A couple of weeks from now I will
be in hospital undergoing a knee replacement. It will be the most extreme
surgery I’ve ever experienced and I’m pretty scared. I’ve been told that I can
expect to endure excruciating pain afterwards but I won’t be allowed to lie in
bed feeling sorry for myself. In order to ensure a good recovery I have to get
up and exercise the new joint numerous times a day. Make no mistake, this is
going to hurt.
It may not be too long, however,
until patients like me will be able to ward off their agonies simply by playing
virtual reality games. This surprising advance is already being tested, but the
premise behind it is not new.
As neuroscientist David
Linden recently explained on NRP, the brain has more control over pain
than we might at first imagine. It can say “hey that’s interesting, turn up the
volume on this pain information that’s coming in”, or it can say “turn down the
volume on that and pay less attention to it”. In Linden’s book Touch: The
Science of Hand, Heart and Mind, he discusses how our perception of pain relies
on the brain and how it processes information coming from the nervous system.
Lieutenant Sam Brown
Researchers are now attempting to
see if this process can be manipulated through gaming. In the US, a group of
patients suffering from severe burns were invited to play SnowWorld, a virtual reality
computer game devised by two cognitive psychologists, Hunter Hoffman and Dave
Patterson, to persuade the brain to ignore pain signals in favour of more
compelling scenarios. Their motivation, Hoffman said was because
opioids (morphine and morphine-related chemicals) can control burn pain when
the patient is at rest, they are nowhere near adequate to quench the agony of
daily bandage changes, wound cleaning and staple removals.
The best-known SnowWorld
player is lieutenant Sam Brown who, during his first tour of duty in
Kandahar, Afghanistan, in 2008, suffered third degree burns over 30% of his
body. An IED buried in a road hit the vehicle he was travelling in and exploded
into a fireball, engulfing Brown in flames. His injuries were so severe he had
to be kept in a medically induced coma for several weeks. Back in the US, Brown
endured more than two dozen painful surgeries, but none were as bad as the
daily ritual of caring for his wounds. When nurses attended to his burns and
helped him perform the necessary physical therapies, he experienced the most
excruciating pain.
In 2012, NBC News reported
on Brown’s experience and how the pain of dressing burn wounds could be so
intense it could make patients relive the original trauma. In Brown’s case the
procedures were so unbearable that on some occasions his superior officers had
to order him to undergo treatment.
For Brown, help arrived not in
the form of new kinds of medicines or dressings, but by a video game. Brown was
one of the first participants in SnowWorld’s pilot study, which was designed in
conjunction with the US military, to test whether it really could help wounded
soldiers.
A distracting annoyance
At the time, Hoffman’s main work
at the University of Washington was using virtual reality techniques to
help people overcome a pathological fear of spiders. Patterson, based at the
Harborview Burn Centre in Seattle, is an expert in psychological techniques
such as hypnosis that can be used to help burn patients.
It was already known that the way
we experience pain can be psychologically manipulated – for example, anticipating
pain can make it worse. Research looking at how soldiers experience pain has
also revealed how emotions can affect how that pain feels. So if your
brain can interpret pain signals differently depending on what you’re thinking
or feeling at the time, why not see if the experience of pain can be altered by
deliberately diverting a patient’s attention towards something else? If it
worked, the wound care could become more of a distracting annoyance and the
distressing sensation of pain could be much reduced.
It was a long shot, but Hoffman’s
expertise in virtual reality therapy made it possible to develop a game which
offered that kind of diversion. To do this patients first put on a virtual
reality headset and earphones and are then transported through an icy canyon
filled with snowball hurling snowmen, flocks of squawking penguins, woolly
mammoths and other surprises. Flying through the gently falling snow, they can
then retaliate by throwing their own snowballs. Often, they get so involved with
it that they don’t even notice when their procedure has finished.
In the interview with NBC Patterson
explained how, during painful procedures like scrubbing off a wound, the
patient is taken into a soothing and icy world, a completely different place
from the reality. It works, he said, “for as long as people seem to be in the
virtual world.”
The 2011 pilot study showed
promising results. In some cases, soldiers with the worst pain reported that
SnowWorld worked better than morphine. Brown himself is now much recovered, and
attributes a large part of that success on his immersive experience.
Similar projects are happening
elsewhere. In the UK, staff at Queen Elizabeth Hospital Birmingham and the
University of Birmingham have been looking at how computer game technology can
alleviate patients’ pain and discomfort through distraction therapy in
which patients “wander around” a virtual world based on real locations in the
Devon countryside. The idea is to combine authentic natural landscapes with
virtual reality aids that help patients divert their attention from pain while
also offering opportunities for real physical exercise – walking up hill, going
over bridges, sitting on the beach – that creates movement inside the game.
As with SnowWorld, patients are
generally injured military personnel. Most suffer from severe burns, but some
also have phantom pain from amputated limbs.
No comments:
Post a Comment