situated in scenic, often remote locations, the dwellings of high net worth individuals and families pose particular challenges when it comes to disaster resiliency. But help is on the way.

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Armed with loss data, innovative new programs, technological advances, and a growing army of niche service-providers aimed at addressing an astonishingly diverse set of risks, insurers are increasingly determined to not just insure against their high net worth clients’ losses, but to prevent them.

Insurers have long been proactive in risk mitigation, but increasingly, after the recent surge in wildfire and storm losses, insureds are now, too.

“Before, insurance was considered the only step in risk management. Now, our client families realize it is one of the many imperative steps in an effective risk management strategy,” said Laura Sherman, founding partner at Baldwin Krystyn Sherman Partners.

And especially in the high net worth space, preventing that loss is vastly preferable to a payout, for insurers and insureds alike.

“If insurers can preserve even one house that’s 10 or 20 or 40 million dollars … whatever they have spent in a year is money well spent. Plus they’ve saved this important asset for the client,” said Bruce Gendelman, chairman and founder Bruce Gendelman Insurance Services.

High Net Worth Vulnerabilities

Laura Sherman, founding partner, Baldwin Krystyn Sherman Partners

As the number and size of luxury homes built in vulnerable areas has increased, so has the frequency and magnitude of extreme weather events, including hurricanes, harsh cold and winter storms, and wildfires.

“There is a growing desire to inhabit this riskier terrain,” said Jason Metzger, SVP Risk Management, PURE group of insurance companies. “In the western states alone, a little over a million homes are highly vulnerable to wildfires because of their proximity to forests that are fuller of fuel than they have been in years past.”

Such homes are often filled with expensive artwork and collections, from fine wine to rare books to couture to automobiles, each presenting unique challenges. The homes themselves present other vulnerabilities.

“Larger, more sophisticated homes are bristling with more technology than ever,” said Stephen Poux, SVP and head of Risk Management Services and Loss Prevention for AIG’s Private Client Group.

“A lightning strike can trash every electronic in the home.”

Niche Service Providers

A variety of niche service providers are stepping forward to help.

Secure facilities provide hurricane-proof, wildfire-proof off-site storage for artwork, antiques, and all manner of collectibles for seasonal or rotating storage, as well as ahead of impending disasters.

Other companies help manage such collections — a substantial challenge anytime, but especially during a crisis.

“Knowing where it is, is a huge part of mitigating the risk,” said Eric Kahan, founder of Collector Systems, a cloud-based collection management company that allows collectors to monitor their collections during loans to museums, transit between homes, or evacuation to secure storage.

“Before, insurance was considered the only step in risk management. Now, our client families realize it is one of the many imperative steps in an effective risk management strategy.” — Laura Sherman, founding partner, Baldwin Krystyn Sherman Partners

Insurers also employ specialists in-house. AIG employs four art curators who advise clients on how to protect and preserve their art collections.

Perhaps the best known and most striking example of this kind of direct insurer involvement are the fire teams insurers retain or employ to monitor fires and even spray retardant or water on threatened properties.

High-Level Service for High Net Worth

All high net worth carriers have programs that leverage expertise, loss data, and relationships with vendors to help clients avoid and recover from losses, employing the highest levels of customer service to accomplish this as unobtrusively as possible.

“What allows you to do your job best is when you develop that relationship with a client, where it’s the same people that are interacting with them on every front for their risk management,” said Steve Bitterman, chief risk services officer for Vault Insurance.

Site visits are an essential first step, allowing insurers to assess risks, make recommendations to reduce them, and establish plans in the event of a disaster.

“When you’re in a catastrophic situation, it’s high stress, time is of the essence, and people forget things,” said Sherman. “Having a written plan in place is paramount to success.”

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Another important component is knowing who will execute that plan in homes that are often unoccupied.

Domestic staff may lack the knowledge or authority to protect the homeowner’s assets, and during a disaster may be distracted dealing with threats to their own homes and families. Adequate planning includes ensuring that whoever is responsible has the training and authority to execute the plan.

Evaluating New Technology

Insurers use technologies like GPS and satellite imagery to determine which homes are directly threatened by storms or wildfires. They also assess and vet technologies that can be implemented by homeowners, from impact glass to alarm and monitoring systems, to more obscure but potentially more important options.

AIG’s Poux recommends two types of vents that mitigate important, and unexpected risks.

“There’s a fantastic technology called Smart Vent, which allows water to flow in and out of the foundation,” Poux said. “… The weight of water outside a foundation can push a foundation wall in. If you equalize that water inside and out at the same level, you negate that.”

Another wildfire risk — embers getting sucked into the attic — is, according to Poux, “typically the greatest cause of the destruction of homes.” But, he said, “Special ember-resisting venting, like Brandguard Vents, can remove that exposure altogether.”

Building Smart

Many disaster resiliency technologies can be applied at any time, but often the cost is fractional if implemented during initial construction. AIG’s Smart Build is a free program for new or remodeled homes that evolved out of AIG’s construction insurance programs.

Previously available only to homes valued at $5 million and up, Smart Build recently expanded to include homes of $1 million and up. Roughly 100 homes are enrolled, with an average value of $13 million.

“In the high net worth space, sometimes it takes longer potentially to recover, simply because there are limited contractors available to do specialty work.” — Curt Goetsch, head of underwriting, Private Client Group, Ironshore

“We know what goes wrong in high net worth homes,” said Poux, citing AIG’s decades of loss data.

“We’re incenting our client and by proxy their builder, their architects and their broker, to give us a seat at the design table. … That enables us to help tweak the architectural plans in ways that are very easy to do with a pencil, as opposed to after a home is built.”

Poux cites a remote ranch property in Texas.

Curt Goetsch, head of underwriting, Private Client Group, Ironshore

“The client was rebuilding a home but also installing new roads and grading and driveways. … The property was very far from the fire department and there wasn’t any available water on the property.”

Poux’s team was able to recommend underground water storage tanks, something that would have been prohibitively expensive after construction.

“But if the ground is open and you’ve got heavy equipment, it’s a relatively minor additional expense.”

Homes that graduate from the Smart Build program may be eligible for preferred pricing due to their added resilience, Poux said.

Recovery from Loss

A major component of disaster resiliency is still recovery from loss, and preparation is key to the prompt service expected by homeowners paying six- or seven-figure premiums.

Before Irma, PURE sent contact information for pre-assigned claim adjusters to insureds in the storm’s direct path.

“In the high net worth space, sometimes it takes longer potentially to recover, simply because there are limited contractors available to do specialty work,” said Curt Goetsch, head of underwriting for Ironshore’s Private Client Group.

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“If you’ve got custom construction or imported materials in your house, you’re not going to go down the street and just find somebody that can do that kind of work, or has those materials in stock.”

In the wake of disaster, even basic services can be scarce.

“Our claims and risk management departments have to work together in advance of the storm,” said Bitterman, “to have contractors and restoration companies and tarp and board services that are going to respond to our company’s clients, that will commit resources to us.”

And while local agents’ connections can be invaluable, Goetsch sees insurers taking more of that responsibility from the agent, to at least get the claim started.

“When there is a disaster, the agency’s staff may have to deal with personal losses,” Goetsch said. &

Jon McGoran is a novelist and magazine editor based outside of Philadelphia. He can be reached at [email protected]