This research project aims to investigate the barriers and facilitators encountered by early-stage technology companies in making VR therapies for chronic pain available through the National Health Service (NHS). The value of this research is the identification of thematic issues that hinder or drive implementation and adoption of VR therapies that have the potential to improve patients' quality of life and reduce the well documented economic burden on the NHS. The findings would enable existing and emerging VR companies to adapt their strategies effectively, facilitating swifter market entry for their VR therapies within the NHS, thereby indirectly benefiting patients by accelerating access to these innovative treatments. Moreover, the research findings will provide valuable insights for NHS commissioners, highlighting potential areas for improvement in existing frameworks, such as NICE evidence standards, innovation pathways, and inappropriate grant criteria, which may inadvertently create barriers for early-stage VR therapy companies seeking to enter the healthcare market.

The journey: This project began before I started at LIS really. I distinctly remember sharing my interest in pain science with members of faculty on an Open Day visit and I’ve been biding my time ever since to explore this complex clinical, social, and economic problem. I finished reading Dr Lyman’s book “The Painful Truth” last term and was intrigued by the use of VR for phantom limb pain and complex burn surgeries. With the Apple Vision Pro UK launch on the horizon, I didn’t think it would long until someone created chronic pain content, and wanted to get a head start.

‍Disciplinary perspectives: The adoption of Virtual Reality (VR) therapies for chronic pain treatment presents a complex intersection of Cognitive Neuroscience and Health Economics within the context of the NHS. Cognitive Neuroscience provides insights into how VR can alter pain perception and potentially help individuals with chronic pain, while Health Economics offers an understanding of the systemic, regulatory, and financial implications of integrating innovative technologies into a public healthcare system like the NHS.

‍Research methods: This project employs a mixed methods exploratory sequential research design. Three participants, including a VR company CEO, COO, and a General Practitioner sponsoring a VR product pilot, were interviewed. The interviews were  analysed thematically to identify key themes related to the challenges and enablers for NHS adoption of VR therapy. Additionally, an observation of the VR pilot involving five patients using the VR product at local GP surgery was conducted. Sequentially the quantitative research picks up on the barrier emerging from thematic analysis. The evidence standards required (achieved by clinical trials) places a financial burden on early-stage technology companies. The analysis explores the power calculation for a hypothetical clinical trial investigating the effectiveness of VR therapy on patients with chronic back pain. The goal was to determine the minimum desirable effect size (MDES) and appropriate participant sample size required to achieve a high power, specifically aiming for between 80% and 90% power. A combination of experimental design, simulation, and permutation testing was employed to run and analyse 7,000 hypothetical clinical trials each with different group sizes.

The final product was an investigative report inspired by BBC Radio 4s show More or Less. “Out Of The Lab and Into the World: Is Virtual Reality a Solution for the Silent Epidemic?”. In the report we hear from four stakeholders, a General Practitioner with a special interest in pain, a consultant at UCL Partners Health Innovation Network, and the CEO and COO of Phase Space a VR start-up with a promising product for chronic pain.

Picking just one thing is incredibly difficult. During my research I was invited to observe individuals with chronic pain try VR for the first time. One participant became really emotional. I felt really privileged to share that moment with them and for me it really solidified that the potential of non-pharmacological treatments.