VR Treatments Reduce Pain
research made possible by funding from the following major benefactors (and
also local private donations raised by Ross Chambers and Melody Burson).
And by the Pfeiffer Research Foundation
Immersive virtual reality pain distraction was originated and developed by Hoffman and Patterson at the University of Washington and Harborview Burn Center
All images on this webpage are copyrighted.
VR Pain Control environment now on display at the Cooper-Hewitt Smithsonian Triennial Design Exhibition: Design Life Now (Dec. 2006 to July 2007) on museum row in Manhattan New York City. Visit this exhibit and experience SnowWorld firsthand. Fly through an icy 3-D canyon throwing snowballs at snowmen, penguins and woolly mammoths. SnowWorld gives visitors the illusion of “being in another place” (using table mounted VR goggles built by Jeff Magula, UW).
Virtual Reality Analgesia
The University of Washington Harborview Burn Center, directed by Dr. Nicole Gibran, is a regional burn center. Patients with severe burns from 5 surrounding states are sent to Harborview for special care. Harborview has pioneered a number of advanced treatments (e.g., early skin grafting). As a result of advances here and elsewhere, the chances of surviving a bad burn, and quality of living for survivors has improved dramatically over the past 20 years.
Unfortunately, the amount of pain and suffering experienced by patients during wound care remains a worldwide problem for burn victims as well as a number of other patient populations.
As can be seen from the left figure below, when patients are resting (most of the time), opioids (morphine and morphine-related chemicals) are adequate for controlling their burn pain (few patients are in the red zone).
In sharp contrast, during wound care such as daily bandage changes, wound cleaning, staple removals etc., opioids are not enough, not even close. As shown in the figure on the right above, over 86% of the burn patients reported having severe to excruciating pain during wound care (shown in red), even when standard levels of opioids were used. The pain management techniques in use are not good enough. Patients are suffering, a fact particularly disturbing when the patients are children.
In 1996, Hunter Hoffman and David Patterson co-originated the new technique of using immersive VR for pain control and began collaborating with Sam Sharar, MD shortly thereafter. Hunter is a VR researcher from the U.W. Human Interface Technology Laboratory with a background in human cognition and attention. Since 1993 he has been exploring ways to increase the illusion of going inside virtual worlds (presence), how VR affects allocation of attentional resources, and therapeutic applications of VR.
Professor David R. Patterson studies psychological techniques (e.g., hypnosis) for reducing severe acute burn pain of patients at Harborview Burn Center in Seattle. Dave is head of the Division of Psychology of the U.W. Dept of Rehabilitation Medicine. He is a recipient of the Milton H. Erickson Award for Scientific Contributions to Hypnosis, and has a grant from NIH to study VR burn pain control. Our interdisciplinary research team is using VR adjunctively, IN ADDITION TO TRADITIONAL opioids. This UW/Harborview clinical team includes Sam Sharar, Gretchen Carrougher, Mark Jensen, Rob Sweet, Maryam Soltani, Laura Jewett-Leahy and Dana Nakamura.
SnowWorld, developed at the University of Washington HITLab in collaboration with Harborview Burn Center, was the first immersive virtual world designed for reducing pain. SnowWorld was specifically designed to help burn patients. Patients often report re-living their original burn experience during wound care, SnowWorld was designed to help put out the fire. Our logic for why VR will reduce pain is as follows. Pain perception has a strong psychological component. The same incoming pain signal can be interpreted as painful or not, depending on what the patient is thinking. Pain requires conscious attention. The essence of VR is the illusion users have of going inside the computer-generated environment. Being drawn into another world drains a lot of attentional resources, leaving less attention available to process pain signals. Conscious attention is like a spotlight. Usually it is focussed on the pain and woundcare. We are luring that spotlight into the virtual world. Rather than having pain as the focus of their attention, for many patients in VR, the wound care becomes more of an annoyance, distracting them from their primary goal of exploring the virtual world.
In our preliminary case study (Hoffman, Doctor, Patterson, Carrougher and Furness, 2000), two patients with severe burns went into SpiderWorld. They saw a virtual kitchen complete with kitchen countertops, a window with a partly cloudy sky, as well as 3-D cabinets, and doors that could be opened and shut. Patients could pick up a teapot, plate, toaster, plant, or frying pan by inserting their cyberhand into the virtual object, and clicking a grasp button on their 3-D mouse. Each patient also physically picked up a virtual wiggly-legged spider possessing solidity and weight, using a mixed-reality force feedback technique developed by one of our team members. Patient 1 had 5 staples removed from a burn skin graft while playing Nintendo, and six staples removed from the same skin graft while in VR. He reported dramatic reductions in pain during VR.
Patient 2 was perhaps a bigger challenge. He had a severe burn covering over 33% of his body.
Patient 2 showed a similar large but less extreme pattern (reduction of pain during wound care while in VR compared to while playing a video game). The results of these two patients are described in a clinical note in the March 10th, 2000 issue of the medical journal PAIN. Clinical notes are inconclusive by nature, and larger studies are needed (and underway).
In a related preliminary clinical study that is now completed, (Hoffman, Patterson and Carrougher, 2000), have found additional support for the efficacy of VR for pain control. Twelve patients with severe burns at Harborview reported highly significant reductions in pain levels during physical therapy when in VR compared to no VR (conventional treatment). In addition to distracting the patients, VR can likely be used to motivate patients to perform desired stretching motions, using behavioral reinforcement techniques (e.g., they could get more gas for their jet by gripping and ungripping their healing hand 10 times).
As shown in the graph below, a controlled analog laboratory pain study using healthy volunteers has also shown encouraging results (Hoffman, Garcia-Palacios, Kapa, Beecher, & Sharar, 2003). With no distraction, pain went up and up every two minutes, as is typical of 10 min blood pressure cuff ischemas. During the last two minutes, subjects went into virtual reality, and their pain dropped dramatically.
In all of our VR pain control studies, patients, (especially children and teenaged burn patients) have shown enthusiasm about participating.
Harborview occupational therapist Dana Nakamura stretching a young female patient's healing skin during physical therapy,while the patient explores SpiderWorld.
Use of VR on multiple occassions with the same patient have been reported by Hoffman Patterson, Carrougher and Sharar, 2001; and Hoffman Patterson, Carrougher, Nakamura et al.
With funding from NIH (by principal investigators Dave Patterson and Sam Sharar, MD), generous private funding from the Paul G. Allen Family Foundations, Scan/Design Foundation by Inger and Jens Bruun, the William Randolph Hearst Burn Center in New York, and local donors (thanks to fundraising by Ross Chambers and Melody Burson), we are now developing several new virtual environments specifically designed for increasing the effectivesness of Virtual Reality pain distraction. For example, SuperSnowWorld, is an especially attention-grabbing virtual environments designed to minimize or avoid simulator sickness. SuperSnowWorld is being programmed by Worldbuilder Ari Hollander using Virtools Worldbuilding Software. Ari Hollander has a masters degree from the University of Washington HITLab, as well as a degree in Astrophysics from Berkeley. Ari and Hunter have been collaborating since 1993.
Virtual Reality Exposure
therapy for Post Traumatic Stress Disorder (click here).
Virtual Reality Exposure therapy for Spider phobia (click here).
Magnet-friend fMRI brain scans studing changes in pain-related brain activity associated with virtual reality analgesia (click here).
Water-friendly virtual reality helmet for treating burn patients who are sitting in a tub of water during wound care (click here).
"Virtual Reality Therapy" article published in the Aug 2004 issue of Scientific American Magazine (see also www.sciam.com)
"Pain Control During Wound Care for Combat-Related Burn Injuries Using Custom Articulated Arm Mounter Virtual Reality Goggles:" Journal of CyberTherapy & Rehabilitation 2008:1(2)
To see a 1 min digital video
clip interview of a 6 year old burn patient after virtual reality…click
or just keep scrolling down to see our website on using virtual reality to treat pain in burn patients.
You can experience a hands-on immersive VR demonstration of SnowWorld opening December 8th 2006 open through August 2007 at the Smithsonian Cooper-Hewitt National Museum Design Triennium museum exhibit on museum row in Manhattan New York City. Visitors to this exhibit will fly through an icy 3-D canyon called SnowWorld, where they can shoot snowballs at snowmen, snowwomen, igloos robots etc. SnowWorld gives visitors the illusion of “going to a place” when in SnowWorld.
12th Annual CyberTherapy Conference, 6/11 to 6/14, 2007, Washington DC This year's theme is "Transforming Healthcare Through Technology" http://www.interactivemediainstitute.com/conference2007/index.htm
A snapshot of SnowWorld, image by Stephen Dagadakis, copyright Hunter Hoffman, U.W. The original version of SnowWorld (completed in 2003) was developed by Hunter Hoffman, with help from Kristin Darken, Jeff Bellinghausen and Chuck Walter from Multigen, Brian Stewart from SimWright Inc., Howard Abrams (freelance worldbuilder), and Duff Hendrickson from the UW HITLab.
here for information about
contributing to this project.