Annals of Behavioral Medicine

, Volume 41, Issue 2, pp 183–191 | Cite as

Virtual Reality as an Adjunctive Non-pharmacologic Analgesic for Acute Burn Pain During Medical Procedures

  • Hunter G. Hoffman
  • Gloria T. Chambers
  • Walter J. MeyerIII
  • Lisa L. Arceneaux
  • William J. Russell
  • Eric J. Seibel
  • Todd L. Richards
  • Sam R. Sharar
  • David R. Patterson
Original Article

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.

Keywords

Virtual reality Pain distraction Analgesia 

Supplementary material

12160_2010_9248_MOESM1_ESM.doc (66 kb)
ESM 1Left image, an artist’s rendition of a patients looking into SnowWorld via magnet-friendly VR goggles during an fMRI brain scan. Right image, with no VR (left head), the brain showed large amounts of pain-related brain activity (where yellow shows high brain activity and orange shows moderate brain activity). The participants reported less pain, and showed large drops in pain-related brain activity during VR, (head on right). (Image credits—left image by Duff Hendrickson, UW; copyright Hunter Hoffman, UW. Right image by Todd Richards and Aric Bills, UW; copyright Hunter Hoffman, UW) (DOC 66 kb)

References

  1. 1.
    American Burn Association: Burn Incidence and Treatment in the US: 2007 Fact Sheet. Available from: http://www.ameriburn.org/resources_factsheet.php
  2. 2.
    Hoffman HG, Patterson DR, Seibel E, et al.: Virtual reality pain control during burn wound debridement in the hydrotank. Clin J Pain. 2008, 24:299–304.PubMedCrossRefGoogle Scholar
  3. 3.
    Perry S, Heidrich G, Ramos E: Assessment of pain by burn patients. Journal of Burn Care and Rehabilitation. 1981, 2:322–326.CrossRefGoogle Scholar
  4. 4.
    Ptacek J, Patterson D, Doctor J: Describing and predicting the nature of procedural pain after thermal injuries: Implications for research. Journal of Burn Care and Rehabilitation. 2000, 21:318–326.PubMedCrossRefGoogle Scholar
  5. 5.
    Melzack R: The tragedy of needless pain. Scientific American. 1990, 262:27–33.PubMedCrossRefGoogle Scholar
  6. 6.
    Berger AC, Whistler JL: How to design an opioid drug that causes reduced tolerance and dependence. Ann Neurol. 2010, 67:559–569.PubMedCrossRefGoogle Scholar
  7. 7.
    Cherny N, Ripamonti C, Pereira J, et al.: Strategies to manage the adverse effects of oral morphine: An evidence-based report. Journal of Clinical Oncology. 2001, 19:2542–2554.PubMedGoogle Scholar
  8. 8.
    Shang AB, Gan TJ: Optimising postoperative pain management in the ambulatory patient. Drugs. 2003, 63:855–867.PubMedCrossRefGoogle Scholar
  9. 9.
    Ward R: Physical Rehabilitation. In G. Carrougher (ed), Burn Care and Therapy. New York: Mosby, 1998, 293–327.Google Scholar
  10. 10.
    Montgomery GH, DuHamel KN, Redd WH: A meta-analysis of hypnotically induced analgesia: How effective is hypnosis? Int J Clin Exp Hypn. 2000, 48:138–153.PubMedCrossRefGoogle Scholar
  11. 11.
    Patterson DR: Is hypnotic pain control effortless or effortful? Hypnos. 2001, 28:132–134.Google Scholar
  12. 12.
    Patterson DR: Clinical Hypnosis for Pain Control. Washington, DC: American Psychological Association, 2010.CrossRefGoogle Scholar
  13. 13.
    Patterson DR, Jensen MP: Hypnosis and Clinical Pain. Psychological Bulletin. 2003, 129:495–521.PubMedCrossRefGoogle Scholar
  14. 14.
    Fernandez E, Turk DC: The utility of cognitive coping strategies for altering pain perception: A meta-analysis. Pain. 1989, 38:123–135.PubMedCrossRefGoogle Scholar
  15. 15.
    Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L: Music for pain and anxiety in children undergoing medical procedures: A systematic review of randomized controlled trials. Ambul Pediatr. 2008, 8:117–128.PubMedCrossRefGoogle Scholar
  16. 16.
    Cepeda MS, Carr DB, Lau J, Alvarez H: Music for pain relief. Cochrane Database of Systematic Reviews (Vol. Issue 2), 2006.Google Scholar
  17. 17.
    Eccleston C: Role of psychology in pain management. Br J Anaesth. 2001, 87:144–152.PubMedCrossRefGoogle Scholar
  18. 18.
    Eccleston C, Crombez G: Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychological Bulletin. 1999, 125:356–366.PubMedCrossRefGoogle Scholar
  19. 19.
    Kahneman D: Attention and effort. Englewood Cliffs, NJ: Prentice-Hall, 1973.Google Scholar
  20. 20.
    Hoffman HG, Garcia-Palacios A, Kapa VA, Beecher J, Sharar SR: Immersive virtual reality for reducing experimental ischemic pain. International Journal of Human-Computer Interaction. 2003, 15:469–486.CrossRefGoogle Scholar
  21. 21.
    Hoffman HG: Virtual Reality Therapy. Scientific American. 2004, 291:58–65.PubMedCrossRefGoogle Scholar
  22. 22.
    Hoffman HG, Doctor JN, Patterson DR, Carrougher GJ, Furness TA, 3rd: Use of virtual reality as an adjunctive treatment of adolescent burn pain during wound care: A case report. Pain. 2000, 85:305–309.PubMedCrossRefGoogle Scholar
  23. 23.
    Hoffman HG, Patterson DR, Magula J, et al.: Water-friendly virtual reality pain control during wound care. Journal of Clinical Psychology. 2004, 60:189–195.PubMedCrossRefGoogle Scholar
  24. 24.
    van Twillert B, Bremer M, Faber AW: Computer-generated virtual reality to control pain and anxiety in pediatric and adult burn patients during wound dressing changes. J Burn Care Res. 2007, 28:694–702.PubMedCrossRefGoogle Scholar
  25. 25.
    Carrougher GJ, Hoffman HG, Nakamura D, et al.: The effect of virtual reality on pain and range of motion in adults with burn injuries. J Burn Care Res. 2009, 30:785–791.PubMedCrossRefGoogle Scholar
  26. 26.
    Hoffman HG, Patterson DR, Carrougher GJ: Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: A controlled study. Clin J Pain. 2000, 16:244–250.PubMedCrossRefGoogle Scholar
  27. 27.
    Hoffman HG, Patterson DR, Carrougher GJ, Sharar SR: Effectiveness of virtual reality-based pain control with multiple treatments. Clin J Pain. 2001, 17:229–235.PubMedCrossRefGoogle Scholar
  28. 28.
    Schmitt YS, Hoffman HG, Blough DK, et al.: A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns. Burns. 2010.Google Scholar
  29. 29.
    Sharar SR, Carrougher GJ, Nakamura D, et al.: Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: Preliminary results from 3 ongoing studies. Arch Phys Med Rehabil. 2007, 88:S43–49.PubMedCrossRefGoogle Scholar
  30. 30.
    McCaul KD, Malott JM: Distraction and coping with pain. Psychological Bulletin. 1984, 95:516–533.PubMedCrossRefGoogle Scholar
  31. 31.
    Crombez G, Eccleston C, Baeyens F, Eelen P: When somatic information threatens, catastrophic thinking enhances attentional interference. Pain. 1998, 75:187–198.PubMedCrossRefGoogle Scholar
  32. 32.
    Jensen MP: The validity and reliability of pain measures in adults with cancer. Journal of Pain. 2003, 4:2–21.PubMedCrossRefGoogle Scholar
  33. 33.
    Jensen MP, Karoly P: Self-report scales and procedures for assessing pain in adults. In D. C. Turk and R. Melzack (eds), Handbook of pain assessment. New York: Guilford Publications, 2001, 15–34.Google Scholar
  34. 34.
    Gracely RH, McGrath P, Dubner R: Ratio scales of sensory and affective verbal pain descriptors. Pain. 1978, 5:5–18.PubMedCrossRefGoogle Scholar
  35. 35.
    Slater M, Wilbur S: A framework for immersive virtual environments (FIVE): speculations on the role of presence in virtual environments. Presence Teleoper Virtual Environ. 1997, 6:603–616.Google Scholar
  36. 36.
    Hoffman HG, Seibel EJ, Richards TL, et al.: Virtual reality helmet display quality influences the magnitude of virtual reality analgesia. J Pain. 2006, 7:843–850.PubMedCrossRefGoogle Scholar
  37. 37.
    Hoffman HG, Sharar SR, Coda B, et al.: Manipulating presence influences the magnitude of virtual reality analgesia. Pain. 2004, 111:162–168.PubMedCrossRefGoogle Scholar
  38. 38.
    Wender R, Hoffman HG, Hunner HH, et al.: Interactivity Influences the Magnitude of Virtual Reality Analgesia. J Cyber Ther Rehabil. 2009, 2:27–33.PubMedGoogle Scholar
  39. 39.
    Dahlquist LM, McKenna KD, Jones KK, et al.: Active and passive distraction using a head-mounted display helmet: Effects on cold pressor pain in children. Health Psychol. 2007, 26:794–801.PubMedCrossRefGoogle Scholar
  40. 40.
    Hoffman HG, Richards TL, Coda B, et al.: Modulation of thermal pain-related brain activity with virtual reality: Evidence from fMRI. Neuroreport. 2004, 15:1245–1248.PubMedGoogle Scholar
  41. 41.
    Hoffman HG, Richards TL, Bills AR, et al.: Using fMRI to study the neural correlates of virtual reality analgesia. CNS Spectrums. 2006, 11:45–51.PubMedGoogle Scholar
  42. 42.
    Hoffman HG, Richards TL, Magula J, et al.: A magnet-friendly virtual reality fiberoptic image delivery system. Cyberpsychol. Behav. 2003, 6:645–648.PubMedCrossRefGoogle Scholar
  43. 43.
    Hoffman HG, Richards TL, Van Oostrom T, et al.: The analgesic effects of opioids and immersive virtual reality distraction: Evidence from subjective and functional brain imaging assessments. Anesth Analg. 2007, 105:1776–1783, table of contents.PubMedCrossRefGoogle Scholar
  44. 44.
    Patterson DR, Hoffman HG, Palacios AG, Jensen MP: Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain. J Abnorm Psychol. 2006, 115:834–841.PubMedCrossRefGoogle Scholar
  45. 45.
    Maani C, Hoffman HG, DeSocio PA, et al.: Pain control during wound care for combat-related burn injuries using custom articulated arm mounted virtual reality goggles. Journal of CyberTherapy and Rehabilitation. 2008, 1:193–198.Google Scholar
  46. 46.
    Hoffman HG, Patterson DR, Soltani M, et al.: Virtual reality pain control during physical therapy range of motion exercises for a patient with multiple blunt force trauma injuries. Cyberpsychol Behav. 2008, 19:47–49.Google Scholar
  47. 47.
    Furman E, Jasinevicius TR, Bissada NF, et al.: Virtual reality distraction for pain control during periodontal scaling and root planing procedures. J Am Dent Assoc. 2009, 140:1508–1516.PubMedGoogle Scholar
  48. 48.
    Hoffman HG, Garcia-Palacios A, Patterson DR, Jensen MP, Furness III TA: The effectiveness of virtual reality for dental pain control: A case study. Cyberpsychol Behav. 2001, 4:527–535.PubMedCrossRefGoogle Scholar
  49. 49.
    Garcia-Palacios A, Hoffman HG, Richards TR, Seibel EJ, Sharar SR: Use of virtual reality distraction to reduce claustrophobia symptoms during a mock magnetic resonance imaging brain scan: a case report. Cyberpsychol Behav. 2007, 10:485–488.PubMedCrossRefGoogle Scholar
  50. 50.
    Wright JL, Hoffman HG, Sweet RM: Virtual reality as an adjunctive pain control during transurethral microwave thermotherapy. Urology. 2005, 66:1320.PubMedGoogle Scholar
  51. 51.
    Steele E, Grimmer K, Thomas B, et al.: Virtual reality as a pediatric pain modulation technique: A case study. Cyberpsychol Behav. 2003, 6:633–638.PubMedCrossRefGoogle Scholar
  52. 52.
    Gershon J, Zimand E, Pickering M, Rothbaum BO, Hodges L: A pilot and feasibility study of virtual reality as a distraction for children with cancer. J Am Acad Child Adolesc Psychiatry. 2004, 43:1243–1249.PubMedCrossRefGoogle Scholar
  53. 53.
    Windich-Biermeier A, Sjoberg I, Dale JC, Eshelman D, Guzzetta CE: Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer. J Pediatr Oncol Nurs. 2007, 24:8–19.PubMedCrossRefGoogle Scholar
  54. 54.
    Gold JI, Kim SH, Kant AJ, Joseph MH, Rizzo AS: Effectiveness of virtual reality for pediatric pain distraction during i.v. placement. Cyberpsychol Behav. 2006, 9:207–212.PubMedCrossRefGoogle Scholar
  55. 55.
    Chan EA, Chung JW, Wong TK, Lien AS, Yang JY: Application of a virtual reality prototype for pain relief of pediatric burn in Taiwan. J Clin Nurs. 2007, 16:786–793.PubMedCrossRefGoogle Scholar
  56. 56.
    Das D, Grimmer K, Sparnon A, McRae S, Thomas B: The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: A randomized controlled trial. BMC Pediatric. 2005, 5:1.CrossRefGoogle Scholar
  57. 57.
    Malloy KM, Milling LS: The effectiveness of virtual reality distraction for pain reduction: A systematic review. Clin Psychol Rev. 2010, 30:1011–1018.PubMedCrossRefGoogle Scholar
  58. 58.
    Morris LD, Louw QA, Grimmer-Somers K: The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: A systematic review. Clin J Pain. 2009, 25:815–826.PubMedCrossRefGoogle Scholar
  59. 59.
    Schneider SM, Prince-Paul M, Allen MJ, Silverman P, Talaba D: Virtual reality as a distraction intervention for women receiving chemotherapy. Oncol Nurs Forum. 2004, 31:81–88.PubMedCrossRefGoogle Scholar
  60. 60.
    Liebovici V, Magora F, Cohen S, Ingber A: Effects of virtual reality immersion and audiovisual distraction techniques for patients with pruritus. Pain Res Manag. 2009, 14:283–286.Google Scholar
  61. 61.
    Flores A, Hoffman HG, Russell W, et al.: Longer, multiple virtual reality pain distraction treatments of Hispanic and Caucasian children with large severe burns. CyberTherapy Conference. San Diego, CA, 2008.Google Scholar
  62. 62.
    Patterson DR, Sharar SR: Burn pain. In J. D. Loeser (ed), Bonica’s Management of Pain. Philadelphia, PA: Lippincott, Williams & Wilkins, 2001, 780–787.Google Scholar
  63. 63.
    Malchow RJ, Black IH: The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism. Crit Care Med. 2008, 36:S346–357.PubMedCrossRefGoogle Scholar
  64. 64.
    D’Souza AL, Nelson NG, McKenzie LB: Pediatric burn injuries treated in US emergency departments between 1990 and 2006. Pediatrics. 2009, 124:1424–1430.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2011

Authors and Affiliations

  • Hunter G. Hoffman
    • 1
    • 3
  • Gloria T. Chambers
    • 1
  • Walter J. MeyerIII
    • 2
  • Lisa L. Arceneaux
    • 2
  • William J. Russell
    • 2
  • Eric J. Seibel
    • 1
  • Todd L. Richards
    • 1
  • Sam R. Sharar
    • 1
  • David R. Patterson
    • 1
  1. 1.University of WashingtonSeattleUSA
  2. 2.University of Texas Medical Branch and Shriners Children’s Hospital Galveston TXGalvestonUSA
  3. 3.Human Interface Technology Laboratory, Human Photonics Lab, and Department of Mechanical EngineeringUniversity of WashingtonSeattleUSA

Personalised recommendations