Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures

Abstract

Introduction: Excessive pain during medical procedures is a widespread problem but is especially problematic during daily wound care of patients with severe burn injuries.

Methods: Burn patients report 35-50% reductions in procedural pain while in a distracting immersive virtual reality, and fMRI brain scans show associated reductions in pain-related brain activity during VR. VR distraction appears to be most effective for patients with the highest pain intensity levels. VR is thought to reduce pain by directing patients' attention into the virtual world, leaving less attention available to process incoming neural signals from pain receptors.

Conclusions: We review evidence from clinical and laboratory research studies exploring Virtual Reality analgesia, concentrating primarily on the work ongoing within our group. We briefly describe how VR pain distraction systems have been tailored to the unique needs of burn patients to date, and speculate about how VR systems could be tailored to the needs of other patient populations in the future.

Fig. 1

Left, a burn patient getting wound cleaning/debridement in a hydro(scrub) tank “goes into” the immersive virtual world (shown on the right) to distract him from his excessive pain. The custom water-friendly system uses fiberoptic image guides to safely transmit computer-generated images from the immersive virtual reality to the patient via photons (light). (Photo credits—left photo by Hunter Hoffman, UW; image on the right by Stephen Dagadakis, UW, shows the 2003 version of SnowWorld, (designed at the University of Washington, www.vrpain.com, created by Jeff Bellinghausen and Chuck Walter from Multigen, and upgraded by Brian Stewart from SimWright Inc., Howard Abrams (freelance worldbuilder), and Duff Hendrickson, UW))

Fig. 2

A schematic showing the laboratory pain stimulation paradigm used in an fMRI brain scan study exploring whether virtual reality changes the amount of pain-related brain activity

Fig. 3

Patient with combat-related burn injuries receiving wound care in immersive virtual reality via robot-like arm mounted VR goggles which do not require wearing a head mounted VR helmet. (Photo credits by Hunter Hoffman, www.vrpain.com)

Fig. 4

Pediatric burn patient in virtual reality during passive range of motion exercises. The VR helmet shown has high-technology 80° diagonal field of view goggle views of the virtual world, as seen by the patient. (Photo credit—left photo by Hunter Hoffman, www.vrpain.com)