Virtual reality as an adjunctive pain control during burn wound care in adolescent patients
Abstract
For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16-year-old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the 'real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.
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VR is being used to distract severe burn patients from their pain during severe burn wound cleaning, and burn patients report large reductions in the amount of time they spend thinking about their pain during painful medical procedures.
“VR is so attention grabbing that it is being used to distract severe burn patients from their pain during severe burn wound cleaning, and burn patients report large reductions in the amount of time they spend thinking about their pain during painful medical procedures [22–25].”
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ResultMott, J., Bucolo, S., Cuttle, L., Mill, J., Hilder, M., Miller, K., & Kimble, R. M. (2008) · Burns · doi:10.1016/j.burns.2007.10.010 · Cited by 155 · see citing works
“[8] Hoffman H, Doctor J, Patterson D, Carrougher G, Furness T.”
BackgroundApplications of virtual reality for pain management in burn-injured patients
Sharar, S. R., Miller, W. M., Teeley, A., Soltani, M., Hoffman, H. G., Jensen, M. P., & Patterson, D. R. (2008) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.8.11.1667 · Cited by 154 · see citing works
Self-citationUsing fMRI to Study the Neural Correlates of Virtual Reality Analgesia
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The Illusion of Presence in Immersive Virtual Reality during an fMRI Brain Scan
Hoffman, H. G., Richards, T. L., Coda, B. A., Richards, A. L., & Sharar, S. R. (2003) · CyberPsychology & Behavior · doi:10.1089/109493103321640310 · Cited by 151 · see citing works
Self-citationExploring the Design of Tailored Virtual Reality Experiences for People with Dementia
Hodge, J., Balaam, M., Hastings, S., & Morrissey, K. (2018) · Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems · doi:10.1145/3173574.3174088 · Cited by 150 · see citing works
“VR has been used in the treatment of psychological dysfunction including PTSD, phobias and eating and body image disorder, as well as in pain management to distract from uncomfortable procedures [18].”
MethodInterfaces that heal: coupling real and virtual objects to treat spider phobia
Hoffman, H. G., Garcia-Palacios, A., Carlin, A., Furness III, T. A., & Botella-Arbona, C. (2003) · International Journal of Human-Computer Interaction · doi:10.1207/s15327590ijhc1602_08 · Cited by 144 · see citing works
Self-citationVirtual reality for psychotherapy: Current reality and future possibilities.
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“3 Another report indicated that VR was somewhat successful in relieving children’s anxiety associated with chemotherapy.”
Overview: Virtual Reality in Medicine
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Treatment of Pain in Acutely Burned Children
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“While other therapeutic technologies distract users from negative experiences [20, 28, 44], these systems are often designed”
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Virtual reality for acute and chronic pain management in adult patients: a narrative review
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Xiang, H., Shen, J., Wheeler, K. K., Patterson, J., Lever, K., Armstrong, M., Shi, J., Thakkar, R. K., Groner, J. I., Noffsinger, D. L., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.12082 · Cited by 132 · see citing works
Application of a virtual reality prototype for pain relief of pediatric burn in Taiwan
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“The use of videogames and virtual environments (VEs) in studies involving children has shown positive results for pain management (Hoffman et al. 2000, Ahmadi 2001).”
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Virtual Reality for the Enhancement of Emotion Regulation
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Analgesic effect of watching TV during venipuncture
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Virtual Reality Analgesia During Venipuncture in Pediatric Patients With Onco-Hematological Diseases
Atzori, B., Hoffman, H. G., Vagnoli, L., Patterson, D. R., Alhalabi, W., Messeri, A., & Grotto, R. L. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.02508 · Cited by 121 · see citing works
“…VR for distraction among children and adolescents; however, to date most clinical studies on VR analgesia have included burn patients during physical therapy (Carrougher et al., 2009) or during burn wound cleaning (Das et al., 2005; Maani et al., 2011; Hoffman et al., 2014; Dascal et al., 2017).”
BackgroundSelf-citationMulti-modal distraction. Using technology to combat pain in young children with burn injuries
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Virtual reality distraction for acute pain in children
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“[2] Hoffman HG, Doctor JN, Patterson DR, Carrougher GJ, Furness 3rd TA.”
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Therapeutic Uses of Active Videogames: A Systematic Review
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The effect of visual stimuli on pain threshold and tolerance
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Virtual Reality Analgesia for Pediatric Dental Patients
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“SnowWorld VR software is specifically designed to be distracting, pleasant and nonnauseogenic, and to be used by patients who need to keep their heads and bodies still during the medical procedure (Hoffman et al., 2001).”
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Treating psychological and phsyical disorders with VR
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- Authors
- Hoffman, H. G., Doctor, J. N., Patterson, D. R., Carrougher, G. J., & Furness, T. A.
- Affiliations
- University of Washington (US)
- Corresponding author
- Patterson, David R.
- Venue
- Pain
- Published
- 2000-03-01
- Volume
- 85
- Issue
- 1
- Pages
- 305-309
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2034120147
- Cited by
- 651
- References
- 36
- Citations by year
- 2026: 30 · 2025: 29 · 2024: 43 · 2023: 46 · 2022: 42 · 2021: 50 · 2020: 46 · 2019: 31 · 2018: 31 · 2017: 30 · 2016: 19 · 2015: 15 · 2014: 30 · 2013: 11 · 2012: 20
- FWCI
- 14.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of General Medical Sciences (GM42725-07, R01GM042725)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Health Sciences › Medicine › Epidemiology › Burn Injury Management and Outcomes
- Keywords
- virtual reality, burn wound care, procedural pain, distraction therapy, non-pharmacological analgesia, adolescents, opioid analgesics, pain intensity, anxiety, video games, staple removal, acute pain management
- MeSH terms
- Adolescent, Burns, Computer Graphics, Humans, Male, Pain, Pain Measurement, User-Computer Interface, Pain Management
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