Virtual Reality Therapy for Burns

(BURN-360 Trial)

Overseen By Alan D Rogers, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Sunnybrook Health Sciences Centre

Disqualifiers: Mechanical ventilation, Intravenous sedation, Face burns, Resistant bacteria, Motion sickness, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

Duration: 2 days

80 Participants Needed

Trial Summary

What is the purpose of this trial?

Burn injury and its treatment is an intensely painful experience. Most severely injured patients require numerous dressing changes and skin grafting procedures (removing skin from healthy part of the body and moving it to damaged area of the body). This procedure cause extensive pain and anxiety and many patients can become dependent on pain killers during their hospital stay and throughout rehabilitation. This can delay reintegration into society and increase the chance of opioid dependence. An effective pain management plan plays a large role in patient recovery. In addition to the physical pain experienced by these patients, burn injury is an intensely stressful and emotional life experience. This study will use a non-drug approach to reduce pain and extensive use of pain killers (opioids) during dressing changes. In particular, the study will use an immersive (allows to experience computer-generated environment as a real world) Virtual reality (VR) distraction tool during dressing change after skin graft surgery. Individuals who will decide to participate in this study will be asked to wear headgear to view immersive 360 videos specially designed by the study team. Before and after this exposure participants will be asked to complete a measurement of their anxiety level (VAS) and rate their pain. This study will help to determine if using VR as a distraction tool during painful dressing changes will reduce pain and anxiety, and therefore opioid medications requirements, and will rely on participants experience and adapt VR videos according to participants' response.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. It focuses on using virtual reality to reduce the need for painkillers during dressing changes.

What data supports the effectiveness of the treatment Immersive VR Video, Immersive Virtual Reality, VR Distraction Tool, Virtual Reality Therapy for burns?

Research shows that using virtual reality (VR) alongside regular pain medication can help reduce pain and anxiety in burn patients during wound care and physical therapy. VR acts as a distraction, making the painful procedures more bearable. ^{1 2 3 4 5}

Is virtual reality therapy safe for burn patients?

Research on virtual reality therapy for burn patients shows it is generally safe, with studies focusing on its ability to reduce pain and anxiety during treatment. While side effects are not extensively detailed, the therapy is used alongside standard pain management, suggesting it is considered safe for use in these settings. ^{1 2 5 6 7}

How is virtual reality therapy different from other treatments for burns?

Virtual reality therapy for burns is unique because it uses immersive virtual environments to help reduce pain and anxiety during wound care and rehabilitation, unlike traditional treatments that rely solely on pain medications. This approach provides a distraction that can make painful procedures more tolerable and enjoyable for patients. ^{1 4 7 8 9}

Research Team

Alan D Rogers, MD

Principal Investigator

SHSC

Eligibility Criteria

This trial is for adults over 18 who are alert, can watch VR videos and answer questions. They must be in the hospital for at least two days of dressing changes after one skin graft surgery for burns but haven't had significant face, neck or scalp burns, resistant bacteria infections, communication issues, severe motion sickness history or need mechanical ventilation or IV sedation.

Inclusion Criteria

I am mentally alert and can watch videos and answer questions.

I will need to stay in the hospital for at least two days for dressing changes.

I am expected to have one skin graft surgery for my burn injury.

Exclusion Criteria

I have an infection caused by bacteria resistant to common antibiotics.

I am unable to communicate effectively.

I am currently receiving sedation through an IV.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo dressing changes with VR-360 distraction video to reduce pain and anxiety

2 days

2 visits (in-person)

Follow-up

Participants are monitored for opioid use and anxiety levels post-treatment

3 months

1 visit (in-person)

Long-term follow-up

Participants are assessed for opioid use and PTSD symptoms at 3 months post-procedure

3 months

Treatment Details

Interventions

• Immersive VR Video

Trial Overview The study tests if immersive Virtual Reality (VR) during dressing changes post-skin graft surgery can reduce pain and anxiety. This could potentially lower the need for opioid painkillers. Participants will use VR headgear to view 360 videos created by researchers and rate their pain and anxiety before and after.

Participant Groups

Group I: VR-360 group (VR-group) Experimental Treatment 1 Intervention

Patients will watch a VR-360 distraction video during dressing change. The patient will be asked or helped to wear the HMD write in full at the onset of a procedure and watch the VR-360 video during the dressing change procedure. When experiencing pain, the patient may indicate the need for further analgesic medication during the procedure, the patient will be asked to push a button in their hand that will trigger a light-based signal for the nurse to provide further analgesic medication. Should their hands both be involved in the burn injury, the patient will indicate the same verbally.

Group II: Control Group (standard treatment) Active Control 1 Intervention

The patients will receive standard treatment and will be instructed to use the same button to indicate their pain.

Who Is Running the Clinical Trial?

Sunnybrook Health Sciences Centre

Lead Sponsor

Trials

693

Recruited

1,569,000+

Findings from Research

Virtual Reality (VR) significantly reduces pain in burn injury patients during wound dressing changes and physiotherapy when used alongside pharmacologic analgesics, based on a systematic review of nine studies.

The evidence for VR's effectiveness in reducing anxiety during these procedures is less clear, indicating a need for further research to explore its potential benefits in managing anxiety for burn patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review. Morris, LD., Louw, QA., Grimmer-Somers, K.[2022]

Immersive virtual reality (VR) distraction significantly reduces pain in burn patients undergoing passive range-of-motion physical therapy, with reductions of 20% in worst pain intensity and 26% in pain unpleasantness when compared to standard analgesic treatment alone.

The use of VR distraction is safe, with only 15% of patients experiencing mild nausea, and it is effective regardless of patient factors such as age, sex, or size of burn injury, making it a valuable nonpharmacologic adjunct to pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Sharar, SR., Carrougher, GJ., Nakamura, D., et al.[2008]

In a study involving four patients undergoing burn wound care, the use of virtual reality (VR) distraction significantly reduced the time spent thinking about pain and increased the enjoyment of the experience compared to standard care without VR.

Brain imaging showed that VR led to a relative decrease in cerebellar activation, suggesting that VR may alter brain activity related to pain perception, supporting its potential as an effective distraction analgesia tool.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Role of the Cerebellum in Pain Perception: A Brain SPECT Perfusion Study in Patients with Burn Injuries. Bermo, MS., Zacharias, C., Patterson, D., et al.[2021]

Virtual reality (VR) interventions significantly reduce pain during burn wound care procedures compared to standard care, with a moderate effect size (SMD = -0.49) and even greater effectiveness when immersive VR is used (SMD = -0.71).

While VR shows promise in alleviating pain, it does not significantly improve range of motion outcomes, indicating that further research is needed to fully understand its benefits and to standardize its use in medical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual reality intervention as a support method during wound care and rehabilitation after burns: A systematic review and meta-analysis. Czech, O., Wrzeciono, A., Batalík, L., et al.[2022]

The study involving 11 adult burn patients suggested that using a low-cost VR system alongside pharmacological analgesia may help reduce pain and anxiety during physiotherapy, although the differences were not statistically significant.

Despite the lack of significant results, the VR system was deemed safe and could potentially enhance pain management strategies in burn treatment settings, indicating a promising area for further research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and potential effect of a low-cost virtual reality system on reducing pain and anxiety in adult burn injury patients during physiotherapy in a developing country. Morris, LD., Louw, QA., Crous, LC.[2019]

A systematic review of 10 studies involving pediatric patients with burn injuries found that virtual reality (VR) significantly reduces pain and anxiety during wound care procedures, with a moderate to large effect size (SMD=0.60).

The effectiveness of VR was consistent across studies, supporting its integration into traditional pain management protocols for children undergoing burn care, regardless of the specific VR content or delivery method used.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis. Smith, KL., Wang, Y., Colloca, L.[2022]

A systematic review and meta-analysis of 30 studies involving 1,293 burn patients found that virtual reality (VR) significantly reduces pain severity during wound care procedures, with a strong effect size (SMD: -0.70).

Immersive VR interventions were particularly effective in decreasing pain intensity compared to control groups, while non-immersive VR did not show significant benefits, suggesting that immersive VR should be prioritized in burn care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Virtual Reality-Based Interventions on Pain During Wound Care in Burn Patients; a Systematic Review and Meta-Analysis. Norouzkhani, N., Chaghian Arani, R., Mehrabi, H., et al.[2022]

Virtual reality (VR) can effectively reduce pain during burn care, but implementing it in a clinical setting requires a significant time commitment from staff, averaging 59 minutes per session for setup, instruction, therapy, and cleaning.

The lack of on-site technical support for VR equipment poses challenges, making it difficult for smaller burn centers to allocate the necessary resources for a VR program, highlighting the need for further research to evaluate the cost-effectiveness of VR in pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual reality: feasibility of implementation in a regional burn center. Markus, LA., Willems, KE., Maruna, CC., et al.[2019]

An 11-year-old burn patient experienced significant pain reduction during therapy when using inexpensive Oculus Rift Virtual Reality (VR) goggles, with pain intensity ratings dropping from severely painful to moderately painful.

This study suggests that immersive VR environments can be an effective and cost-efficient method for managing acute procedural pain in burn patients, warranting further research into its broader applications in pain control and therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of articulated arm mounted Oculus Rift Virtual Reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients. Hoffman, HG., Meyer, WJ., Ramirez, M., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. [2008]

3. United States pubmed.ncbi.nlm.nih.gov

The Role of the Cerebellum in Pain Perception: A Brain SPECT Perfusion Study in Patients with Burn Injuries. [2021]

4. Scotland pubmed.ncbi.nlm.nih.gov

Virtual reality intervention as a support method during wound care and rehabilitation after burns: A systematic review and meta-analysis. [2022]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Feasibility and potential effect of a low-cost virtual reality system on reducing pain and anxiety in adult burn injury patients during physiotherapy in a developing country. [2019]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis. [2022]

7. Iran pubmed.ncbi.nlm.nih.gov

Effect of Virtual Reality-Based Interventions on Pain During Wound Care in Burn Patients; a Systematic Review and Meta-Analysis. [2022]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Virtual reality: feasibility of implementation in a regional burn center. [2019]

9. United States pubmed.ncbi.nlm.nih.gov

Feasibility of articulated arm mounted Oculus Rift Virtual Reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients. [2022]