Applications of virtual reality for pain management in burn-injured patients

Abstract

The pain associated with burn injuries is intense, unremitting and often exacerbated by anxiety, depression and other complicating patient factors. On top of this, modern burn care involves the repetitive performance - often on a daily basis for weeks to months - of painful and anxiety-provoking procedures that create additional treatment-related pain, such as wound care, dressing changes and rehabilitation activities. Pain management in burn patients is primarily achieved by potent pharmacologic analgesics (e.g., opioids), but is necessarily complemented by nonpharmacologic techniques, including distraction or hypnosis. Immersive virtual reality provides a particularly intense form of cognitive distraction during such brief, painful procedures, and has undergone preliminary study by several research groups treating burn patients over the past decade. Initial reports from these groups are consistent in suggesting that immersive virtual reality is logistically feasible, safe and effective in ameliorating the pain and anxiety experienced in various settings of post-burn pain. Furthermore, the technique appears applicable to a wide age range of patients and may be particularly well-adapted for use in children, one of the most challenging populations of burn victims to treat. However, confirmation and extension of these results in larger numbers of patients in various types of burn-related pain is necessary to more clearly define the specific benefits and limitations of virtual reality analgesia in the burn care setting.

Figure 1. Compared with distraction with a 2D video game (dark bars), immersive virtual reality (light bars) significantly reduced various subjective pain and anxiety ratings in a 17-year-old male undergoing bedside burn wound care

VAS: Visual Analog Scale. Reproduced with permission from [11].

Figure 2. A 40-year-old male undergoes burn wound care (bandage removal and wound cleaning) partially submerged in a hydrotank while experiencing immersive virtual reality delivered by a photonic, non-electric, ‘water-friendly’ virtual reality delivery system

The patient navigates and interacts with the virtual world using a hand-controlled joystick. ^©Hunter Hoffman, University of Washington, DC, USA.

Figure 3. An adolescent male with a left upper extremity burn undergoes passive range-of-motion physical therapy while experiencing immersive virtual reality

The patient navigates the virtual world using a head position-tracking head-mounted-display and interacts with the virtual world using a fingertip-controlled mouse.

Figure 4. Mean subjective pain and mood (fun) ratings during post-burn, passive range-of-motion physical therapy in a population of 88 subjects (aged 6–65 years) receiving standard pharmacologic analgesia (dark bars) and standard pharmacologic analgesia plus immersive (light bars)

GRS: Graphic rating scale; VR: Virtual reality.