Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study.

OBJECTIVE The pain experienced by burn patients during physical therapy range of motion exercises can be extreme and can discourage patients from complying with their physical therapy. We explored the novel use of immersive virtual reality (VR) to distract patients from pain during physical therapy. SETTING This study was conducted at the burn care unit of a regional trauma center. PATIENTS Twelve patients aged 19 to 47 years (average of 21% total body surface area burned) performed range of motion exercises of their injured extremity under an occupational therapist's direction. INTERVENTION Each patient spent 3 minutes of physical therapy with no distraction and 3 minutes of physical therapy in VR (condition order randomized and counter-balanced). OUTCOME MEASURES Five visual analogue scale pain scores for each treatment condition served as the dependent variables. RESULTS All patients reported less pain when distracted with VR, and the magnitude of pain reduction by VR was statistically significant (e.g., time spent thinking about pain during physical therapy dropped from 60 to 14 mm on a 100-mm scale). The results of this study may be examined in more detail at www.hitL.washington.edu/projects/burn/. CONCLUSIONS Results provided preliminary evidence that VR can function as a strong nonpharmacologic pain reduction technique for adult burn patients during physical therapy and potentially for other painful procedures or pain populations.

[1]  P. Wall,et al.  Pain mechanisms: a new theory. , 1965, Science.

[2]  E. Huskisson Measurement of pain. , 1974, Lancet.

[3]  Ronald Dubner,et al.  Ratio scales of sensory and affective verbal pain descriptors , 1978, Pain.

[4]  S. Perry,et al.  Assessment of Pain by Burn Patients , 1981 .

[5]  Siang-Yang Tan,et al.  Cognitive and cognitive-behavioral methods for pain control: A selective review , 1982, Pain.

[6]  K. Mccaul,et al.  Distraction and coping with pain. , 1984, Psychological bulletin.

[7]  C. Chapman,et al.  Psychological control of acute pain in medical settings. , 1986, Journal of pain and symptom management.

[8]  A. Gift,et al.  Visual Analogue Scales: Measurement of Subjective Phenomena , 1989, Nursing research.

[9]  R Melzack,et al.  The pain of burns: characteristics and correlates. , 1989, The Journal of trauma.

[10]  Dennis C. Turk,et al.  The utility of cognitive coping strategies for altering pain perception: a meta-analysis , 1989, Pain.

[11]  R Melzack,et al.  The tragedy of needless pain. , 1990, Scientific American.

[12]  Behavioral intervention to reduce child and parent distress during venipuncture. , 1990 .

[13]  D. Patterson Practical applications of psychological techniques in controlling burn pain. , 1992, The Journal of burn care & rehabilitation.

[14]  A. Miller,et al.  A distraction technique for control of burn pain. , 1992, The Journal of burn care & rehabilitation.

[15]  G. Leonard Burns,et al.  Hypnosis for the treatment of burn pain. , 1992, Journal of Consulting and Clinical Psychology.

[16]  J. Schwarzwald,et al.  Humor as a cognitive technique for increasing pain tolerance , 1995, PAIN®.

[17]  D. Patterson,et al.  Non-opioid-based approaches to burn pain. , 1995, The Journal of burn care & rehabilitation.

[18]  H. Bingham,et al.  Pain and anxiety during burn dressing changes: concordance between patients' and nurses' ratings and relation to medication administration and patient variables. , 1995, The Journal of burn care & rehabilitation.

[19]  D. Heimbach,et al.  Pain, coping, and adjustment in patients with burns: preliminary findings from a prospective study. , 1995, Journal of pain and symptom management.

[20]  K. Slifer A Video System to Help Children Cooperate with Motion Control for Radiation Treatment Without Sedation , 1996 .

[21]  R. Blount,et al.  Nurse coaching and cartoon distraction: an effective and practical intervention to reduce child, parent, and nurse distress during immunizations. , 1997, Journal of pediatric psychology.

[22]  R. Kozarek,et al.  Prospective trial using Virtual Vision as distraction technique in patients undergoing gastric laboratory procedures. , 1997, Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates.

[23]  S. Weghorst,et al.  Virtual reality and tactile augmentation in the treatment of spider phobia: a case report. , 1997, Behaviour research and therapy.

[24]  D. Patterson,et al.  Lorazepam as an adjunct to opioid analgesics in the treatment of burn pain , 1997, Pain.

[25]  Hunter G. Hoffman,et al.  Virtual Chess: Meaning Enhances Users' Sense of Presence in Virtual Environments , 1998, Int. J. Hum. Comput. Interact..

[26]  D M Ehde,et al.  The quota system in burn rehabilitation. , 1998, The Journal of burn care & rehabilitation.

[27]  T. Furness,et al.  Virtual reality as an adjunctive pain control during burn wound care in adolescent patients , 2000, Pain.