Jeff Hathaway, Physical Therapist and CEO & Founder of Breakthrough Physical Therapy talks about understanding pain and how virtual reality can help some patients.
Interview conducted by Ivanhoe Broadcast News in October 2019.
So let’s start off with what you do, Jeff. You’re a physical therapist. Is managing pain a difficult thing to do.
HATHAWAY: Well, what’s interesting about managing pain over the years is that what we’ve come to learn is that what we understood about pain and what we’re taught about pain in medical school was completely wrong. And about three years ago, I began to realize that when I was sitting through a class on the neuroscience of pain and began to realize, wait a minute, this is completely different. And then when you understand how pain really works and then you look at, you know, the opioid crisis and the approach we had with pain, it just wasn’t going to get to the cause of the problem. So we began to go down a road of – how can we start changing the dialogue and change how we actually address pain, both acute and chronic or persistent pain?
Exactly. Because you get patients on all sides.
HATHAWAY: Correct.
I must imagine that it’s difficult with patients with chronic pain because the answer was pain pills for a long time.
HATHAWAY: Yeah. It became the quick fix. All right, so we’ll give someone a pill, and then they’ll be able to do more. But unfortunately what we found out is a very negative side effects to those pain pills. And again, it’s not really addressing what we now know leads to ongoing, persistent pain. And so until we address the real cause, we’re just simply a Band-Aid. And in physical therapy, what we try to pride ourselves in is not treating symptoms, but treating the cause of whatever injury somebody has or whatever condition they have. And pain is simply the same thing – we have to get to the place where we’re addressing what really – how pain really works.
How does pain really work?
HATHAWAY: Well, for years we were taught, basically, that the tissue that was damaged told the brain to perceive pain. And what we’ve learned over time is that, actually, it’s the opposite – that the brain decides whether the pain – the signal it’s getting is important and whether you should feel pain or not. And so it is in your head, but not in a psychological way, in more of a physiological way. And so once we understood and began to see how the brain actually takes these messages and whether it takes those messages and either senses pain or doesn’t, we began to realize that there was ways to adapt our therapy to be able to address it and get people perceiving less pain and doing more and getting back to their life, which is really what everybody in chronic pain is really looking for.
Let’s talk a little bit about the approach that you guys take, especially in Mia’s case or people like Mia.
HATHAWAY: Sure.
What’s the approach that you guys take that is different?
HATHAWAY: Well, what we do is we try to get people to understand the difference between hurt and harm, and the pain signal in the brain is actually a good thing as long as it’s at the right level. In other words, when we become too sensitive to pain signals, then the pain tends to take over our life. And what happens in chronic pain is patients aren’t sure if the pain is harmful or not. And so if we can help them distinguish that and give them tools and techniques to be able to bring that sensitization of the brain down – so in other words, the story we use with patients a lot is that it’s like a house that has an alarm system, OK? And if someone breaks a window or knocks down a door, there’s danger, and so the alarm goes off, OK? Well, that’s a good alarm, right? But if that alarm got so sensitive that when the wind blew and the leaves went across the porch that the alarm went off, you’d say, well, there’s no harm here, there’s no danger, yet the alarm is going off. The alarm’s too sensitive. That’s exactly what’s going on inside the brain with chronic pain is that that’s – that area has become too sensitive to these messages. And so if we can teach you some techniques to turn that down so that the alarm is at the right level – that you’re getting pain signals when there’s actually harm, then we can get them moving and get them back to their life.
That is interesting. That was a good analogy. So then, when it comes to pain, we can have our brains turn that down to the proper level?
HATHAWAY: Yeah. So we actually have done studies. We’ve done a study in for low back, knee, and shoulder. And we’ve given them this pain education before the surgery and after, and then we track them for a year. And what we’ve found is that the cost of the people who understand pain is 45 percent less a year later, which means that they now have the right level of sensitization about their pain and they understand it better, so they’re not going to the E.R. because they’re in pain and are concerned. They actually understand what’s happening and they know the difference between hurt and harm. So then their recovery is on track and doesn’t get off the rails.
Is one of the ways to do this to desensitize your brain to pain? How does the virtual reality therapy come in?
HATHAWAY: You’re right because most VR for pain is actually using games for distraction. But the real question is, why does distraction work? What’s going on? And so we’re actually using VR for a couple of things. Number one is to educate them – get them to understand things like the house and the alarm, OK? And how that works. Then we give them techniques such as breathing, meditation, and mindfulness – to give them techniques where they can actually desensitize their central nervous system – their brain, so that now the pain signal doesn’t trigger the alarm, OK? So what we’re using VR for is more education and those key skills that the patient can actually use when they leave, OK? But it also helps us in the therapy. So what we do is we give them the VR session, we bring that sensitization down, and then they go do their session, like Mia did, so that now she can do those and be in a better place and understand the difference between hurt and harm and being willing to go a little bit further in her exercises each time. So that, over the course of time, she’s able to do more and get back to her life.
What is the patient seeing with the virtual reality? In Mia’s case, you guys had her do the virtual reality pre-surgery.
HATHAWAY: Yeah. She knew she was going in for a unique surgery and a serious surgery. And just to have her understand the process and how her body was going to respond and keep her level of fear or anxiety at the proper level – she’s going to recover faster and do better. So again, if we can introduce these skills to a patient, they’re able to resume normal activities with the
Describe a little bit what the patient sees.
HATHAWAY: Yeah. The example of the house and the alarm – if they see that story, it’ll be animated and it’ll be narrated so that they get it in layman’s terms. So we can take this – all this research around neuroscience, we can put it into language and pictures that people understand. And then, around the mindfulness or the meditation, they can choose the scene – they can be on a mountain, they can be at the ocean, and it runs them through those scenarios. And then the breathing as well – we teach them how to breathe. So they actually are mentored through a breathing process so that they become – it’s like doing your exercises, right? The more you do it, the better you get at it. And so when they’re out and about and the pain starts to go up, they can actually start their own breathing exercise because they’ve been through it. The VR allows us to put them in an environment where it’s easier to understand and we can block everything else out and put them in a real quiet environment. And we just find that they – the retention is much higher.
So they retain that info and they use it outside the course.
HATHAWAY: Exactly, yeah.
Are they reducing their amount of usage, if any, of pain killers? Are they reducing it or eliminating it?
HATHAWAY: We have cases of both. We have to be very careful when you taper off of an opioid. But, yeah, we can see a complete elimination or at least a reduction. You know, the whole idea here is – again, is if I empower you – if I teach you to be able to do this stuff. So over time, we track them. We also track, in the VR, how well they’re doing in terms of their perception of pain and their perception of how much they can do. And we’ve shown with that data that people, in fact, are able to do more.
Because you guys are collecting that data.
HATHAWAY: Correct.
So this has been, in your experience, very successful.
HATHAWAY: Yes. This is a game-changer. Number one because it’s getting out there the new information on how pain works. If we continued in the old model, we’re really not going to get out of any opioid crisis or anything like that. In fact, one of the things we’re doing right now is we’re putting this into elementary school education so that students, at a young age, begin to understand how pain works. And sort of like they did with Mothers Against Drunk Driving, right? They wanted the schools to teach it so that people understood – it’s the same type of concept, and we’re seeing very good results with that as well.
This is really cool. And this can be used to manage chronic pain or acute pain.
HATHAWAY: Correct. Yes. How the brain works in terms of pain is the same. And so it can be applied in either situation. Like I said, we’ve done it with pre-surgical, which is acute pain. And we’ve done it with people who’ve had years of persistent pain.
And on that note, Jeff, is it possible to change someone’s course – if they have been on painkillers for years, can they ween off and use this?
HATHAWAY: Yes. There’s no question. It’s like anything else. The patient has to be motivated and ready. And I think now, with the education about opioids, more and more people are ready to try to get off of it because of the dangers – or not get on it to begin with. And that’s our hope is that this becomes not something that’s used mostly for people already on opioids, but also becomes a preventative mode.
Right, and that’s key. And is this being widely used out there? Is this being used nationwide? Or is this very new, and it’s just starting to get out there?
HATHAWAY: It’s new. When you say nationwide, I wouldn’t say it’s readily available. Within our business, we’re in, I think, 13 – 14 – 15 states, and it’s available in those states in certain pockets. So it really depends. It is available to clinics outside of our business because we’re seeing more and more success, so our goal’s to get this out there and not make it exclusive.
And would this be something that your physician would refer to you?
HATHAWAY: Yeah. Depending on what state you’re in – almost all states, you could come directly to us to get this. Or we are out educating physicians all the time about this. So it could be either way. You know, in our case, you can come in, we’ll show it to you for free, we’ll give you an idea of what it’s going to be and if it could it help you, and then you can determine if you want to go ahead. It should only take two to three visits to know if it’s for you. So it’s not something that’s a big commitment.
Right. It doesn’t work with everyone is what you’re saying.
HATHAWAY: Yeah. Everybody’s an individual. And again, the patient has to be ready. And so, when they’re ready, it tends to work.
Do insurance companies cover the cost?
HATHAWAY: Yeah. They cover physical therapy. They don’t necessarily cover the virtual reality specifically. We’re working with payers to get them to take a look at this and really evaluate it because we think it has a lot of value, hence the reason we’re gathering data. But we feel that, eventually, it will be.
END OF INTERVIEW
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