Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles

Abstract

Background: This is the first controlled study to explore whether adjunctive immersive virtual reality (VR) can reduce excessive pain of soldiers with combat-related burn injuries during wound debridement.

Methods: Patients were US soldiers burned in combat attacks involving explosive devices in Iraq or Afghanistan. During the same wound care session using a within-subject experimental design, 12 patients received half of their severe burn wound cleaning procedure (~6 minutes) with standard of care pharmacologies and half while in VR (treatment order randomized). Three 0 to 10 Graphic Rating Scale pain scores for each of the treatment conditions served as the primary variables.

Results: Patients reported significantly less pain when distracted with VR. "Worst pain" (pain intensity) dropped from 6.25 of 10 to 4.50 of 10. "Pain unpleasantness" ratings dropped from "moderate" (6.25 of 10) to "mild" (2.83 of 10). "Time spent thinking about pain" dropped from 76% during no VR to 22% during VR. Patients rated "no VR" as "no fun at all" (<1 of 10) and rated VR as "pretty fun" (7.5 of 10). Follow-up analyses showed VR was especially effective for the six patients who scored 7 of 10 or higher (severe to excruciating) on the "worst pain" (pain intensity) ratings.

Conclusions: These preliminary results provide the first evidence from a controlled study that adjunctive immersive VR reduced pain of patients with combat-related burn injuries during severe burn wound debridement. Pain reduction during VR was greatest in patients with the highest pain during no VR. These patients were the first to use a unique custom robot-like arm mounted VR goggle system.

Figure 1

(A and B) US Army soldier receiving immersive VR to reduce his pain during severe burn wound care. The unique robot-like arm mounted VR goggle holder designed by Hoffman and Magula at the University of Washington, Seattle holds the VR goggles near the patient's eyes weightlessly, reducing the amount of surface contact (if any) needed with the patient. Photos and copyrights Hunter Hoffman, U.W. see also http://www.youtube.com/watch?v=jNIqyyypojg.

Figure 2

A screenshot of what patients see in the VR goggles during immersive VR pain distraction. This 2006 version of SnowWorld was designed by Hoffman, developed by Hoffman and Patterson, University of Washington, Seattle, WA, and created for the UW/Harborview Burn Center by worldbuilders at Firsthand. Image by Firsthand Inc., Seattle, WA, copyright Hunter Hoffman, UW, www.vrpain.com.

Figure 3

Compared with pharmacologies + No VR (shown in solid), patients (n = 12) reported large reductions pain during pharmacologies + immersive VR (shown as white bars) during severe burn wound care of burn injury. Standard deviations are show in the error bars. (*p < 0.05), (**p < 0.01), (***p < 0.001).