Feasibility of articulated arm mounted Oculus Rift Virtual Reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients

Abstract

For daily burn wound care and therapeutic physical therapy skin stretching procedures, powerful pain medications alone are often inadequate. This feasibility study provides the first evidence that entering an immersive virtual environment using very inexpensive (∼$400) wide field of view Oculus Rift Virtual Reality (VR) goggles can elicit a strong illusion of presence and reduce pain during VR. The patient was an 11-year-old male with severe electrical and flash burns on his head, shoulders, arms, and feet (36 percent total body surface area (TBSA), 27 percent TBSA were third-degree burns). He spent one 20-minute occupational therapy session with no VR, one with VR on day 2, and a final session with no VR on day 3. His rating of pain intensity during therapy dropped from severely painful during no VR to moderately painful during VR. Pain unpleasantness dropped from moderately unpleasant during no VR to mildly unpleasant during VR. He reported going "completely inside the computer generated world", and had more fun during VR. Results are consistent with a growing literature showing reductions in pain during VR. Although case studies are scientifically inconclusive by nature, these preliminary results suggest that the Oculus Rift VR goggles merit more attention as a potential treatment for acute procedural pain of burn patients. Availability of inexpensive but highly immersive VR goggles would significantly improve cost effectiveness and increase dissemination of VR pain distraction, making VR available to many more patients, potentially even at home, for pain control as well as a wide range of other VR therapy applications. This is the first clinical data on PubMed to show the use of Oculus Rift for any medical application.

FIG. 1.

(a) VR during wound cleaning of a soldier. (b) VR of pediatric burn patient during passive range of motion exercises. VR, virtual reality. Photo credits and copyright Hunter Hoffman, UW, www.vrpain.com.

FIG. 2.

Pediatric burn patient was the first to try out the Oculus Rift VR goggles for VR pain distraction during physical therapy. Photo credits and copyright Hunter Hoffman, UW, www.vrpain.com.

FIG. 3.

(a) SnowWorld, a VR world designed for distracting patients from acute procedural pain. During wound cleaning and physical therapy, severe burn trauma patients typically report 35–50 percent reductions in worst pain intensity on subjective pain rating scales.^, (b) Functional magnetic resonance imaging (fMRI) brain scan studies show large reductions in pain-related brain activity in subjects using SnowWorld.^, SnowWorld still image by Ari Hollander and Howard Rose, copyright Hunter Hoffman, UW, www.vrpain.com. fMRI brain image by Todd Richards and Aric Bills, copyright Hunter Hoffman, UW, www.vrpain.com.

FIG. 4.

Pain during passive range of motion exercises during no VR, (gray bars) vs. pain during the same exercises while in VR (black bar).

FIG. 5.

SpiderWorld VR exposure therapy for phobias. Photo credit Stephen Dagadakis, copyright Hunter Hoffman, www.vrpain.com.