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A Virtual Refuge From Real Pain

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Dec. 11, 2014 -- Luke Moore spent 3 weeks in the burn unit at Harborview Medical Center in Seattle, WA, while he recovered from second- and third-degree burns on his left leg. He had fallen asleep too close to the fire on a September camping trip in the Wenatchee National Forest.

For Moore, as for all burn patients, the reality of treatment can be more painful than the burn itself. Even morphine is often not enough.

Because of that, some researchers have turned to virtual reality to help patients like Moore control their pain.

The 25-year-old spent many of his treatment sessions wearing headgear covering his eyes and ears that put him in a snowy, Arctic wonderland. While health care workers cleaned his wounds and stretched his tender skin, Moore threw snowballs to music and floated along a river through a canyon with penguins, woolly mammoths, flying fish, and snowmen.

He was part of an experiment that tested the ability of SnowWorld, a virtual reality game, to distract people from burn-care pain.

“It takes a big chunk of the pain off your mind,” Moore says. “For the last session, I even did it without pain medicine. It’s definitely worse without the game.”

SnowWorld is one of a handful of computer games aimed at helping users control or ignore pain. The games mostly target temporary pain, or discomfort and anxiety, during procedures, such as dental and urology ones. But research is expanding into ongoing, chronic pain as well. The games are part of the larger market of brain-training games, or neurogames, that promise a number of benefits, most commonly to improve certain mental skills.

Although research has supported the benefits of virtual reality for more than a decade, the video games remain in experimental settings, mostly because the headgear they require is expensive and cumbersome. That could soon change. Samsung, Sony, newcomer DeepStream VR, and Oculus -- which was just bought by Facebook -- are all developing more practical, lower-cost viewers for commercial sale, which could make virtual reality widely available in health care facilities in the near future.

Enter Another World

SnowWorld is intended to represent the exact opposite of fire, says Hunter Hoffman, PhD. He's a cognitive psychologist and virtual reality researcher at University of Washington. He created the game in 2001 with David Patterson, PhD, a specialist in burn trauma and pain control. “It taps into a good place to go.”

Hoffman says SnowWorld’s interactivity and command of patients’ hearing and sight immerses them in another world more completely than a typical video game or passive screen time. Studies show that whether patients use SnowWorld with morphine or by itself, the game is more effective than morphine alone to reduce their reported pain, along with pain activity on brain scans.

In another small study, SnowWorld eased burn-care pain drastically compared to Nintendo. Burn patients who play SnowWorld -- throwing snowballs with a mouse-click -- have far less pain than those who just passively watch it without a mouse. Bigger eyepieces also make a difference: The more side vision that’s impacted, the better the pain reduction. 

Virtual reality isn’t just about comfort. “When you’re pushing a person’s pain up into severe-to-excruciating repeatedly, as burn care can do, there are concerns that this can change the brain’s wiring and increase risk of developing chronic pain later,” Hoffman says. “So better acute pain control could potentially lower [the] risk of developing chronic or persistent pain 6 months out.”

Virtual reality may ease ongoing pain, too. Researchers at Simon Fraser University in Canada have created a virtual reality experience that simulates a meditative walk for people who live with chronic pain. Like SnowWorld, the simulated walk takes users to another world. Other researchers are using virtual reality for phantom limb pain that's felt in the area where a limb has been amputated.

“Part of the reason [virtual reality is] effective,” Hoffman says, “is that patients are willing to cooperate and go into another world if it means they get more pain reduction.”

WebMD Article Reviewed by Hansa D. Bhargava, MD on December 11, 2014

Sources

SOURCES:

Hunter Hoffman, PhD, cognitive psychology, research scientist, University of Washington.

Luke Moore, Clifton Forge, VA.

International Anesthesia Research Society.

Journal of Cybertherapy and Rehabilitation.

Journal of Pain.

Urology.

Journal of American Dental Association.

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