Let It Snow, In VR

There is a field of snow as far as the eye can see. It falls all around, as the dulcet tones of Paul Simon surround you in an icy wonderland. Snowmen stare. There are penguins, wooly mammoths and flying fish. This is the strange and magical place called "SnowWorld."  This virtual world is the first of its kind. This world was built for people to escape their pain.

As medical technology improves, people are surviving more and more serious damage. It becomes increasingly important to find ways to help people endure they pain they live with as they heal. Immersive VR has been shown to have use in relieving the suffering of burn victims from children to veterans.

The idea of using immersive VR for pain control was pioneered by  Hunter Hoffman and David Patterson in 1996. Their concept would later lead to "SnowWorld," which is "the first immersive virtual world designed for reducing pain."  The logic is that they are addressing the "psychological component" of pain. The brain can only do so much--including process pain. The magical, virtual, world keeps the brain busy and distracted.  (1)

Opioids are currently one of the main treatments for pain in burn victims. This can be problematic, as opioids alone can be inadequate for controlling the pain involved in the treatment of burns.  Additionally, the CDC finds that "91 Americans die every day from an opioid overdose" and they also consider that "overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths." Depending on opioids alone for treatment of the excruciating pain associated with turn treatment may be a thoroughly inadequate solution. (2)

The treatment of burns includes "debridement," a process where "foreign materials and dead tissue are removed from the open wound." This can be an especially difficult part of treatment for patients. Even if the “resting pain,” pain felt while "lying still," is fairly low, "most patients with burn injuries report severe pain during burn wound care."  

Skin grafting is another painful stage in burn treatment. If the tissue is removed from a patient's healthy skin--that. that leaves an open sore. The grafts may be stapled on and during the "wound care process" and later these staples may need to be removed from the delicate healing tissue. As the skin begins to heal, the wounds may require physical therapy in order to "counteract the tendency of healing burned skin to harden." This may require stretching the skin or other similar movements to retain the elasticity of the skin. The pain of these movements may be restrictive to patients compliance with their necessary treatment.

All of these steps in treatment are very difficult for patients to endure. Opioids are currently the main treatment for this sort of pain. However even at "maximal usage," the opioids may not be enough to fully control the severe pain. Also, tolerance increases with daily usage of opioids which can lead to an increasing severity of pain felt by the users.

This is where VR may step in to help. The logic is this: "pain requires attention." VR is the ultimate distraction. It engages the eyes and ears. The world immerses you with surround sound. As spatial movements create results in this immersive world the brain has less processing power left for pain. The brain is too busy for pain. (3)

Shriners Hospitals for Children — Galveston "provides highly specialized acute, reconstructive and rehabilitative care for children with burns and other soft tissue conditions."  Researchers at this hospital are studying the effectiveness of "SnowWorld" at reducing the pain in children receiving treatment for burns.  They estimate that their young patients "may experience up to 35-40 percent less pain and discomfort during daily baths and wound dressing changes." This estimation falls in line with previous positive results shown in testing. (4)

Children are not the only ones who benefit from VR therapy. This technique of therapy is also showing positive results for wounded veterans.  In "the first controlled study" to examine whether VR reduces soldiers' pain during wound debridement, the VR therapy was shown to be effective. 

These participants were "US soldiers burned in combat attacks involving explosive devices in Iraq or Afghanistan." In the study, they were distracted from debridement by immersion into a magical world of mammoths, snowmen, and penguins. They threw virtual snowballs at these virtual creatures as a virtual sky soared above them and a virtual river flowed beneath. The sweet song of Paul Simon played in the background.

But it worked. The intensity of "worst pain" was reduced and the “Pain unpleasantness” ratings dropped from "moderate" to "mild." Apparently, the VR also added an element of "pretty fun" to the process as described by the participants.  Even more surprising, was the fact that " VR analgesia was unusually effective in the six soldiers reporting severe to excruciating pain." Some might assume that the VR treatment wouldn't work as well for very intense pain, the experience was actually especially effective for those experiencing the most severe pain. (5)

So far, these studies are showing very positive results for the potential of VR to help people. With the limitations of purely pharmacological solutions, VR may emerge as a tool for smoothing along the healing process. The VR game SnowWorld may be just the may be just the escape people need to get better.


1. http://www.vrpain.com/

2. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

3. Hoffman, H.G.; Chambers. G.T.; Meyer. W.G.; Arceneaux, L.L.; Russell, W.J.; Seibel, E.J.; Richards, T.L.; Sharar, S.R.; and Patterson, D.R. “Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures.,” Annals of behavioral medicine: a publication of the society of behavioral medicine, vol. 41, iss. 2, pp. 183-91, 2011.

4. www.shrinersinternational.org/~/media/SHC/Files/.../VirtualRealityAnalgesia.pdf

Shriners Hospitals for Children® — Galveston. (n.d.). Virtual Reality Analgesia for Pediatric Burn Survivors [Press release]. Retrieved from https://www.shrinershospitalsforchildren.org/galveston

5. Maani, C.V; Hoffman, H.G.; Morrow, M.; Maiers, A.; Gaylord, K.; McGhee, L.L.; and a DeSocio, P. “Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles.,” The Journal of trauma, vol. 71, iss. 1 Suppl, p. S125–30, 2011.