Pain control during wound care for combat-related burn injuries using custom articulated arm mounted virtual reality goggles

We describe the first two cases where virtual reality was added to usual pain medications to reduce excessive pain during wound care of combat-related burn injuries. Patient 1 was a 22 year old male who suffered 3rd degree burns on 32% of his body, including his right hand, during a roadside bomb terrorist attack in Iraq. The nurse administered wound care to half of the right hand during VR and the other half of the same hand during no VR (treatment order randomized). This patient was the first to use a unique custom articulated robotic-like arm mounted VR goggle system. Three 0-10 graphic rating scale pain scores for each of the two treatment conditions served as the primary dependent variables. The patient reported less pain when distracted with VR. Time spent thinking about pain dropped from 100% during no VR to 15% during VR, "pain unpleasantness" ratings dropped from "moderate" (6/10) to "mild" (4/10). Wound care was no fun at all (0/10) during no VR but was pretty fun (8/10) during VR. However, Patient 1 reported no reduction in worst pain during VR. Patient 2 suffered 2nd and 3rd degree burns when his humvee was hit by a terrorist's rocket propelled grenade in Iraq. During his wound care debridement, time spent thinking about pain was 100% (all of the time) with no VR and 0 (none of the time) during VR, pain unpleasantness ratings dropped from severe (7/10) to none. Worst pain dropped from severe (8/10) to mild pain (2/10). And fun increased from zero with no VR to 10 (extremely fun) during VR. Although preliminary, using a within-subjects experimental design, the present study provided evidence that immersive VR can be an effective adjunctive nonpharmacologic analgesic for reducing cognitive pain, emotional pain and the sensory component of pain of soldiers experiencing severe procedural pain during wound care of a combat-related burn injury.