Computer-Generated Virtual Reality to Control Pain and Anxiety in Pediatric and Adult Burn Patients During Wound Dressing Changes

Abstract

Changing daily wound dressings provokes a substantial amount of pain in patients with severe burn wounds. Pharmacological analgesics alone often are inadequate to solve this problem. This study explored whether immersive virtual reality (VR) can reduce the procedural pain and anxiety during an entire wound care session and compared VR to the effects of standard care and other distraction methods. Nineteen inpatients ages 8 to 65 years (mean, 30 years) with a mean TBSA of 7.1% (range, 0.5-21.5%) were studied using a within-subject design. Within 1 week of admission, standard care (no distraction), VR, or another self-chosen distraction method was administered during the wound dressing change. Each patient received the normal analgesic regimen. Pain was measured with visual analog thermometer scores, and anxiety was measured with the state-version of the Spielberger State Trait Anxiety Inventory. After comparing different distraction methods, only VR and television showed significant pain reductions during wound dressing changes. The effects of VR were superior, but not statistical significant, to that of television. Thirteen of 19 patients reported clinically meaningful (33% or greater) reductions in pain during VR distraction. No side effects were reported. No correlations were found between the reduction in pain ratings and patient variables like age, sex, duration of hospital stay, or percentage of (deep) burns. There was no significant reduction of anxiety ratings.

The use of virtual reality for pain control: A review

“…In another study, van Twillert et al [25] compared the within-patient effects of VR with alternate forms of distraction (eg, TV, music) and standard of care during dressing changes in 19 participants with burns (age 8-65 years). Pain intensity was measured using a visual analogue thermometer, an adapted version of the VAS for patients with burns.…”

“…Hoffman et al [14][15][16]22,28], Wright et al [20], van Twillert et al [25], Sharar et al [26••] Virtual Gorilla program [40] User takes on the persona of a gorilla and interacts with other gorillas in the habitat. A joystick is used to maneuver through the environment.…”

Psychological Factors Influencing the Effectiveness of Virtual Reality–Based Analgesia: A Systematic Review

“…Participants with a lower level of anxiety had better improvement in pain reduction; therefore, it may be important to use proper instruments to evaluate dispositional anxiety in patients before VR interventions, such as STAI. 74 In fact, Van Twillert et al 75 were the only researchers to measure trait and state anxiety using the STAI questionnaire. Patients with burn injuries (N = 19) were either not distracted or were exposed 340 TRIBERTI ET AL.…”

Feasibility of Articulated Arm Mounted Oculus Rift Virtual Reality Goggles for Adjunctive Pain Control During Occupational Therapy in Pediatric Burn Patients

“…Patients feel less pain, and spend less time thinking about their pain. [8][9][10][11][12] SnowWorld was the first virtual reality world specifically designed for treating pain (www.vrpain.com). SnowWorld is custom designed to treat burn patients who are on powerful pain medications, and in pain.…”