If this works as well as advertised........

Virtual reality eases real pain of burn victims
Special games help reduce kids' suffering, researchers find

Sheryl Ubelacker The Canadian Press Friday, March 04, 2005

TORONTO -- There are few hospital procedures more distressing for a child than treatment for a severe burn. But doctors think they've found a way to help kids escape the often excruciating pain by taking them on a virtual journey.

Australian researchers have found that hooking children up to a virtual reality game that immerses them in a world of monsters and aliens allows them to better withstand the pain of having their burn sites cleaned and rebandaged.

On average, the children reported that entering the virtual world dropped their pain levels by almost 75 per cent, said researchers at the Women's and Children's Hospital in Adelaide and the University of South Australia.

"We feel really keen that the virtual reality is an effective mechanism of reducing whatever the children suffer, whether it's pain or pain wrapped up in anxiety or anxiety that's enhancing the pain," said lead investigator Karen Grimmer, an associate professor of health science at the university.

The equipment consists of a laptop computer to run a specially designed virtual reality game that's delivered through a goggle-like apparatus. The child interacts with the computer-driven environment by moving the head and neck. The computer's mouse is the trigger that allows the kids to seek out and destroy nasty fantasy beings they encounter in this parallel world.

The study, which appeared this week in the journal BMC Pediatrics, dealt with seven boys and girls aged five to 16, whose burns on average covered about five per cent of the body; the causes included coming into contact with an ATV muffler, playing with gasoline and fire or getting splashed with hot liquid.

When it came time for their dressings to be changed -- a procedure which involves "debriding" dead tissue, then applying ointments and sterile bandages -- the young patients were asked to play the game in addition to receiving their usual painkillers.

Researchers then assessed the pain the kids experienced while engaged in the virtual world compared to levels when drugs alone were used. Doctors used a Faces zero-10 scale, a series of "happy faces" that show a smiling countenance for no pain through to a grimacing, teary-eyed face with a down-turned mouth to represent "very bad pain."

On average, the children rated their discomfort level at 4.1 with just the drugs -- strong painkillers, muscle relaxants and sedatives -- compared to 1.3 when they added the virtual game headset.

Parents and caregivers confirmed the difference, with the nurse of one child telling the authors: "From my past experience, I can tell that it (changing burn dressings) can be a real problem. It was not a problem today. He did not even flinch while the dressing was being taken off."

Grimmer said the researchers were surprised that children medicated for pain were "still incredibly anxious, when to all intents and purposes they shouldn't be feeling any pain because they've been given an injection."

"So what the virtual reality does, we believe, is not only distract the child ... but they also get this huge anxiety relief which seems to be actually more important than the pain management," Grimmer said Wednesday from Adelaide.

Dr. Patricia McGrath, scientific director of pain management and research at Toronto's Hospital for Sick Children, said that while the study is small, it is significant in demonstrating that using virtual reality can help at least some kids deal with acute discomfort.

"It is building on research that shows that distraction and attention and imagination are very effective non-drug strategies for helping to alleviate pain, and they work really well when you combine them with good drug management for procedures that are going to be relatively painful and relatively frequent," McGrath said.

Burns, as well as diseases such as cancer, usually involve repeated painful procedures, which can make children increasingly anxious over time, she said. "Inevitably, they have one treatment that doesn't go as well as another, and so they become afraid, they become tense and you often get a bad cycle of heightened anxiety, heightened distress and then more pain.

"And so a treatment that would capture their imagination in such a positive way and help to counter the adverse aspects of the procedure as well as help lessen pain would be enormously beneficial."

Anesthesiologist Stephen Brown, director of chronic pain services at Sick Kids, said treatment of burns in children can be traumatic for hospital staff and is especially hard on families.

And it can be "excruciatingly painful" for the child, especially if there's been a previous bad experience with debridement, in which the burnt skin and other tissue are snipped away.

While the patients he sees have usually suffered extensive, deep burns that initially require general anesthetic for redressing, Brown said the Australian study holds a lot of promise.

"I think it's a good way to go. It sounds like they've had wonderful results and I think it's an area we and others are planning to explore in the future."

Grimmer said her team is planning studies involving more children, possibly with games geared to different age groups, in the hope that virtual reality could one day greatly reduce the need for painkillers.

"We think that virtual reality offers a huge opportunity. The sky's the limit."

Times Colonist (Victoria) 2005