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.


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.


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

Cyber Resilience

No, Seriously. You Need a Comprehensive Cyber Incident Response Plan Before It’s Too Late.

Awareness of cyber risk is increasing, but some companies may be neglecting to prepare adequate response plans that could save them millions. 
By: | June 1, 2018 • 7 min read

To minimize the financial and reputational damage from a cyber attack, it is absolutely critical that businesses have a cyber incident response plan.

“Sadly, not all yet do,” said David Legassick, head of life sciences, tech and cyber, CNA Hardy.


In the event of a breach, a company must be able to quickly identify and contain the problem, assess the level of impact, communicate internally and externally, recover where possible any lost data or functionality needed to resume business operations and act quickly to manage potential reputational risk.

This can only be achieved with help from the right external experts and the design and practice of a well-honed internal response.

The first step a company must take, said Legassick, is to understand its cyber exposures through asset identification, classification, risk assessment and protection measures, both technological and human.

According to Raf Sanchez, international breach response manager, Beazley, cyber-response plans should be flexible and applicable to a wide range of incidents, “not just a list of consecutive steps.”

They also should bring together key stakeholders and specify end goals.

Jason J. Hogg, CEO, Aon Cyber Solutions

With bad actors becoming increasingly sophisticated and often acting in groups, attack vectors can hit companies from multiple angles simultaneously, meaning a holistic approach is essential, agreed Jason J. Hogg, CEO, Aon Cyber Solutions.

“Collaboration is key — you have to take silos down and work in a cross-functional manner.”

This means assembling a response team including individuals from IT, legal, operations, risk management, HR, finance and the board — each of whom must be well drilled in their responsibilities in the event of a breach.

“You can’t pick your players on the day of the game,” said Hogg. “Response times are critical, so speed and timing are of the essence. You should also have a very clear communication plan to keep the CEO and board of directors informed of recommended courses of action and timing expectations.”

People on the incident response team must have sufficient technical skills and access to critical third parties to be able to make decisions and move to contain incidents fast. Knowledge of the company’s data and network topology is also key, said Legassick.

“Perhaps most important of all,” he added, “is to capture in detail how, when, where and why an incident occurred so there is a feedback loop that ensures each threat makes the cyber defense stronger.”

Cyber insurance can play a key role by providing a range of experts such as forensic analysts to help manage a cyber breach quickly and effectively (as well as PR and legal help). However, the learning process should begin before a breach occurs.

Practice Makes Perfect

“Any incident response plan is only as strong as the practice that goes into it,” explained Mike Peters, vice president, IT, RIMS — who also conducts stress testing through his firm Sentinel Cyber Defense Advisors.


Unless companies have an ethical hacker or certified information security officer on board who can conduct sophisticated simulated attacks, Peters recommended they hire third-party experts to test their networks for weaknesses, remediate these issues and retest again for vulnerabilities that haven’t been patched or have newly appeared.

“You need to plan for every type of threat that’s out there,” he added.

Hogg agreed that bringing third parties in to conduct tests brings “fresh thinking, best practice and cross-pollination of learnings from testing plans across a multitude of industries and enterprises.”

“Collaboration is key — you have to take silos down and work in a cross-functional manner.” — Jason J. Hogg, CEO, Aon Cyber Solutions

Legassick added that companies should test their plans at least annually, updating procedures whenever there is a significant change in business activity, technology or location.

“As companies expand, cyber security is not always front of mind, but new operations and territories all expose a company to new risks.”

For smaller companies that might not have the resources or the expertise to develop an internal cyber response plan from whole cloth, some carriers offer their own cyber risk resources online.

Evan Fenaroli, an underwriting product manager with the Philadelphia Insurance Companies (PHLY), said his company hosts an eRiskHub, which gives PHLY clients a place to start looking for cyber event response answers.

That includes access to a pool of attorneys who can guide company executives in creating a plan.

“It’s something at the highest level that needs to be a priority,” Fenaroli said. For those just getting started, Fenaroli provided a checklist for consideration:

  • Purchase cyber insurance, read the policy and understand its notice requirements.
  • Work with an attorney to develop a cyber event response plan that you can customize to your business.
  • Identify stakeholders within the company who will own the plan and its execution.
  • Find outside forensics experts that the company can call in an emergency.
  • Identify a public relations expert who can be called in the case of an event that could be leaked to the press or otherwise become newsworthy.

“When all of these things fall into place, the outcome is far better in that there isn’t a panic,” said Fenaroli, who, like others, recommends the plan be tested at least annually.

Cyber’s Physical Threat

With the digital and physical worlds converging due to the rise of the Internet of Things, Hogg reminded companies: “You can’t just test in the virtual world — testing physical end-point security is critical too.”


How that testing is communicated to underwriters should also be a key focus, said Rich DePiero, head of cyber, North America, Swiss Re Corporate Solutions.

Don’t just report on what went well; it’s far more believable for an underwriter to hear what didn’t go well, he said.

“If I hear a client say it is perfect and then I look at some of the results of the responses to breaches last year, there is a disconnect. Help us understand what you learned and what you worked out. You want things to fail during these incident response tests, because that is how we learn,” he explained.

“Bringing in these outside firms, detailing what they learned and defining roles and responsibilities in the event of an incident is really the best practice, and we are seeing more and more companies do that.”

Support from the Board

Good cyber protection is built around a combination of process, technology, learning and people. While not every cyber incident needs to be reported to the boardroom, senior management has a key role in creating a culture of planning and risk awareness.

David Legassick, head of life sciences, tech and cyber, CNA Hardy

“Cyber is a boardroom risk. If it is not taken seriously at boardroom level, you are more than likely to suffer a network breach,” Legassick said.

However, getting board buy-in or buy-in from the C-suite is not always easy.

“C-suite executives often put off testing crisis plans as they get in the way of the day job. The irony here is obvious given how disruptive an incident can be,” said Sanchez.

“The C-suite must demonstrate its support for incident response planning and that it expects staff at all levels of the organization to play their part in recovering from serious incidents.”

“What these people need from the board is support,” said Jill Salmon, New York-based vice president, head of cyber/tech/MPL, Berkshire Hathaway Specialty Insurance.

“I don’t know that the information security folks are looking for direction from the board as much as they are looking for support from a resources standpoint and a visibility standpoint.

“They’ve got to be aware of what they need and they need to have the money to be able to build it up to that level,” she said.

Without that support, according to Legassick, failure to empower and encourage the IT team to manage cyber threats holistically through integration with the rest of the organization, particularly risk managers, becomes a common mistake.

He also warned that “blame culture” can prevent staff from escalating problems to management in a timely manner.

Collaboration and Communication

Given that cyber incident response truly is a team effort, it is therefore essential that a culture of collaboration, preparation and practice is embedded from the top down.


One of the biggest tripping points for companies — and an area that has done the most damage from a reputational perspective — is in how quickly and effectively the company communicates to the public in the aftermath of a cyber event.

Salmon said of all the cyber incident response plans she has seen, the companies that have impressed her most are those that have written mock press releases and rehearsed how they are going to respond to the media in the aftermath of an event.

“We have seen so many companies trip up in that regard,” she said. “There have been examples of companies taking too long and then not explaining why it took them so long. It’s like any other crisis — the way that you are communicating it to the public is really important.” &

Antony Ireland is a London-based financial journalist. He can be reached at [email protected] Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]