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Virtual Reality Pain Control During Burn Wound Debridement of Combat-Related Burn Injuries Using Robot-Like Arm Mounted VR Goggles

Maani, Christopher V. MD; Hoffman, Hunter G. PhD; Morrow, Michelle RN; Maiers, Alan PsyD; Gaylord, Kathryn PhD; McGhee, Laura L. PhD; DeSocio, Peter A. DO

The Journal of Trauma: Injury, Infection, and Critical Care: July 2011 - Volume 71 - Issue 1 - p S125-S130
doi: 10.1097/TA.0b013e31822192e2
Original Article

Background: This is the first controlled study to explore whether adjunctive immersive virtual reality (VR) can reduce excessive pain of soldiers with combat-related burn injuries during wound debridement.

Methods: Patients were US soldiers burned in combat attacks involving explosive devices in Iraq or Afghanistan. During the same wound care session using a within-subject experimental design, 12 patients received half of their severe burn wound cleaning procedure (∼6 minutes) with standard of care pharmacologies and half while in VR (treatment order randomized). Three 0 to 10 Graphic Rating Scale pain scores for each of the treatment conditions served as the primary variables.

Results: Patients reported significantly less pain when distracted with VR. “Worst pain” (pain intensity) dropped from 6.25 of 10 to 4.50 of 10. “Pain unpleasantness” ratings dropped from “moderate” (6.25 of 10) to “mild” (2.83 of 10). “Time spent thinking about pain” dropped from 76% during no VR to 22% during VR. Patients rated “no VR” as “no fun at all” (<1 of 10) and rated VR as “pretty fun” (7.5 of 10). Follow-up analyses showed VR was especially effective for the six patients who scored 7 of 10 or higher (severe to excruciating) on the “worst pain” (pain intensity) ratings.

Conclusions: These preliminary results provide the first evidence from a controlled study that adjunctive immersive VR reduced pain of patients with combat-related burn injuries during severe burn wound debridement. Pain reduction during VR was greatest in patients with the highest pain during no VR. These patients were the first to use a unique custom robot-like arm mounted VR goggle system.

From the U.S. Army Institute of Surgical Research (C.V.M., M.M., A.M., K.G., L.L.M., P.A.D.), Brooke Army Medical Center, Fort Sam, Houston, Texas; and University of Washington (H.G.H.), Seattle, Washington.

Submitted for publication March 11, 2011.

Accepted for publication April 26, 2011.

Supported by U.S. Army Institute of Surgical Research. Hoffman's time was funded with help from the Gustavus and Louise Pfieffer Research Foundation, the Scan Design Foundation by Inger and Jens Bruun, and the following NIH grants to Drs. Patterson and Sharar at the UW: NIH HD40954-01, 1R01AR054115-01A1, R01GM042725-17A1.

The opinions and assertions contained in this article are solely the authors' private ones and are not to be construed as official or reflecting the views of the United States Army or the Department of Defense.

Address for reprints: Christopher V. Maani, MD, and Hunter G. Hoffman, PhD, email: and

© 2011 Lippincott Williams & Wilkins, Inc.