Army Study Uses Virtual Reality Technology to Help Ease Burn Pain

10/20/2009

The Burn Center at Brooke Army Medical Center in San Antonio Texas is a busy place. More than 800 injured military personnel from the wars in Iraq and Afghanistan have been treated at the centers state of the art facility. Patients with burns endure painful daily wound care. The routine is emotionally difficult for everyone. A recently completed study by the Army used The Burn Center to test a virtual reality program designed to help alleviate some of the pain associated with wound care. "Snow World" was developed at the University of Washington.

Doctor: "How's the splint working?"

About a year ago Sergeant Oscar Liberetto was with his unit in Iraq when and IED detonated near the Humvee he was riding in. He suffered severe burns on his left arm and hand. He was the only survivor from his group of five.

Doctor: "You feel like when you take it off fingers are straighter?"

Libretto: "Yeah, they feel straighter."

Libretto's a 23–year–old from Ferndale, Washington. He says he remembers waking up in the fire and fleeing the vehicle. Then nothing until his arrival in Texas. But the excruciating pain he experienced while doctors and nurses worked tried to save his hand and arm still gives him pause.

Libberetto: "It was pretty painful. Sometimes I didn't think that I was going to make it but. I don't know."

Libberetto is one of a dozen military burn patients being treated at Brooke Army who participated in a study using "Snow World". The program was designed by University of Washington researchers Hunter Hoffman and David Patterson.

Hoffman says "Snow World" is a virtual three dimensional distraction. In order to feel pain Hoffman says, you have to pay attention to it.

Hoffman: "Humans have a limited amount of attention. There's so much information in the world usually where your looking is one way of limiting what information comes into your brain since we're so visual."

So for soldier with severe burns, that means a daily view of their charred skin. By wearing high tech goggles with a wide field of vision Hoffman says patients can block that unpleasant view and navigate an icy canyon instead.

Push a button and throw a snow ball at a giant snow man. Pelt a mammoth and it will trumpet angrily. All to the soothing sounds of Paul Simon.

[Paul Simon singing "Call Me Al."]

I know Paul Simon? Turns out he's a friend of Hoffman's. But even Hoffman admits there was a lot of resistance to "Snow World" and Paul Simon when they first brought it to The Burn Center.

Hoffman: "They said it's not violent enough and we need something you know where's Van Halen? The truth is once you get them opiated and they're getting their wound care the combination really works."

It did for Sergeant Liberetto. He used "Snow World" daily during some of his most painful wound care.

Liberetto: "I think the environment makes you feel like you're at peace. Snow, shooting snow balls and penguins. Kind of looks like the ice age."

Dr. Christopher Maani is the Chief of Anesthesia at the Institute of Surgical Research and The Burn Center at Brooke Army Medical Center. He's also the principal investigator for the Virtual Reality study.

Maani says the VR technology is especially helpful when dealing with combat burn injuries, which usually range between 60 and 80 percent of the body.

Maani: "Our burns are bigger because, you know a soldier may be inside a vehicle, in a very contained space when this happens as opposed to a person who can stop drop and roll and not have concerns over the tactical situation that you're in."

Maani says part of the challenge when treating burn patients is the extremely high amounts of opium painkillers they need just to tolerate wound care.

The side effects can include nausea and constipation. Those things make it difficult to eat the tremendous amount of calories needed to support the recovery process. Then there's the emotional strain of wound care.

In addition Maani says the anticipation of enduring repeated painful treatments can wreak havoc on recovery.

Maani: "They spend the better part of the night restless not being able to sleep. They spend the better part of the day worried about it. Then as soon as it's over they spend the better part of the day worried about, you know, it's going to happen all over again."

Maani says study group patients using "Snow World" were able to alleviate some of the pain and in turn lessen wound care anxiety. And less patient anxiety produced a cascade of unexpected benefits.

The field of wound care, has an extremely high emotional burn out rate. Nurses using the VR technology reported less stress because they had another tool to help keep their patients comfortable. Then there was the appreciation from soldier's family members.

Maani: "You know you can be stopped in the hallway and a hug is a very simple thing but it means so much. Those are the true rewards and it really is making a difference and it really is helping our patients and our families."

Officially the yearlong study ended this summer.

Hunter Hoffman says the results were promising and consistent with earlier studies done at the UW and Harborview Medical Center. All of the patients showed at least some pain reduction.

Hoffman: "What we found was about half of the patients really responded strongly. The other patients showed some reduction in pain but not as much. But what was encouraging was the ones that needed it the most. So the patients that were in the most pain showed the most pain reduction from "Snow World"."

The Army is now exploring the use of "Snow World" for painful physical therapy sessions. While none of the researchers are calling virtual reality a magic bullet that will eliminate pain entirely, those on the front line of caring for patients with burns know even a little bit of help can make a huge difference.

Patricia Murphy, KUOW News.

© Copyright 2009, KUOW