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[Review] Flowly: An Interactive App for Chronic Pain and Anxiety

by SpineNation Published May 27, 2020

(Graphic: SpineNation)

Flowly is an interactive app for smartphones designed to help users cope with pain and anxiety. Users can explore interactive experiences that teach them how to regulate their nervous system through relaxation training. The application tracks user progress and, if they choose, users may share activity and growth with a supportive community. All content can be experienced on your phone or in a Virtual Reality (VR) headset that comes with every subscription.

How Flowly works

Flowly offers a variety of interactive experiences, or Worlds, that engage users in biofeedback for relaxation training through guided breathing. That means that with the VR headset and sensor or their index finger, users can monitor and adjust how they breathe and how they focus. With time users learn how to regulate their nervous system better. All while immersed in beautiful and relaxing virtual environments.

Every session completed in the #BreatheTogether module contributes 50 cents to COVID-19 Relief Fund.

There are currently seven worlds in the flowly app, with an additional free module called #BreatheTogether created to serve the greater global community during the COVID-19 pandemic. Each world is a different virtual experience with different surroundings and stimuli. The #BreatheTogether and Intro World are free to use without limitation. Access to other worlds, such as Wave World, Rainbow Valley, and Galactic Harvest, is only available with a subscription.

Users may choose to use the VR headset and biofeedback sensor while interacting with Worlds or use their finger to provide biofeedback. When using a finger, users touch the screen or lay their finger across the camera flash and lens on their phone. Either way, the app tracks the user's pulse and HRV or Heart Rate Variability. The HRV is a measurement of the time between each heartbeat. That rate changes as users interact with the flowly World and achieve relaxation through guided, diaphragmatic breathing. The better their breathing and HRV, the more stimuli and changes in the environment the user will experience in the virtual World.

An advanced tool for mindfulness

A screen image from the #BreatheTogether interactive module.

Research has shown that meditation and mindfulness can help ease the symptoms of anxiety and chronic pain. However, as most people living with chronic pain can tell you, it is often challenging to meditate or practice mindfulness exercises when in a pain flare. SpineNation Senior Community Leader, Kelly Mendenhall, has been using the Flowly app and VR system since February 2020. 

Kelly lives with chronic back pain and nerve pain due to spinal cord injury, as well as Major Depressive Disorder and Complex-PTSD. Anxiety especially exacerbates her sciatica pain because of a condition called Piriformis Syndrome. She made the perfect test subject to try flowly out in the real world and report back to the SpineNation community. 

The following is a summary of Kelly's experience and review of the flowly app experience and results, perfect timing for #MentalHealthAwareness Month.

Real-world experience with chronic pain and anxiety

I have worked with a psychiatrist who specializes in chronic pain and PTSD for two years now. The majority of the pain I have struggled with for the past three years comes from a combination of nerve pain caused by herniated discs and spinal cord crush-injury. Sciatica nerve pain is my most consistent challenge. Narcotic and opioid medications are mostly ineffective for my pain. I chose to avoid such prescriptions except for post-op recovery. The side effects of nerve-blocking drugs such as Gabapentin were too unpleasant, so I discontinued use after about ten months. 

My psychiatrist felt that mindfulness and meditation would help ease my pain and anxiety, both of which exacerbate the other. He would guide me through meditation exercises in his office, which worked ok. However, at home, I couldn't focus enough, especially during a pain flare of eight or 10 out of 10 on the pain scale. I tried some meditation apps, but those didn't work great for me either. I found it challenging to focus on meditating and not on the pain itself. I would often dissociate and disengage not only from the app but from the world entirely.

I was very excited when I learned about the development of Flowly and reached out to co-creator Celine Tien immediately upon release. I learned Flowly's mission is to take typically inaccessible therapies like biofeedback and VR, and put it in the hands of the people who need it most. For someone like me, who can only sit upright for a few hours each day without increased pain, it was appealing to me to have such an accessible tool. I can use flowly sitting in my recliner, laying in bed, or wherever I am most comfortable on any given day.

How flowly works for me

A month with Flowly by Kelly (SpineNation Facebook)

Flowly is a game-changer. An immersive VR environment is the tool I always needed and didn't have before flowly. My favorite world is Wave World, in which the user is standing on a beach at night. Stars in the sky, waves are coming in close to your feet, grounded on the sand. It isn't just a visual experience. You can hear the sounds of the waves coming in on the beach. 

As you follow the guided breathing exercise and decrease your heart's beats per minute (BPM,) your HRV increases, and you are in-flow, as the app puts it. You slowly become aware of the gradual changes taking place around you. Stars twinkle brighter, northern lights begin to dance through the sky, and the colors become more plentiful and vivid as you continue. I feel most at-peace in Wave World.

I quickly found that my focus is not easily broken because I experience the virtual environment audibly and visually. The same remains true even during high pain flares. If I am anxious with a rapid resting heart rate when I begin my time in the app, I see my heart rate drop between 10-20 BPMs in one 15-minute session. As I relax, my muscles relax, which releases the pressure on my sciatic nerve from my piriformis muscle. I have experienced pain decreasing by two levels or more after one to two sessions. 

I began using Flowly in early February 2020, and as I write this, it is mid-May 2020. I use Wave World most often, but I have been through all eight sessions of the Intro World, as well as some modules in Rainbow Valley and Galactic Harvest. In Rainbow Valley, you are looking at a mountain range, and as your biofeedback improves, you see more rainbows, clouds, and birds. 

In the Galactic Harvest modules, you are standing on Planet Flow, an intergalactic experience. You look down to see you're holding a hose and begin watering seeds in the ground ahead of you. The better your biofeedback and HRV, the more flowers and plants you will harvest. You earn points for each harvest, making this particular module a lot like a video game.

A screen image of the flowly Galactic Harvest virtual world.

Flowly works even when you're not using the app.

Something that I noticed within the first two weeks of using the flowly VR system is that my breathing throughout the day or certain activities became more steadied and measured. For instance, while doing battle rope exercises in physical therapy, I often struggled with breathing and asthma. I felt out of breath before my body fatigued, forcing me to quit. 

Learning to engage in diaphragmatic breathing in the flowly app carried over into real-world activities. Within two weeks, I increased my time behind the battle ropes by 30-seconds per set. I also noticed that calming myself when I started to feel anxiety, especially in public settings or after an unexpected loud noise, became more natural. I sometimes close my eyes and imagine myself in a flowly world following the breathing guide to calm myself on such occasions.

Tips for ease of use

Since I've been using the app for a few months now, I have a few tips to share for new users:

  1. The front of the VR goggles is magnetically attached and pops right off. Before beginning your session, pop that piece off to allow better ventilation for your phone so that it doesn't get too hot during use.

  2. If you have glasses, the VR goggles will accommodate them! However, if you need to remove them for comfort, there are focus knobs built into the headset that can be adjusted as needed.

  3. If your phone is in a thick case, you will likely want to remove it from the case to fit well into the VR headset.

  4. If you have long hair, you may find it easier to keep the headset in place if you put your hair back in a messy bun before starting your session.


I highly recommend flowly for others living with anxiety, chronic pain, or a combination of the two. I find flowly so useful that SpineNation has partnered with flowly in a variety of ways. Active member-users on SpineNation who are participating in support groups for chronic pain management and mental health will find a unique promo code at the bottom of this article. This promo code allows users to begin their Flowly experience at 20% off discount for the first 90 days of any monthly subscription, and 20% off the entire first year of any annual subscription (because Apple doesn’t allow discounts in the app).

A screen image of the flowly app home screen and community chat.

In the coming months, users will notice that there is a SpineNation community within the flowly app where users can share their stats. Users can encourage each other support as well. The SpineNation-flowly community will provide further opportunities for interaction with SpineNation staff and users as well. Our partnership with flowly furthers our mission to help our members put their back pain behind them and improve their quality of life.



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