Launch HN: Flowly (YC S21) – Manage pain using VR and biofeedback

[tamadevr]

Hey HN! This is Celine, Julien, and Narae of Flowly (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/id1.... We're working on an Android version. We welcome your feedback, questions and advice. Thank you for reading!

[KLR-motion]

Sounds amazing. I went through a minor stroke when I was 26 and i had a lot of symptoms induced by anxiety, indeed i was afraid to do another stroke and my anxiety produced similar sensations. Any time I had those symptoms coming I would play video games or whatch my metrics to reassure myself until it was gone. I think this tool would have been very helpful at the time. Thanks for trying to provide drug free solutions for people experiencing such problems!

[tamadevr]

Wow thank you for sharing your experience, and that's very intuitive and innovative of you to use video games to track your metrics. If you have any feedback for us please don't hesitate to reach out to me at [email protected]

[tamadevr]

This 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]

Sounds 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)?

[awwx]

Pricing is hard to find; the main site only says "Join today for $29.99 to start." which could mean anything ("$30 for the first month and $300/month after that")

I had to click through to the portal and then get past the kit to find the actual pricing. $30/month is quite reasonable if it works, and it'd be reassuring to see that up front!

[tamadevr]

Thank you for this feedback because we are still trying to work out how to best present information on our website. Do you think the pricing should come up earlier on the homepage?

[dr_orpheus]

What is the timeline for the Android version of the app to be available? Is there a way I can sign up for a notification on the website when this comes available?

I would be very interested in this for my father's chronic pain but he currently only has an Android device.

[tamadevr]

Definitely, if you shoot us an email ([email protected]) expressing your interest in the Android version, we will add you to our waitlist for the Android Beta. We are aiming to get it out end of summer/beginning of fall. I hope we can be helpful for your father.

[orliesaurus]

A friend of mine does similar work on cerebral palsy patients - looks like more and more people are getting into VR-health for specific things! Pretty cool and good luck!

[tamadevr]

appreciate it and I can see how helpful VR could be for cerebral palsy patients.

[davidajackson]

I am going to ask a very naive question but I want to understand. I likely have carpal tunnel. Watching Netflix or coding/technology videos are the few things I can do when in pain. For me I need distraction, is this geared more toward relaxation? Are the 2 interchangeable in a medical sense?

[tamadevr]

Not naive at all, distraction is definitely a recommended form of dealing with a lot of types of pain flare-ups. Our experiences are geared towards relaxation, but because our VR worlds are quite immersive, most of our members and study participants report they don't "think about [their] pain" during the session because they're focused on the experience and distracted from their flare-up. We also have some worlds that are more gamified such that you're actually playing a game in VR with a higher distraction element. Relaxation and distraction are not necessarily interchangeable but in VR they can often work together.

[alex-wallish]

I also have severe carpal tunnel and am interested in how this might be able to impact that? Do you have any patients who have used this for that purpose?

[rckoepke]

How does the device measure respiration?

[tamadevr]

Right now we calculate something called Resonant Frequency Breathing Rate which is the unique breathing rate each person can breathe at to best optimize their Heart Rate Variability. We calculate this Breathing Rate through data derived from our Heart Rate sensor.

[lettergram]

Interesting, I did something different with an EEG. Worked on kids with adhd and anxiety. Worked well to teach them, we used a candle in VR, etc

Kudos and good luck!

[tamadevr]

Amazing, we have started working with pediatric pain and kids with anxiety as well. Thank you for sharing.

[midnightmonster]

This looks very much worth a try. I've already ordered a kit. If it works well, there's probably 3-4 people in my household that could benefit from it. Is there a way for us to share using separate iPhones? Using the same iPhone?

[tamadevr]

Thank you for your support! Yes, if you have multiple people in your household we recommend everyone have an individual membership so you can track personalized data, but if you’re willing to share a Kit we can give you a heavy discount for each additional membership you purchase. If you decide to do so just email me directly and I will set you up myself: [email protected]

[yewenjie]

Another naive question : is this relevant for chronic back pain originating from bad posture?

[tamadevr]

For many people this is relevant for chronic back pain originating from bad posture. Our clinical studies actually focus on chronic back pain. But of course, everyone's case is unique so I would say it's worth a try, but I'd love to hear your feedback.

[Fede_V]

Really exciting work: could you make it easier to find peer reviewed studies (or even better, ongoing clinical tries) that critically evaluate your product on the webpage?

[tamadevr]

Yes definitely. We are in the process of redesigning our website to better reflect relevant studies. Our own studies will be published end of the year.

[nhod]

Tried to sign up and order the VR etc kit but when I get to the shipping address screen it only allows me to press “cancel.” Would love to try it out!

[tamadevr]

Thank you for this feedback, this must be a glitch and I will look into it right away. If you are able, trying signing up here: https://portal.flowly.world/ If this still doesn’t work please call or text us and we will set it up for you: 323-545-3659

[paranorman]

Just signed up, I'd like to have my wife try this out as well. Am I able to share my account with her?

[tamadevr]

Thank you for your support, we'd love to hear your feedback. We always recommend family members have separate accounts so you can keep your data tracking individualized, however if your wife tries a session with your account and is interested in her own membership, we'd be happy to provide a Family discount! Just email me directly at [email protected] mentioning this and I will set you up. Also I love to remind members they can call us at 323-545-3659 when you set up your Kit for the first time to help answer any questions and get tips.

[yccheok]

Any chance to make the app available in App Store in Malaysia? Would love to try out on it. Thanks.

[tamadevr]

Thank you for your interest. Currently we're not operating outside the U.S. because our shipping operations are limited, however, if you're very interested we'd be happy to send you a Testflight link to try. We've had a few members pay for international shipping after they tried the app via the Testflight link.

[marc__1]

How to do compare your approach with the likes of Sana Health?

Congrats for the launch!

[tamadevr]

Thank you. The difference lies primarily with our Virtual Reality component and our price points. Our sessions are interactive and through them you’re learning tools and techniques to reduce pain, stress, and anxiety even outside of the sessions. We often hear our users tell us that they’re able to implement what they’ve learned when they don’t have the headset around. From our understanding, Sana is a device more meant to induce pain reduction when you use it and maybe for some residual effects after. They use light and sound stimulation to do that instead of a full virtual reality experience. Their price point is also significantly higher.

[mooneater]

Looks great, please include Canada :)