Dr. Jose Canseco on behavioral health's place in orthopedics

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Spine surgeon Jose Canseco, MD, PhD, of Rothman Orthopaedic Institute, has his eye on the potential benefits that behavioral healthcare can have for musculoskeletal patients.

The Philadelphia-based practice and Harvard MedTech partnered to study cognitive behavioral therapy in orthopedic patients using virtual reality technology.

Dr. Canseco, principal investigator of the study, spoke with Becker's about the state of behavioral healthcare in orthopedics and where it's headed

Note: This conversation was lightly edited for clarity.

Question: Can you provide more insight into this collaboration and what the study will entail? 

Dr. Jose Canseco: So they developed a technology where they want to look into virtual reality or augmented reality and see how that can affect patients being treated for pain related to surgery. They're very interested in two populations of patients that have had a history of issues with narcotic pain medications — spine and shoulder. 

Along with spine patients, the goal is to have between 15 and 25 shoulder patients on each arm and try to have two subgroups on each side with and without the treatment and see if we can find if intervention helps with their pain control. Because of the way that the opioid epidemic is affecting our country, we're trying to find alternatives to pain control other than narcotic pain medicines. Some studies that have already been published have shown that some of these virtual reality environments have helped in patients outcomes and help improve their pain control.

Q: What has been your experience in your practice with addressing the mental health side of pain management?

JC: We did publish a study a couple of years ago where we're looking at patients that were diagnosed with some form of psychiatric disorder, either anxiety or depression, and if that affected their outcomes in spine surgery. We found people with a co-diagnosis of depression or anxiety have worse outcomes after spine surgery, and it is all related to the way that they see their disease progressing. If you're depressed and you're in pain even after surgery, you're going to feel worse than if you're not depressed after surgery. Right now for patients with anxiety and depression, we try to communicate with their primary care providers or with their mental health providers and see if there's any optimization they can get prior to surgery. But it's really hard now because that sometimes entails changing their medications. If we can have some alternative form of therapy that can help with those symptoms, I think that'd be fantastic. I've used Oculus headsets in gaming, and once you take it off, you feel a little dizzy because you're so immersed and it really changes the way you perceive reality. Hopefully it has that effect in patients. 

Q: Current VR headsets and hardware can be a little bit expensive. Have you done any other research on mental healthcare and accessibility in orthopedics?

JC: We've seen that in that study that we published that people who got their mental healthcare by their providers have better outcomes compared to the people that didn't have them. 

Other than that, this is really the first time we're going into alternative therapies in mental health and orthopedics. As an orthopedic physician, it's hard to address psychiatric illness without the help of a provider that can look into other symptoms that we're unable to see in the short period of time that we take care of them. A lot of patients have very long term relationships with their mental health providers, and it's a different type of relationship than what we can provide. 

But in this type of therapy it's longer term. They follow the patient before and after the surgery for up to six months to a year. It sounds like that's going to really provide access that otherwise it would be unavailable. Patients in the study won't pay for the VR headset, and the goal is to have them covered by insurance. Now with the improvement in technology, these headsets are getting cheaper and cheaper. 

Q: How would you rate the current state of mental healthcare integration in orthopedics? Do you think this is something that will grow in future years?

JC: Over the past couple of years, mental health has taken a forefront in many aspects. You see it in sports, you see it in the Olympics, and you're going to see physicians and patients taking care of their mental health. Now that we're more aware and people are less afraid of speaking about it, we can take more time discussing with patients about their mental health and trying to find therapies that can co-address that. 

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