GRAND Director of Health Research Dr. Diane Gromala demonstrates how virtual reality can ease chronic pain. PHOTO CREDIT: SFU

(VANCOUVER) Since 2010, GRAND’s Confronting Pain: Redefining Mobility (CPRM) project has been at the forefront of an emerging field of research exploring new uses of innovative computer technologies to treat chronic pain – a notoriously complex, but epidemic disease that affects one in five Canadians.

Chronic Pain (CP) is an enormous health problem in North America. Conservative estimates put the percentage of the population suffering with the disease between 15-30%, and growing. The costs to society surpass cancer, heart disease and HIV infection combined.

Lead by Dr. Diane Gromala, a Canadian Research Chair and Professor at Simon Fraser University’s School of Interactive Arts + Technology, CPRM researchers are using biofeedback systems, immersive virtual reality, visualization, robotics and innovative social media to develop non-pharmacological approaches for people to effectively manage their long-term pain.

In May 2013, Gromala’s team will take pain research another step forward with the launch of the SFU Chronic Pain Research Institute. In addition to increasing awareness about CP, the Institute’s five-year $2 million research funding target will accelerate cross-institutional collaborations and fast track the adoption of CPRM’s innovative technologies in clinical practice.

“We’re basically taking a GRAND project that grew to become this marvelous opportunity to form an institute,” said Gromala. “As in any field, the difference between research and its actual use can be a very large distance. What we’re trying to do with the institute is give the researchers a place where they can do collaborative research that is highly responsive to clinical observations.”

Holistic approach to pain research

Unlike acute pain, CP is not a symptom but a systemic and degenerative disease that lasts longer than six months – and can last a lifetime. Patients’ bodies are in a continual state of overdrive and hypersensitivity, but show few biomarkers that would indicate dysfunction. Sometimes no injury or other disease can be identified as the cause, and there is no cure. Patients also endure complications of immobility, depression, insomnia, cognitive impairment, anxiety and social isolation, which correlate with early death.

“This is one of the reasons chronic pain is said to kill: it’s an enormous strain on the body and its sub-systems start to malfunction. Patients grieve for their loss of ability to live life normally,” said Gromala.

From her perspective, traditional health research – evidence-based health research focused on the physical aspects of pain – neglects the psychological experiences and social context of patients that cannot be easily measured. The prescribed treatment is also typically focused on pharmaceuticals such as opiods, which can lead to dependence or addiction.

Advocating a very different “bio-psycho-social” or holistic approach, Gromala has tapped the GRAND network to join physicians with experts in computing science, engineering, sociology, psychology from across Canada, as well as artists and designers, to explore new technologies, practices and policies for pain treatment.

“We are, in essence, extending [healthcare] capacity by including experts who can help patients manage their pain in diverse ways, from tracking their sleep, activity and pain levels to developing devices that can help them manage medications, physiotherapy and stress. If I didn’t have a GRAND-funded project, I wouldn’t be collaborating with the people I’m working with at other institutions. It would have taken me years to meet them, years to find people interested in [pain research] or who have expertise. It’s not only that the researchers hadn’t met; the [research] areas hadn’t overlapped until now. Research in robotics in chronic pain [for example] didn’t exist [before GRAND].”

Through in-depth studies of the real needs of CP patients, CPRM’s interdisciplinary research in a clinical environment has contributed directly to the health research community and pain medicine. At UBC, for instance, HCI (Human Computer Interaction) expert Dr. Karon MacLean is developing emotionally responsive haptic devices that help patients cope with pain. U of T's TAGlab, founder and director Dr. Ronald Baecker is working with researchers to create an interactive digital picture frame that facilitates social connections, especially when individuals are physically isolated due to immobilizing pain. Other projects have broken new ground in pain research and treatment.

Gromala's own study of immersive Virtual Reality (VR) as a way to treat chronic pain, in particular, has resulted in novel systems that help patients use mindfulness meditation and engaging forms of biofeedback to reduce stress levels and self-manage pain. The system is currently used in over 20 hospitals and clinics across North America.

Industry collaboration to develop affordable VR pain treatment

By raising the profile and reach of CPRM, GRAND has also enabled Gromala to lead a Canadian-U.S. collaboration with the Seattle-based VR company Firsthand Technology. Funded by the American National Institutes of Health (NIH), they are developing and testing affordable VR technology for clinics and private practices.

“Our collaboration with Dr. Gromala and SFU developing applications for chronic pain enters a whole new realm of research, using virtual environments as a means to train the brain to better handle pain,” said Firsthand Technology President Howard Rose. “It's been extremely exciting working with the Transforming Research Pain Group because of their considerable expertise in pain, and their forward-thinking attitude and willingness to think way outside the box.”

Their prototype virtual environment "Virtual Meditative Walk” includes a new $5,000 head-mounted VR display customized for CP patients that is comparable to an existing $40,000 unit.

Google recently selected the Focus Forward film In Your Head about the collaboration to be featured on Google’s exclusive Solve for X website, a forum for showcasing breakthrough technologies for worldwide problems.

Raising awareness of long term pain

In spite of the urgent demand for pain specialists, there are few in Canada, and a pervasive lack of awareness about the disease persists among family physicians. The College of Surgeons and Physicians only recognized chronic pain as a disease in 2012. This knowledge gap has made diagnosing chronic pain a challenge, and patients can often wait seven years before admitted to a pain clinic, or to see an expert.

“[Pain is] such a common experience and yet we know so little about it. Not a lot of people are in pain research because it seems a hopeless, complex, massive problem that can’t be solved,” said Gromala.

Gromala is optimistic, however, that the Institute will effectively maintain and put into practice the knowledge of Canadian pain experts, including experts whose work is not widely known among healthcare researchers. Her research team has already collectively trained more than 100 graduate students, many who have gone on to significant positions in academia, industry, and government.

Gromala is also working to expand the capacity of health providers. Through a partnership with Pain BC – BC’s largest nonprofit dedicated to chronic pain – CPRM researchers have aggregated clinical pain research and practices from across Canada. Online informational tools provide patients and health practitioner direct access to the knowledgebase. The collaboration has also provided researchers unprecedented access to patients.

“That has been amazingly productive because getting access to patients is notoriously difficult and time-consuming. Through Pain BC I’ve been able to accelerate that by years,” said Gromala. Plans are also underway to partner with Surrey Memorial Hospital and the Fraser Health Authority, which employ many of the Institute's pain physicians.

“Patients who’ve been told they’re a malingerer, or that their pain wasn’t real tell me that many kinds of experts are working on solutions to this seemingly intractable problem. That in itself offers them hope.”

The Institute will also host conferences, seminars, workshops and related events focused on chronic pain research and training that reach out to experts in many fields. Community outreach will further raise the public profile of chronic pain.

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Contact: Spencer Rose
Communications Officer
GRAND NCE