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Launch HN: Flowly (YC S21) – Manage pain using VR and biofeedback
Hey HN! This is Celine, Julien, and Narae of Flowly (https://www.flowly.world/ https://www.flowly.world/). Flowly is an app that combines VR and biofeedback training to help people manage pain, reduce anxiety, and increase relaxation (we send every member a VR headset and Realtime HR Sensor to use). We started this company to serve the 1 in 3 Americans who suffer from chronic pain and we’re now backed by the NIH and National Institute of Drug Abuse.
The opioid crisis has exposed how prevalent chronic pain is and how inaccessible and limited pain management solutions are today. Many pain management tools don't address all aspects of pain because pain encompasses more than physical pain: the top symptoms of chronic pain actually include anxiety, depression, and feelings of social isolation. In other words, chronic pain is a bio-psycho-social condition. It is important to us that we address it as such and this comprehensive approach is one of our core differentiators.
I (Celine) started the company because I grew up around pancreatic cancer patients, who were experiencing excruciating pain. People close to me passed away from morphine overdose and not even the cancer itself. I saw how pain affected someone not just physically, but also psychologically and socially.
Later when I was developing interactive content at DreamWorks, I got involved with VR and biometric feedback for entertainment experiences. At a certain point, I realized that all this cool tech had actually been studied since the 80s for pain management. This resonated strongly with me because of my personal experience. I brought in my best friend from Yale, Julien, who was at Hyperloop One doing controls on their Transponics team, and then Narae, an internationally recognized designer and animator from Broadway and California Institute of the Arts. Together we convinced the Chair of Anesthesiology at UCLA to come aboard and design the Flowly prototype together.
When we developed Flowly we were adamant about two things: it has to be accessible (needs to be easy to use at home) and it has to be science-backed. Our NIH grant cites over 300+ studies using VR and biofeedback for pain and anxiety management. We've conducted case studies, Phase I clinical trials, and have more trials coming up. Our Chief Principal Investigator is the Chair of Perioperative Medicine at UPMC and our Director of Research is at USC.
Another aim we have is to make Flowly reimbursable (covered by insurance so people who can’t afford it can use it too)— as you may know, that is not an easy journey, but we are working on it. In the meantime, we provide it direct-to-consumer for those who do have the ability to pay for a subscription which is $30/month. We are acutely aware this price point privileges certain populations to Flowly and that’s why we are working hard to get Flowly to be reimbursable. If you have experience with this or have advice we would love all the help we can get to make Flowly as accessible as possible.
The Flowly we've launched today works like this: you receive a kit with your subscription that includes a mobile VR headset and real-time Heart Rate Sensor that work with our iOS App. You enter a Flowly session in VR which helps to tackle pain in a few ways. First, you enter a beautiful immersive VR world that can work to distract you from existing pain or anxiety (called Gate Control Theory). Second, in each session you are guided to autoregulate and control your nervous system, which is where much of the body’s pain response is modulated. You learn to control your nervous system through biofeedback training which is the ability to see your realtime biometric data (Heart Rate, Heart Rate Variability, respiration) and then through calibrated breathing guides, voice-over, and light gamification, we teach you how to control those metrics and shift your body from fight-or-flight mode (your sympathetic nervous system) to rest-and-recovery mode (your parasympathetic nervous system). Third, we incorporate voice-overs in every session that focus on different therapeutic approaches like Acceptance and Commitment Therapy, Value Affirmation exercises, etc. Afterwards, you can track your progress through a personalized data analytics portal. You'll also get access to a text/call line with our Health Coach for questions or help getting set-up.
We're partnered with University of Pittsburgh Medical Center, USC, US Pain Foundation, and other institutions to provide Flowly to those who need it. Surprisingly to us, this past year many people we didn't expect to need Flowly also came to us for help— folks like therapists who needed anxiety management themselves, or families dealing with pain and stress at home.
We have a long way to go, but we feel passionate about creating an opioid-sparing tool for pain management. Check out our iOS app here: https://apps.apple.com/us/app/flowly-relaxation-training/id1485955236 https://apps.apple.com/us/app/flowly-relaxation-training/id1.... We're working on an Android version.
We welcome your feedback, questions and advice. Thank you for reading!
- tamadevr 5y agoThis didn’t fit in with the above but dang said y’all might find this interesting: While developing VR experiences optimized for relaxation, we discovered different visual elements that most universally resonated across varying populations. We discovered horses resonated as an animal that represented comfort and relaxation with the majority of study participants who tried Flowly experiences. We had multiple participants who cried in relief after spending time with horses in our VR experiences. An unexpected discovery from all our testing.
- dharma1 5y agoSounds very cool. Would it be possible to have a software only package (SteamVR and support for Apple/Android watch or similar sensors for heart rate/HRV) for those of us who already have the hardware (don't need the kit and are not in the US)?
- tamadevr 5y agoWe are hoping to provide software-only packages as well however at the moment, most wearables actually don't provide the realtime peak-to-peak heart rate interval data required to do the type of closed loop biofeedback we do. Once wearables are able to support this type of data we would love to provide Flowly software-only.
- disabled 5y agoTo do accurate and reliable HRV analysis you need a sensor (PPG/ECG/etc) that has a sampling rate of 500-1000 Hz minimum. This is especially the case for closed-loop. This is in order to do further calculations such as via respiratory sinus arrhythmia, to detect respiration rate. “More conservative guidelines advise between 500 and 1000 Hz (Riniolo and Porges, 1997; Berntson et al., 2007), which may be particularly relevant in case of lower amplitude RSA (Riniolo and Porges, 1997).” See: https://www.frontiersin.org/articles/10.3389/fpsyg.2017.00213/full https://www.frontiersin.org/articles/10.3389/fpsyg.2017.0021... In terms of notable hardware you may want to look at this: https://plux.info/kits/511-bitalino-mini-solo-kit-810121033.html https://plux.info/kits/511-bitalino-mini-solo-kit-810121033.... Anyways, this series of boards (biosignalsplux) interfaces with Android/iOS/Unity/etc via hardware-specific SDKs. Obviously Unity is for SteamVR or just Steam in general. The boards also have official support for the package LabStreamingLayer (there are also LSL interfaces for Unity on GitHub), which is extremely useful for the kind of work you are doing, with respect to calculations, processing, and analysis. I actually routinely work with physiological signals generated from the autonomic nervous system, and I do both processing and interfacing sides of this work. I also have an immune-mediated form of ANS failure, so I have personal relevant and translatable experience with respect to your project as a patient too. I hope this info helps!