Brooke Army Medical Center is the home of the Department of Defense's top burn unit. If a service member from any of the branches (Army, Navy, Marines and Air Force) suffers severe burns on the battlefield, in training or simply in an accident, they'll be flown to BAMC's Institute for Surgical Research, where some of the best burn specialists oversee their care.
Dr. (Maj.) Christopher Maani, the Institute for Surgical Research's Chief of Anesthesia, has been working on new ways to help burn patients handle the intense pain of their injuries. Service members with third degree burns require dressing changes and wound cleanings that can be even more painful than the injuries themselves. "These can be excruciatingly painful, but necessary," Maani explains. "The unique situation that a lot of the burn patients face is that it doesn't stop with one trip to the operating room. It's something they're going to have for a much longer period of time. Their wound care and rehabilitation can often takes week, months, even years."
For much of the wound care, severely burned patients are sedated, essentially undergoing a mini surgery every day, sometimes twice a day, in the effort to prevent infection while their skin heals. But researchers at the University of Washington's Human Interface Technology Laboratory have developed a virtual reality pain control system that BAMC is beginning to use on severely burned service members.
"The system is a virtual world where you take the burn patient away from everything that reminds them of their burns," Maani explains. Think of a high definition video game tailored to make the patient forget about his burns. It's a first person game, much like shooter games such as "Call of Duty" and "Modern Warfare." But instead of hunting down opposing troops, the player runs through icy canyons, throwing snowballs at woolly mammoths and flying fish. "It's an arctic scene that takes them as far away from their burn injury as possible," Maani says. "We overwhelm their senses, overwhelm their vision and use things like noise-canceling headphones with calm, soothing music."
On the day Maani demonstrated the system at the Institute for Surgical Research, a young soldier played a demonstration version of the game while Paul Simon's "Graceland" blared over loud speakers. Burn patients play the game using virtual reality goggles that are specially designed to avoid rubbing on sensitive parts of the face, such as the bridge of the nose.
By keeping the patient active, doctors and therapists hope that they can control the pain of daily wound care without anesthesia or resorting to medication. "We get to them to actively engage their minds," Maani says. "They're using a mouse, targeting and engaging their systems. The patient becomes so invested that they don't appreciate as much of the pain. We minimize the pain medication while maximizing pain control."
While the virtual reality system helps new patients, it could have far-reaching benefits in many medical areas. Troops returning from today's battlefields, especially those with severe burns or traumatic brain injury, face long recoveries and even longer battles with chronic pain. Maani believes that one of the keys to controlling chronic pain is to deal with the acute pain from the injuries, and the virtual reality system can play a major part in that struggle. "If we can't control their acute pain, the pain that they're experiencing in the moment, oftentimes that can snowball and develop into chronic pain," Maani says. "That's one of the things that's not really well understood, but we're learning more and more about that as we go along."