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Distraction and presence in painkilling SnowWorld

February 20, 2012 | Hogan Keyser
[Image: Ari Hollander/Hunter Hoffman]

Burning Man

On his first tour of duty in Afghanistan, Sam Brown was set on fire by an improvised explosive device. He survived, only to find himself, like thousands of other vets, doomed to a post-traumatic life of unbearable pain. Even hallucinogen-grade drugs offered little relief, and little hope.

Then his doctors told him about an experimental treatment, a painkilling video game supposedly more effective than morphine. If successful, it would deliver Brown from his living hell into a strange new world--a digital winter wonderland

By Jay Kirk February 2012 via ISPR
-- Hunter Hoffman hadn't set out to help burn patients. As a cognitive psychologist--who had gotten his start back in the '80s conducting experiments at Princeton to test the mind's ability to discern between real and false memories--he had begun experimenting with virtual reality as a treatment for arachnophobes. Using a VR game he'd designed called SpiderWorld (see box), he had helped a number of individuals so crippled by fear that they had to seal up their windows to sleep. Outfitted with virtual-reality goggles, the patient began at the far end of a virtual kitchen, opposite the counter, upon which was a small, barely visible spider. Once the fight-or-flight response had subsided, the patient could inch closer until he could stand being close enough to see the spider's reflection in the toaster's chrome finish. Hoffman had created a world that people could enter, reemerging with their nightmares erased. It was an artificial world with the power to transform meaning itself in the so-often-insufferable sphere known as the real.

One day in 1994, a colleague of Hoffman's told him he'd been observing patients at a burn center using hypnosis to control pain. His colleague wasn't exactly sure how the treatment worked, but he thought it had something to do with distraction.

"Distraction?" Hoffman said. "I'll show you distraction," and he showed his friend SpiderWorld.

Not long after, Hoffman went to meet the hypnotist himself, who agreed VR sounded like a pretty good idea. On the very first burn patient they tried, SpiderWorld worked. He simply forgot to think about his pain. Still, stoves and toasters didn't seem right, considering--kind of cruel, really. So Hoffman hired a world builder to make something else, something colder, fireproof.

Later, after Hoffman became director of the Virtual Reality Analgesia Research Center at the University of Washington Human Interface Technology Laboratory, or HITLab, he had some remarkable success. Using $35,000 goggles--the sort of hardware ordinarily used for training fighter pilots--researchers obtained drops in pain ratings by 30 to 50 percent.

If distraction was the key, why not just use over-the-counter video games for a fraction of the cost? To answer that question, Hoffman had run a control experiment. In his first case study, he had a teenager with a severe flash burn play Nintendo Mario Kart while having five staples removed from a skin graft. The data showed that in terms of reducing pain, anxiety about pain, and time spent thinking about pain, playing Nintendo Mario Kart compared poorly to SpiderWorld. The reason VR was so much more effective than a regular video game came down to a quality called "presence"--that sense of being immersed inside an artificial world.

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