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

For daily burn wound care procedures, opioid analgesics alone are often ina dequate. Since most burn patients experience severe to excruciating pain du ring wound care, analgesics that can be used in addition to opioids are nee ded. This case report provides the first evidence that entering an immersiv e 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 wit h 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 som e playing a video game. On a 100 mm scale, he provided sensory and affectiv e pain ratings, anxiety and subjective estimates of time spent thinking abo ut his pain during the procedure. For the first session of wound care, thes e 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 se ssion involving staple removal, scores also decreased. The second patient w as a 17-year-old male with 33.5% total body surface area deep hash bums on his face, neck, back, arms, hands and legs. He had difficulty tolerating wo und care pain with traditional opioids alone and showed dramatic drops in p ain 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-c apturing medium capable of maximizing the amount of attention drawn away fr om the 'real world', allowing patients to tolerate painful procedures. Thes e preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain. (C) 2000 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.