Virtual Reality Pain Reduction

University of Washington Seattle and U.W. Harborview Burn Center

This 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 & Patterson at the Univ. of Washington Seattle and Harborview Burn Center.

All images on this webpage are copyrighted. Please e-mail hunter@hitL.washington for permission.

Photo on right shows a patient using U.W. HITLab/Harborvview’s SnowWorld pain distraction at Shriners Children’s Burn Center Galveston. UW designer/researcher Hunter Hoffman’s latest version of SnowWorld was created for the UW by gifted worldbuilders at www.firsthand.com:  using www.Virtools.com Virtual World Development Software.

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.

When patients are resting (most of the time), opioids (morphine and morphine-related chemicals) are adequate for controlling their burn pain.

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.

 

                                                    David Patterson, Ph.D, (above in living color) and Sam Sharar, MD (above in black and white)

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, Maryam Soltani, Laura Jewett-Leahy, Aubriana Teeley, working with dedicated staff at Harborview Hospital.

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 focused 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, and several have now been published).

In all of our VR pain control studies, patients, (especially children and teenaged burn patients) have shown enthusiasm about participating. 

WATERFRIENDLY VR (2008)

Water friendly virtual reality goggles funded largely by the Washington State Firefighters Fund. This fiberoptic VR helmet developed by our team allows patients to go into virtual reality while getting wound care/debridement/bandages changed in a hydro tank, partially submerged in water. (Clinical Journal of Pain, 2008).

	fMRI BRAIN SCANS

Pain research using fMRI brain scans show significant reductions in pain-related brain activity during SnowWorld in healthy volunteers getting thermal pain stimulations (NeuroReport, 2004; see also Anesthesia and Analgesia, 2007).

For a list of VR studies and publications using SnowWorld (click here).

Click here to see 1 min video interview of 6 year old patient about SnowWorld.

Click here to see a 2009 1 min video interview about SnowWorld with a young U.S. soldier burned in Iraq..

 "Virtual Reality Therapy" article published in the Aug 2004 issue of Scientific American Magazine (see also www.sciam.com)

Click here to see Cover Story of UW Medicine Magazzine (see page 10 in the magazine). 

Upcoming 2009 Conference Presentations by our team!

Dave Patterson, Sam Sharar, Aubriana Teely, Maryam Soltani will give presentations and posters at the American Burn Association, March 24-27, 2009  San Antonio, TX.  click here for details

Hunter gives a Keynote at the Inaugural 2009 World Conference on Innovative Virtual Reality, Chalon-sur-Saone, France, Feb 25-26, 2009.  Click here for details.

Hunter will present at the 14th Annual CyberTherapy Conference , June 21st to 23rd 2008 in  at a Lake near Milan Italy
(click here if you want to go)

Hunter will give invited immersive VR demos of BusWorld and the University of Washington's IraqWorld 
at a PostTraumatic Stress Disorder conference in Israel in October 2009. October 18-23 (please check back later for details).

Click here for information about contributing to this project.(TAX DEDUCTABLE and any amount is great).

A snapshot of good old SnowWorld 2003, 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. Thank you. The version of SnowWorld currently being used was designed by Hoffman and built by Ari Hollander and Howard Rose from www.imprintit.com. 

Contacts

Hunter Hoffman <hunterhitL.washington.edu>