Virtual reality goes far beyond playing games with titles like Arizona Sunshine, Moss, Robo Recall, and Tetris Effect. VR also is playing an ever-growing role in health care settings. The global market for VR in health care could reach $3.8 billion in 2020, according to one estimate.

VR is touching all corners of heath, including robotic surgeries, training, pain management, and behavior modification, according to InterbrandHealth, a health care branding agency. And these technologies are happening right here in Houston.

Researchers at Houston Methodist Cancer Center are exploring whether exposure to nature, through either a real garden or VR, can ease pain and distress in cancer patients who are undergoing chemotherapy. This approach might decrease the need for prescription painkillers.

Houston Methodist and Texas A&M University are leading this test. Renee Stubbins, a clinical dietitian at Houston Methodist Cancer Center, and Ashley Verzwyvelt, an infusion oncology nurse at the cancer center, proposed the research after several years of studying ways that nature can boost the healing process.

"Anything that affects our patients' comfort — including easing pain and anxiety, and possibly reducing the need for pain medications — is important to their recovery," Stubbins says in a release. "People have an innate connection to nature, and we hope the patients will respond positively."

Three dozen cancer patients receiving chemotherapy infusions every two weeks during at least six cycles will be randomly assigned to one of three rooms: a live-garden-view room; a window-less room, and a room where nature can be experienced through a VR headset.

Teaming up with Houston-based Skyline Art Services, local artist Gonzo247 produced a nature-inspired mural on a wall behind the live garden to create an immersive environment. The mural depicts a flowering garden, blue sky and sunset that enhance the live garden of Texas wildflowers in the foreground.

Researchers will measure pain, distress, blood pressure, heart rate, and saliva cortisol at the beginning and end of each infusion visit. Saliva cortisol, a hormone produced when the body is stressed, helps gauge a patient's condition.

"If this study proves that real or virtual elements of nature help the healing process, then it has potential to positively impact our patients," Verzwyvelt says. "Some of them are hesitant to take pain medication due to concerns of addiction and adverse side effects, so I'm excited to see the possibilities this kind of research could bring."

Houston Methodist Cancer Center says the VR experiment could have implications for treatment of an array of patients who are immobile or whose immune systems are compromised.

"We looked at multiple studies that showed exposure to nature can reduce stress levels and actually increase productivity and creativity," says Ann McNamara, associate professor in the Department of Visualization at Texas A&M. "We want to see if we can reproduce those effects in a natural environment in virtual reality."

The study is being financed by the Center for Health & Nature, a joint initiative of Houston Methodist, Texas A&M and Texan by Nature, a nonprofit conservation group founded by former first lady Laura Bush. The Center for Health & Nature, housed at Houston Methodist Hospital, debuted in 2018.

"There's a gap in research regarding what nature factors lead to increased health, what exposure to nature means, and how much exposure is needed," Bush said when the center was announced.