A new virtual reality experience has decreased pain, lowered the amounts of medication needed for care and helped doctors and nurses give better care to soldiers.

Snow World is an immersive experience that helps the patient deal with challenges in a calm, cold "place." Designed by Hunter Hoffman, director of the University of Washington VR Analgesia Research Center, with psychologist David Patterson, the chief of rehabilitation medicine at Harborview Burn Center, the game is now being tested on wounded soldiers, and the results are extraordinary.

In many cases, the recovery from burns can be more intensive than the actual injury itself and it can take months of agonizing physical therapy to loosen up the tougher and tighter skin that regrows. Patients have reported that while playing Snow World they feel less pain and are more relaxed; thus; they feel a greater range of motion. Patients also required less pain medication and remained lucid for longer periods of time.

The concept of the game is a basic 3D environment where players move long a snowy path and fire snowballs at non-moving targets. The patient wears a virtual reality headset that prevents him from seeing the therapy and the challenge of the game keeps his mind on aiming instead of the pain. The cool imagery takes his mind away from the burning pain, and the "shooting" keeps his mind occupied. This sort of pain management is not only good for the patient, but also helps the staff dealing with burn victims.

Two soldiers wounded in Iraq with extensive second- and third-degree burns reported marked improvements in their ability to handle the pain involved with daily burn treatment with the interactive system, said Peter DeSocio, D.O., of the Army Institute of Surgical Research in Ft. Sam Houston, Texas.

Those two cases, presented during a poster session at the American Academy of Pain Medicine, were the first of about a dozen who have now been treated in the ongoing study, Dr. DeSocio said.

Because burn patients are intensely sensitive to heat, said Dr. DeSocio, the goal was to avoid anything that would make patients think of hot things. Snow World is also nonviolent, so as not to trigger memories of the event causing their injuries.

In the study, part of each day's burn care for each patient included use of the virtual reality system, with part involving only standard care. In this way, Dr. DeSocio explained, patients serve as their own controls.

Participants rated three separate aspects of pain on a 10-point scale: time spent thinking about pain during the sessions, overall unpleasantness, and the maximum degree of pain. They also rated the enjoyability of Snow World.

One of the two patients whose case was presented at the meeting obtained dramatic relief of pain during the virtual reality sessions -- scoring the three aspects of pain from 7 to 10 (10 is the worst) during standard care. With the virtual reality system in place, the patient gave scores of 0 for time thinking about pain and overall unpleasantness, and a score of 2 for the worst pain.

The other patient reported no difference in the maximum degree of pain, and a reduction in overall unpleasantness from 6 with standard care to 4 with the virtual reality experience.

But the second patient scored time thinking about pain at 1.5 with the virtual reality system, versus 10 during standard care.

Both soldiers gave the system high marks for enjoyability.

This study was funded by the U.S. Army and more studies are planned. For more information regarding research and clinical use contact Dr. Hunter Hoffman, Harborview Medical Center, University of Washington, Seattle.

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