The DOI matches its Crossref record; 33 of the 36 references it cites were found in a registry or an index.
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 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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Schultheis, M. T., & Mourant, R. R. (2001) · PRESENCE Virtual and Augmented Reality · doi:10.1162/1054746011470271 · Cited by 73
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Self-citationFlores, A., Linehan, M. M., Todd, S. R., & Hoffman, H. G. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00531 · Cited by 64
“The current study explored for the first time, the feasibility and clinical potential of using Immersive Virtual Reality (VR) enhanced DBT® Mindfulness skills training to help reduce psychological symptoms (negative emotions and anxiety, ASD/PTSD) of two patients with SCI. Patient 1 was a 39-year-old male patient suff…”
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Carrougher, G., Ptacek, J., Sharar, S., Wiechman, S., Honari, S., Patterson, D., & Heimbach, D. (2003) · Journal of Burn Care and Rehabilitation · doi:10.1097/00004630-200301000-00003 · Cited by 62
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“But if imagination pays a role of such importance in aetiopathogenetic processes of human behavior, the modification and substitution of images associated to these dysfunctions represent indispensable elements in the complex process of diagnosis and care of psychological distress.”
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Does Cartoon Movie Distraction Decrease Burned Children's Pain Behavior?
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Clinical hypnosis for pain control.
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Self-citationAnalgo-Sedation of Patients with Burns Outside the Operating Room
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Use of Virtual Reality Feedback for Patients with Chronic Neck Pain and Kinesiophobia
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Soltani, M., Drever, S. A., Hoffman, H. G., Sharar, S. R., WIECHMAN, S. A., Jensen, M. P., & Patterson, D. R. (2018) · Rehabilitation Psychology · doi:10.1037/rep0000239 · Cited by 59
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Pain management in patients with burn injuries
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BackgroundMethodInfluentialGomez, J., Hoffman, H. G., Bistricky, S. L., Gonzalez, M., Rosenberg, L., Sampaio, M., García‐Palacios, A., Haro, M. V. N., Alhalabi, W., Rosenberg, M., et al. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01611 · Cited by 56
“Immersive VR blocks patients’ view of the real world (Hoffman et al., 2000; Hoffman, 2004), and may help patients focus their attention on the mindfulness skills exercise in VR (Navarro-Haro et al.”
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Extending the Use of Games in Health Care
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“Specifically, use of the same videogame segment in both distraction conditions while varying only the use of the VR helmet helped control for the confound of using different distractor stimuli (e.g., Hoffman et al., 2000).”
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Presence-Inducing Media for Mental Health Applications
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Virtual reality immersion method of distraction to control experimental ischemic pain.
Magora, F., Cohen, S. E., Shochina, M., & Dayan, E. (2006) · PubMed · Cited by 53
Virtual Reality as a Tool for Cognitive Behavioral Therapy: A Review
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“Hoffmann and colleagues [212] presented two case studies on adolescent burn wound patients undergoing wound medication; pain perceived during the procedure when immersed in VR was compared to that perceived while playing a video game.”
BackgroundApproaches and Applications of Virtual Reality and Gesture Recognition
Sudha, M. R., Sriraghav, K., Sudar Abisheck, S., Jacob, S. G., & Manisha, S. (2017) · International Journal of Ambient Computing and Intelligence · doi:10.4018/ijaci.2017100101 · Cited by 53
How to Analyse Therapeutic Games: The Player / Game / Therapy Model
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“The objective is to alleviate the patient’s pain during the bandage change in order to facilitates the care giver’s work [12].”
BackgroundVirtual Reality-Assisted Pain, Anxiety, and Anger Management in the Emergency Department
Sikka, N. K., Shu, L., Ritchie, B. J., AMDUR, R. L., & Pourmand, A. (2019) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2018.0273 · Cited by 52
“17,18 VR can divert a patient’s attention into an alternative reality, which reduces the focus on pain.”
Virtual Reality Analgesia for Children With Large Severe Burn Wounds During Burn Wound Debridement
Hoffman, H. G., Patterson, D. R., Rodriguez, R. A., Peña, R., Beck, W., & Meyer, W. J. (2020) · Frontiers in Virtual Reality · doi:10.3389/frvir.2020.602299 · Cited by 55
“Although the mechanism of how virtual reality reduces pain is not well-understood, researchers propose that VR reduces pain primarily via attention distraction (Hoffman et al., 2000a,b).”
BackgroundSelf-citationThe Potential of Personalized Virtual Reality in Palliative Care: A Feasibility Trial
Perna-Forrest, L., Lund, S., White, N., & Minton, O. (2021) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909121994299 · Cited by 51
“Inclusion criteria: (1) Under the care of the hospice (2) Progressive life limiting condition(s) (3) Aged 18 years or over (4) Full visual and auditory abilities (5) No restriction in their range of head and neck movement (6) Capacity to consent to the study (7) Fluent in English.”
BackgroundTennant, M., Anderson, N., Youssef, G. J., McMillan, L., Thorson, R., Wheeler, G., & McCarthy, M. (2021) · Technical Innovations & Patient Support in Radiation Oncology · doi:10.1016/j.tipsro.2021.06.001 · Cited by 51
Self-Reports of Anxiety in Burn-Injured Hospitalized Adults During Routine Wound Care
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“Pain intensity is a commonly assessed dimension clinically and in outcomes research.(3,5,6) It frequently is quantified using some form of Visual Analog Scale (VAS; usually a 10-cm line with one end representing no pain and the other representing worst pain possible) or Numerical Rating Scale (NRS; a 0–10 or 0–100 sca…”
MethodImmersion and coherence in a stressful virtual environment
Skarbez, R., Brooks, F. P., & Whitton, M. C. (2018) · ACM Symposium on Virtual Reality Software and Technology (VRST) · doi:10.1145/3281505.3281530 · Cited by 51
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“It is further argued that VR may improve analgesia through the reduction of visual cues associated with a painful procedure (Hoffman et al., 2000).”
BackgroundMethodInfluentialFacial expression recognition in virtual reality environments: challenges and opportunities
Zhang, Z., Mir, J. M. F., & Mateu, L. G. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1280136 · Cited by 50
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Ozcelik, G., & Becerik-Gerber, B. (2018) · Advanced Engineering Informatics · doi:10.1016/j.aei.2018.04.008 · Cited by 50
Use of Virtual Reality in Burn Rehabilitation: A Systematic Review and Meta-analysis
Lan, X., Tan, Z., Zhou, T., Huang, Z., Huang, Z., Wang, C., Chen, Z., Ma, Y., Kang, T., Gu, Y., et al. (2022) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2022.08.005 · Cited by 52
“are the first to use VR technology to relieve operative pain in burn patients during dressing changes [14].”
BackgroundAffective Recognition in Dynamic and Interactive Virtual Environments
Moghimi, M., Stone, R. J., & Rotshtein, P. (2017) · IEEE Transactions on Affective Computing · doi:10.1109/taffc.2017.2764896 · Cited by 49
“As well as entertainment, VRs and their so-called “serious games” counterparts have been used for training purposes [7], [8], [9], pain distraction [10], [11], rehabilitation r egimes [12], [13] and emotional disorder therapy [14], [15], to mention but a handful of applications.”
BackgroundVirtual reality for assessment of patients suffering chronic pain: a case study
Llobera, J., González-Franco, M., Pérez-Marcos, D., Valls‐Solé, J., Slater, M., & Sanchez-Vives, M. V. (2012) · Experimental Brain Research · doi:10.1007/s00221-012-3352-9 · Cited by 49
Hoffman, H. G., Patterson, D. R., Soltani, M., Teeley, A., Miller, W. M., & Sharar, S. R. (2008) · CyberPsychology & Behavior · doi:10.1089/cpb.2008.0056 · Cited by 48
Self-citationFord, G. K., Moriarty, O., McGuire, B. E., & Finn, D. P. (2008) · European Journal of Pain · doi:10.1016/j.ejpain.2008.01.002 · Cited by 48
“All rights tual-reality techniques (Hoffman et al., 2000, 2001) have been used to reduce pain, with varying degrees of success.”
MethodWhat are the psychiatric sequelae of burn pain?
Askay, S. W., & Patterson, D. R. (2008) · Current Pain and Headache Reports · doi:10.1007/s11916-008-0018-1 · Cited by 48
Attentional Shifts Alter Pain Perception in the Chicken
Gentle, M. (2001) · Animal Welfare · doi:10.1017/s0962728600023617 · Cited by 47
Lindner, P., Miloff, A., Hamilton, W., & Carlbring, P. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00132 · Cited by 47
Alghamdi, N., Meyer, W. J., Atzori, B., Alhalabi, W., Seibel, C. C., Ullman, D., & Hoffman, H. G. (2020) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2019.00467 · Cited by 49
“Researchers (e.g., Hoffman, 1998; Hoffman et al., 2000; Birnie et al., 2017), propose that VR uses up so much attention, that the patient’s brain has less attention available to process incoming nociceptive signals traveling from the burn wound to the brain while the wound is being cleaned.”
BackgroundInfluentialSelf-citationPediatric Pain Control Practices of North American Burn Centers
Martin-Herz, S. P., Patterson, D. R., Honari, S. E., Gibbons, J., Gibran, N. S., & Heimbach, D. M. (2003) · Journal of Burn Care & Rehabilitation · doi:10.1097/00004630-200301000-00007 · Cited by 47
Kaya, M., & Özlü, Z. K. (2022) · Burns · doi:10.1016/j.burns.2022.06.001 · Cited by 46
Li, J., Yang, H., Xiao, Y., Liu, X., Ma, B., Ma, K., Hu, L., & Lu, X. (2023) · British Journal of Anaesthesia · doi:10.1016/j.bja.2023.09.001 · Cited by 46
Virtual reality as a pain distractor during physical rehabilitation in pediatric burns
Ali, R. R., Selim, A. O., Ghafar, M. A. A., Abdel‐Raouf, O., & Ali, O. I. (2021) · Burns · doi:10.1016/j.burns.2021.04.031 · Cited by 45
Telehealth and Virtual Reality Technologies in Chronic Pain Management: A Narrative Review
Cerda, I. H., Thérond, A., Moreau, S., Studer, K., Donjow, A. R., Crowther, J. E., Mazzolenis, M. E., Lang, M., Tolba, R., Gilligan, C. J., et al. (2024) · Current Pain and Headache Reports · doi:10.1007/s11916-023-01205-3 · Cited by 48
“VR extended beyond its origins in the entertainment industry and into pain management for the first time in 2000, when it was demonstrated that “SnowWorld,” a game in which players threw snowballs at animated characters, effectively reduced burn pain in adolescents [73] and adults [74].”
Virtual medicine: how virtual reality is easing pain, calming nerves and improving health
Spiegel, B. M. R. (2018) · The Medical Journal of Australia · doi:10.5694/mja17.00540 · Cited by 45
Maani, C. V., Hoffman, H. G., Fowler, M., Maiers, A. J., Gaylord, K. M., & DeSocio, P. A. (2011) · Pain Medicine · doi:10.1111/j.1526-4637.2011.01091.x · Cited by 45
Self-citationMartini, M. (2016) · Consciousness and Cognition · doi:10.1016/j.concog.2016.06.005 · Cited by 44
Brady, N., McVeigh, J. G., McCreesh, K. M., Rio, E., Dekkers, T. A., & Lewis, J. S. (2021) · Physical Therapy Reviews · doi:10.1080/10833196.2021.1903209 · Cited by 44
“Sense of presence and immersion achieved with VR leads to greater distraction and reduced awareness of injury and pain during wound care procedures [11].”
BackgroundHitching, R., Hoffman, H. G., García‐Palacios, A., Adamson, M. M., Madrigal, E., Alhalabi, W., Alhudali, A., Sampaio, M., Peterson, B. N., Fontenot, M. R., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12030843 · Cited by 43
“During the early days of VR [33,34], the VR system was heavy and costly (USD 60,000 for one VR system), and included a heavy computer monitor, a 55 lb Silicon Graphics supercomputer, an 8-pound VR helmet, and a separate USD 8000 Polhemus FastTrak electromagnetic tracking system.”
BackgroundMethodSelf-citation
Metadata
- 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 › Surgery › 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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