February 15, 2010 (San Antonio, Texas) — A virtual-reality experience helped reduce pain levels in veterans with combat-associated burns during wound care treatment, according to findings from a study presented here at the American Academy of Pain Medicine (AAPM) 26th Annual Meeting.
In a separate presentation, researchers said that the use of low-dose ketamine (120 μg/kg per hour), continuously administered intravenously, helped control severe pain from combat injuries due to improvised explosive devices, gunshots, and other causes.
That small study involved 19 soldiers at Walter Reed Army Medical Center, in Washington, DC. Ketamine produced a significant drop in current pain intensity (P < .05); however, there was no significant effect on those with pain that was not severe. Results were mixed in those with phantom pain, said researchers, from Walter Reed, the University of Pennsylvania, in Philadelphia, and the Philadelphia VA Medical Center.
In the virtual-reality study, veterans were asked to rate their worst pain, unpleasantness, and time spent thinking about pain while undergoing 6 minutes of wound care, first with virtual reality and then without it. They reported that they experienced significant reductions in each of those categories during a virtual-reality experience full of wintry imagery called SnowWorld.
The results were stronger for patients with more severe pain (a score of 7 or greater on a scale of 10); the differences were not significant for patients with moderate pain, researchers found.
"This clearly shows that there's more of a benefit for severe pain than moderate in this particular study," said Peter DeSocio, DO, from the US Army Institute of Surgical Research Burn Center at Brooke Army Medical Center in Fort Sam Houston, Texas.
Since 2003, when the Iraq War began, more than 900 combat-related burn injuries have been treated at the Brooke Burn Center.
"The severity of the burns and the length of stay for our military burn patient population far exceed that of our civilian population," Dr. DeSocio said.
Soldiers are surviving more severe burns, but that has made the treatment of pain more challenging, he added.
"What we see typically today, based on the technology we have, is that patients are surviving more severe burns," Dr. DeSocio told meeting attendees. "Now you have patients with larger burns and requiring more therapy, which has the potential to generate more acute [pain] and the potential for chronic pain."
The 12 patients in the study were 20 to 27 years of age and had burns covering 4.0% to 57.5% of their bodies.
During the virtual-reality experience, veterans wore goggles and noise-canceling headphones playing a Paul Simon–designed soundtrack.
Overall, the average worst pain score fell from 6.25 to 4.5 with the virtual-reality experience (P = .046). Among those with severe pain, the worst pain score fell from 8.33 to 5.67 during the virtual-reality experience (P = .043).
Dr. DeSocio said extended studies should be done to see whether virtual reality continues to work over the long haul.
Ajay Wasan, MD, assistant professor at Harvard Medical School in Boston, Massachusetts, and cochair of the AAPM 2010 annual meeting, said it shows that there is hope for making an agonizing procedure more bearable.
"There's clearly a really significant distraction effect and a significant effect on the unpleasantness of pain, showing that both the cognitive and the affective components of pain are significantly affected by the use of these goggles," Dr. Wasan said.
"It's taken an excruciatingly unbearable procedure and actually made it tolerable. That's what these data show. The pain score is irrelevant. It's not about the pain score. It's about [intervening in] these affective components of pain. So it really has dramatic potential."
These studies received no commercial support. Dr. DeSocio and Dr. Wasan have disclosed no relevant financial relationships.
American Academy of Pain Medicine (AAPM) 26th Annual Meeting: Poster Abstract 217. Presented February 5, 2010.
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