Cited by 651Pediatric Pain Management TechniquesVirtual Reality Applications and ImpactsBurn Injury Management and Outcomes

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Virtual reality as an adjunctive pain control during burn wound care in adolescent patients

Hoffman, Hunter G., Doctor, Jason N., Patterson, David R., Carrougher, Gretchen J., Furness, Thomas A.·2000·Pain

DOI 10.1016/s0304-3959(99)00275-4

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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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Hawes, D., & Arya, A. (2021) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr50410.2021.00046 · Cited by 23
“, meditation or mindfulness) [14], motivational messaging or imagery [9], repeated content exposure [62,63] and attentional controls [27].”
Background
Effect of Immersive Virtual Reality on Pain and Anxiety at a Veterans Affairs Health Care Facility
Rawlins, C. R., Veigulis, Z. P., Hebert, C. A., Curtin, C. M., & Osborne, T. F. (2021) · Frontiers in Virtual Reality · doi:10.3389/frvir.2021.719681 · Cited by 24
Virtual Reality as a Pain Distraction Modality for Experimentally Induced Pain in a Chronic Pain Population: An Exploratory Study
Brown, P., Powell, W. A., Dansey, N., Al‐Abbadey, M., Stevens, B., & Powell, V. (2021) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2020.0823 · Cited by 23
Behavioral Medicine: A Voyage to the Future
Keefe, F. J. (2011) · Annals of Behavioral Medicine · doi:10.1007/s12160-010-9239-8 · Cited by 23
“At the University of Washington, Hunter Hoffman and his colleague David Patterson have conducted innovative studies testing the efficacy of virtual reality in patients having severe pain during treatment of their burn injuries [51, 52].”
Background
Effectiveness of behavioral modification techniques with visual distraction using intrasulcular local anesthesia in hearing disabled children during pulp therapy
Fakhruddin, K. S., Görduysus, M. Ö., & Batawi, H. Y. E. (2016) · European Journal of Dentistry · doi:10.4103/1305-7456.195159 · Cited by 22
A Universe Inside the MRI Scanner: An In-Bore Virtual Reality Game for Children to Reduce Anxiety and Stress
Liszio, S., Basu, O., & Masuch, M. (2020) · Annual Symposium on Computer-Human Interaction in Play · doi:10.1145/3410404.3414263 · Cited by 21
Who can benefit from virtual reality to reduce experimental pain? A crossover study in healthy subjects
Demeter, N., Josman, N., Eisenberg, E., & Pud, D. (2015) · European Journal of Pain · doi:10.1002/ejp.678 · Cited by 21
“There is compelling evidence beginning from the early 2000s for the effectiveness of the VR technique on pain relief in various clinical pain conditions (Hoffman et al., 2000; Chan et al., 2007; Mott et al., 2008; Schmitt et al., 2011).”
BackgroundMethod
The Meditation Chamber
Shaw, C., Gromala, D., & Song, M. (2011) · IGI Global eBooks · doi:10.4018/978-1-60960-077-8.ch007 · Cited by 21
Virtual Reality distraction during pediatric medical procedures
Lange, B. S., Williams, M., & Fulton, I. (2006) · Adelaide Research & Scholarship (AR&S) (University of Adelaide) · Cited by 21
A clinical update on posttraumatic stress disorder in burn injury survivors
McLean, L., Chen, R., Kwiet, J., Streimer, J. H., Vandervord, J. G., & Kornhaber, R. A. (2017) · Australasian Psychiatry · doi:10.1177/1039856217700285 · Cited by 21
Virtual Reality Therapy for the Management of Chronic Spinal Pain: Systematic Review and Meta-Analysis
Zhang, T., Li, X., Zhou, X., Zhan, L., Wu, F., Huang, Z., Sun, Y., Feng, Y., & Du, Q. (2024) · JMIR Serious Games · doi:10.2196/50089 · Cited by 23
“…reality (VR) is typically characterized by low cost, easy availability, reusability, and personalized customization; VR therapy has been used as an alternative approach for pain management in various populations, such as individuals with spinal cord injuries, burns, and phantom limb pain [17-19].”
Method
Immersive virtual reality as analgesia for women during hysterosalpingography: study protocol for a randomized controlled trial
Wang, Y., Gao, H., Wang, J.-S., Wang, J.-H., Bo, L., Zhang, T., Dai, Y., Gao, L., Liu, Q., Zhang, J., et al. (2020) · Trials · doi:10.1186/s13063-019-4023-y · Cited by 20
Effects of Exergame and Music on Acute Exercise Responses to Graded Treadmill Running
Soltani, P., & Salesi, M. (2013) · Games for Health Journal · doi:10.1089/g4h.2012.0077 · Cited by 20
Guided relaxation-based virtual reality versus distraction-based virtual reality or passive control for postoperative pain management in children and adolescents undergoing Nuss repair of pectus excavatum: protocol for a prospective, randomised, controlled trial (FOREVR Peds trial)
Olbrecht, V. A., Williams, S. E., O’Conor, K. T., Boehmer, C. O., Marchant, G. W., Glynn, S. M., Geisler, K. J., Ding, L., Yang, G., & King, C. D. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-040295 · Cited by 17
Hypnotic Enhancement of Virtual Reality Distraction Analgesia during Thermal Pain: A Randomized Trial
Patterson, D. R., Hoffman, H. G., Chambers, G. T., Bennetts, D., Hunner, H. H., WIECHMAN, S. A., García‐Palacios, A., & Jensen, M. P. (2021) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207144.2021.1882259 · Cited by 23
Self-citation
Contemporary Aspects of Burn Care
Khatib, A. E., & Jeschke, M. G. (2021) · Medicina · doi:10.3390/medicina57040386 · Cited by 18
The Effects of Virtual Reality Glasses on Vital Signs and Anxiety in Patients Undergoing Colonoscopy
Yılmaz, E. D., & Dinçer, N. Ü. (2023) · Gastroenterology Nursing · doi:10.1097/sga.0000000000000733 · Cited by 19
“They concluded that VR was a unique distraction method that helped burn patients tolerate painful procedures (Hoffman et al., 2000).”
Background
Innovative treatment formats, technologies, and clinician trainings that improve access to behavioral pain treatment for youth and adults
Darnall, B. D., Edwards, K. A., Courtney, R. E., Ziadni, M. S., Simons, L. E., & Harrison, L. E. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1223172 · Cited by 21
Case Study: Videogame Distraction Reduces Behavioral Distress in a Preschool-Aged Child Undergoing Repeated Burn Dressing Changes: A Single-Subject Design
Sil, S., Dahlquist, L. M., & Burns, A. J. (2012) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jss128 · Cited by 19
Virtual Reality Graded Exposure Therapy as Treatment for Pain-Related Fear and Disability in Chronic Pain
Parsons, T. D., & Trost, Z. (2014) · Intelligent systems reference library · doi:10.1007/978-3-642-54816-1_25 · Cited by 19
“For example, one virtual environment designed for pain distraction, Snow World, has been successfully employed for acute pain management [57, 58] and provides the suffering patient opportunity to experience a virtual world far removed from their current situation.”
Background
Virtual Reality and Prosocial Behavior
Shriram, K., Oh, S. Y., & Bailenson, J. N. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316676202.022 · Cited by 19
“, 2010), and to alleviate the pain of adolescent burn patients (Hoffman et al., 2000) have been explored.”
Background
Decreasing pediatric pain and agitation during botulinum toxin injections for spasticity with virtual reality: Lessons learned from clinical use
Chau, B., Chi, B., & Wilson, T. (2018) · Journal of Pediatric Rehabilitation Medicine · doi:10.3233/prm-180534 · Cited by 19
“Additionally, VR has been used successfully in pediatric populations to treat other procedure-related discomfort such as burn-wound procedures and routine care [13–16].”
Case Report: Virtual Reality Analgesia in an Opioid Sparing Orthopedic Outpatient Clinic Setting: A Case Study
Firoozabadi, R., Elhaddad, M., Drever, S. A., Soltani, M., Githens, M. F., Kleweno, C. P., Sharar, S. R., Patterson, D. R., & Hoffman, H. G. (2020) · Frontiers in Virtual Reality · doi:10.3389/frvir.2020.553492 · Cited by 19
“…treatment, adjunctive immersive virtual reality distraction, has been shown to reduce pain during painful medical procedures (Hoffman, 1998, 2004; Hoffman et al., 2000, 2019a,b; Gold et al., 2006; Sharar et al., 2007; Li et al., 2011; Garrett et al., 2014; Atzori et al., 2018a,b; Spiegel et al.,…”
BackgroundInfluentialSelf-citation
Feasibility and acceptability of perioperative application of biofeedback-based virtual reality versus active control for pain and anxiety in children and adolescents undergoing surgery: protocol for a pilot randomised controlled trial
Orgil, Z., Johnson, L., Karthic, A., Williams, S. E., Ding, L., Kashikar‐Zuck, S., King, C. D., & Olbrecht, V. A. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-071274 · Cited by 17
Clinical effects of different virtual reality presentation content on anxiety and pain: a randomized controlled trial
Yamashita, Y., Aijima, R., & Danjo, A. (2023) · Scientific Reports · doi:10.1038/s41598-023-47764-8 · Cited by 18
“Another study has reported that the use of VR during burn treatment enables the dose of analgesics to be reduced, a finding that supports our results 16–18 .”
Result
Virtual Natural Environments for Restoration and Rehabilitation in Healthcare
Stone, R. J., Small, C., Knight, J., Qian, C., & Shingari, V. (2014) · Intelligent systems reference library · doi:10.1007/978-3-642-54816-1_24 · Cited by 18
Virtual Reality as an Adjunctive Non-pharmacological Therapy to Reduce Pain in School-Aged Children With Burn Wounds
Wang, Q., Xu, S., Guo, B., Xu, Y. X., & Lu, W. (2022) · Journal of Burn Care & Research · doi:10.1093/jbcr/irac149 · Cited by 17
Cardboard Mobile Virtual Reality as an Approach for Pain Distraction in Clinical Settings
Amin, A. M., Tong, X., Gromala, D., & Shaw, C. (2017) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3027063.3053234 · Cited by 17
“Although patients in this study experience vection (Visually perceived movement that one does not feel) in InMind because it is an on-rails First-person Shooter game, vection didn't seem to adversely affect Hunter Hoffman's work with patients in his VR projects [7].”
Background
Effectiveness of audiovisual distraction with computerized delivery of anesthesia during the placement of stainless steel crowns in children with Down syndrome
Fakhruddin, K. S., Batawi, H. Y. E., & Görduysus, M. Ö. (2017) · European Journal of Dentistry · doi:10.4103/ejd.ejd_288_16 · Cited by 17
Impact of perceived social support on pain perception in virtual reality
Neumann, I., Käthner, I., Gromer, D., & Pauli, P. (2022) · Computers in Human Behavior · doi:10.1016/j.chb.2022.107490 · Cited by 17

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.
ORCID: Hoffman, Hunter G.
Doctor, Jason N.
Carrougher, Gretchen J.
Furness, Thomas A.
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2000-03-01
Volume: 85
Issue: 1
Pages: 305-309
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1016/s0304-3959(99)00275-4
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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Virtual reality as an adjunctive pain control during burn wound care in adolescent patients

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