Roger: I'm really delighted to have stumbled across your exhibit here at WCIT, because it's one of the more fascinating applications that I've seen so far. Would you tell us a little bit about yourself and also what you're working on?
Hunter Hoffman: I'm Hunter Hoffman. I'm the director of the Virtual Reality Research Center at the University of Washington in Seattle. I'm collaborating with Dave Patterson at the Harborview Burn Center in Seattle. That's a regional burn center. We're using virtual reality to distract burn patients from their pain. Most of the time, when burn patients are just lying around in their beds, morphine works well for reducing their pain. The problem is when they get their bandages changed, which typically is every day, when they're cleaning the wound the pain receptors, which are supposed to have skin over them, are naked. They're unusually sensitive, so just gently brushing away the skin is extremely painful.
During those times, the morphine doesn't work well. Most patients report severe to excruciating pain. We're using virtual reality just for 15 to 20 minutes during their wound care sessions to take their mind off their pain.
Pain has a strong psychological component to it. The same incoming neural signal from a pain receptor can be interpreted by the brain as more painful or less painful depending on a number of psychological factors, like where you're focusing your attention.
Usually the patients are watching their wound care, but the wound is not that pleasant to look at, and the other sounds are not that helpful. So we isolate the patients so they can't see their wound anymore, and they can't hear the other sounds. They can't see the hospital room which they've come to associate with pain.
Now they're completely isolated, and they're in SnowWorld. That's proving to be very effective. We're typically seeing 35 to 50% reductions in pain during wound care.
Roger: That's an amazing result. You've had some other tests as well, including looking at brain scans to try to judge whether the activity in the brain reflects that reduction in pain as well.
Hunter: One of the things we found is that when people tell you their pain is dropping while they're in SnowWorld, the pain related brain activity also drops. That's been very helpful, to get converging evidence from these objective measures. In addition to just the people's subjective experience, you're also seeing the neural correlates of virtual reality analgesing. We're at the University of Washington. We have a multidisciplinary project that involves anesthesiologists, radiologists, rehab medicine. I'm a cognitive psychologist in mechanical engineering. It's all a really crazy mixture of people.
We're doing both clinical and laboratory pain studies. We are using a thermal pain stimulator to elicit a painful response, and that way we can study with healthy volunteers. We can accelerate how quickly like the Wright Brothers with their wind tunnel. We can figure out a lot of things before, because by the time we get into the hospital, you want to have your ducks in a row.
I think that's part of the reason we've been able to quickly enhance the effectiveness and the technologies that we've been able to employ, like the articulated arm for holding the goggles near the patient's eyes.
We've been able to respond to requests from the healthcare givers. For example, when we started using it with soldiers, the soldiers complained that the helmet was uncomfortable. They said, "I'd like to use this, but I don't like the helmet." So we ditched the helmet, and we just came up with some new way to hold the goggles near the patient's eyes.
Basically, we're using existing technology that's commercially available, but we're also modifying it as needed, because it's not designed for being used with burn patients.
In addition to the clinical data that we have from a number of studies with over 200 burn patients now at Harborview, we're now doing multi site studies with other burn centers.
Roger: I can see where the anecdotal evidence would be really compelling, but at the same time, you want to be certain that it's actually an organic effect that's taking place in that.
Hunter: There's a long history of snake oil when it comes to pain.
Roger: I recently read somewhere about placebos being only like two percent less effective than certain drugs, so we know there's an effect there.
Hunter: The thing about placebos is for people who are trying to reduce pain, if you could consistently reduce pain with a placebo we'd just use placebos, and everybody would be happy. Roger: It would be over with.
Hunter: The problem is the body can only be tricked a few times, so the placebos typically only work once or twice, and then they start to diminish in effectiveness. So you can get a strong response initially, but it's not practical. It's not practical.
Roger: It's certainly an exciting use of technology, and in the spirit of this particular show that we're standing at right now, which is I guess you could say how technology is enabling and dealing with change in the world, that when you look at people who are fighting in Iraq and coming back with... Because medicine is so good, we save their lives, but of course the other side of the coin is now they have injuries that are so much more severe than we've ever had in the past that we need new methodologies and new understandings to give them some relief.
Hunter: That's right, that's right. Interacting with the patients, you really get a strong sense of how badly they need the pain control, and they're grateful that somebody's trying to help them. Basically, the medical community has become more or less complacent about the relative inadequacy of morphine. Basically, the patients, if they don't get their wound care, they can get infected and they might lose their arm. If they don't get their physical therapy to stretch their newly healing skin, the skin hardens. It loses its elasticity, and they lose range of motion.
The doctors and nurses are doing the patients a favor by encouraging them to get the wound clean and also to do these painful physical therapy sessions, so they've come to the erroneous conclusion that the pain is in some way necessary.
Roger: Part of the treatment.
Hunter: But what we're showing is you can actually get all the benefits of the painful procedures without the pain.
Roger: Wow, that is terrific. At a human level, it's one of the best applications of technology I've come across. Congratulations.
Hunter: Thank you.
Roger: Thank you so much, Hunter. I really appreciate it.
