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Virtual Reality Pain Control During Burn Wound Debridement in the Hydrotank

Hoffman, Hunter G. PhD*; Patterson, David R. PhD; Seibel, Eric PhD*; Soltani, Maryam MEd; Jewett-Leahy, Laura BA; Sharar, Sam R. MD

The Clinical Journal of Pain: May 2008 - Volume 24 - Issue 4 - p 299-304
doi: 10.1097/AJP.0b013e318164d2cc
Special Topics Series

Objective Most burn-injured patients rate their pain during burn wound debridement as severe to excruciating. We explored the adjunctive use of water-friendly, immersive virtual reality (VR) to distract patients from their pain during burn wound debridement in the hydrotherapy tank (hydrotank).

Setting This study was conducted on inpatients at a major regional burn center.

Patients Eleven hospitalized inpatients ages 9 to 40 years (mean age, 27 y) had their burn wounds debrided and dressed while partially submerged in the hydrotank.

Intervention Although a nurse debrided the burn wound, each patient spent 3 minutes of wound care with no distraction and 3 minutes of wound care in VR during a single wound care session (within-subject condition order randomized).

Outcome Measures Three 0 to 10 graphic rating scale pain scores (worst pain, time spent thinking about pain, and pain unpleasantness) for each of the 2 treatment conditions served as the primary dependent variables.

Results Patients reported significantly less pain when distracted with VR [eg, “worst pain” ratings during wound care dropped from “severe” (7.6) to “moderate” (5.1)]. The 6 patients who reported the strongest illusion of “going inside” the virtual world reported the greatest analgesic effect of VR on worst pain ratings, dropping from severe pain (7.2) in the no VR condition to mild pain (3.7) during VR.

Conclusions Results provide the first available evidence from a controlled study that immersive VR can be an effective nonpharmacologic pain reduction technique for burn patients experiencing severe to excruciating pain during wound care. The potential applications of VR analgesia to other painful procedures (eg, movement or exercise therapy) and other pain populations are discussed.

*Human Interface Technology Laboratory, Departments of Mechanical Engineering, University of Washington

Departments of Rehabilitation Medicine

Anesthesiology, University of Washington School of Medicine, Seattle, WA

NIH grants HD37683 and HD40954 to Sam R. Sharar, MD, NIH grant GM42725 to Dave Patterson, the Paul Allen Family Foundation (, and the Scan Design by Inger & Jens Bruun Foundation ( Gustavus and Louise Pfeiffer Research Foundation, (

Reprints: Hunter G. Hoffman, PhD, Human Interface Technology Laboratory, University of Washington, Box 352142, Seattle, WA 98195 (e-mail:

Received for publication October 6, 2007; accepted December 10, 2007

© 2008 Lippincott Williams & Wilkins, Inc.