Ditto!

Researchers from Australia have designed a new tool in the quest to bring pain relief to burn victims. The project, lead by Dr. Sam Bucolo, involves a hand-held circular device which engages children as they get their burn dressings changed. Previous work for burn victims has involved goggles, headsets, or other types of immersive virtual reality settings, but this device, Ditto, is designed specifically for small children, aged three to eight. Preliminary data indicate that Ditto can engage children in less than a minute and keep them preoccupied throughout a full bandage replacement, which typically takes around 20 minutes. The results also show that Ditto had more success reducing pain scores during treatment as opposed to traditional distraction tools, such as videos or computer games. Clinical trials are underway, and Ditto is expected to be released for commercial use within the year.

• ScienceAlert Article
  

VR and Burn Wounds: Hydrotank Research

Researchers from University of Washington's HITLab have published a new study on virtual reality pain control during the removal of burnt tissue in The Clinical Journal of Pain. In burn treatment, patients often experience extreme pain during the earliest treatment sessions, which are often held in hydrotherapy tanks. Although medications are used to reduce pain, analgesics are not always effective and can lead to other side effects. Based on a model in which attention is a requirement for pain, the VR treatment used in this study attempts to distract users with images and sounds that are engaging and positive.

In this experiment, 11 patients (ranging in age from 9 to 40 years of age) were studied during the painful bandage removal and wound cleansing sessions. For part of the treatment, they received no distraction and were asked to report the worst pain they felt, the amount of time they spent thinking about pain, and the unpleasantness of their experience. Two additional ratings that measured 'fun' and 'presence' in the virtual world were also administered. In another part of the treatment, the patients were immersed in a world filled with icy, cool images called SnowWorld. During this phase, the participants were given the same ratings scales as in the other phase. However, treatment sequence was randomized, so some patients received the control treatment first, then the VR treatment; others received it in the opposite order.

The study demonstrated that in the VR condition, participants spent less time thinking about the pain and experienced lower pain intensity and less unpleasantness. The virtual reality condition was rated, unsurprisingly, as more 'fun' than the control condition, which involved no distraction. Interestingly, patients with higher presence ratings - the extent to which they became cognitively involved in the virtual environment - experienced less pain. Pain was reduced from 'severe' to 'moderate' on average, but in the group of the six most engaged participants, ratings dropped from 'severe' to 'mild.'

The study authors point out one possible bias of the study: the nurses providing care knew which treatment the patients were receiving, control or VR, because of the headset. Therefore, there is a chance they could have unknowingly treated the VR patients more gently throughout the treatment.

However, this is the first controlled multi-subject study to demonstrate that virtual reality allows pain reduction for patients undergoing treatment within the hydrotank, which is extremely promising news for burn care. Past pain-reducing options have failed to prove sustainable for many patients undergoing wound treatments, and virtual reality could offer new hope for this group.

• Hoffman, H. (2008). Virtual Reality Pain Control During Burn Wound Debridement in the Hydrotank. Clinical Journal of Pain, 24(4), 299.