Recently in Psychological Consequences of Burns: Long Term Rehabilitation Category

March 24, 2012

Burn Victims Can Reduce Pain Through Virtual Reality Games

In August 2011, Randy McAllister suffered third degree burns while trying to save equipment from a fire in wheat field. Today, he says that when he goes for his burn treatments, "it gets me to the threshold where I can't stand it, but then I find out it can hurt even more," says the 60-year-old farmer. During five weeks at the Oregon Burn Center at Legacy Emanuel Medical Center in Portland, Oregon, McAllister needed repeated rounds of burn wound care to remove dead tissue from his extensive burns. "It's more painful than the fire."

Then a nurse told him about SnowWorld, a computer game designed to help burn patients escape from agonizing pain by distracting their minds during burn treatments. During his next wound care session, McAllister wore headphones and looked through virtual reality goggles. He found himself floating through an icy canyon rendered almost three-dimensional by the wrap-around goggles. By tapping on a computer mouse, McAllister fired snowballs at animated penguins, snowmen and dolphins in the canyon to a soundtrack of upbeat music. And the virtual world made his real-world pain less overwhelming.

It's one of the most successful examples of non-drug pain management techniques to emerge from the work of psychologists and neuroscientists. The search for non-drug options has gained urgency amid a worsening epidemic of overdoses linked to prescription opioid pain relievers such as oxycodone and hydrocodone, which killed 14,800 Americans in 2008 - more those killed from heroin and cocaine overdoses combined.

In clinical trials, burn patients using SnowWorld reported 35 to 50 percent reductions in pain. The system was developed at the University of Washington by research scientist Hunter Hoffman and psychologist David Patterson, with input from burn care experts at Harborview Burn Center in Seattle.

Virtual reality therapy isn't a substitute for opioids and other pain-relieving medications, but it can boost the effectiveness of drugs - and possibly reduce the dosage. Researchers who developed the technology say it might also help people with chronic pain syndromes, although those clinical trials are incomplete.

Theresa McSherry, burn and wound care coordinator at the Oregon Burn Center, says burn patients need more options. Pharmaceutical research has provided safer and more effective anesthetics and opioid pain relievers, but drugs have limits.

"You can't safely give burn patients enough medication to provide adequate pain relief," says McSherry, a registered nurse who has worked with burn patients for more than 10 years. A grant from the Legacy Foundation allowed the Oregon Burn Center to buy the $66,000 virtual reality system in August. About a dozen are being used worldwide.

Preventing pain not only relieves immediate suffering, but also seems to help burn patients weeks and months later. Patterson, the UW psychologist, says the amount of pain during treatment is a stronger predictor of depression, anxiety and distress six months to a year later than the extent of burns or the length of hospital stay. "If you can control more of the acute pain, it can result in better long-term outcomes," he says.

Scientists have known for decades that the human brain can interpret the same signal transmitted by a pain receptor as painful or not, depending on what a person is thinking. Mood and expectation also play a big role. German researchers recently showed that a sad mood consistently makes people experience more pain. In another recent experiment, tricking people to think time passed more quickly reduced perception of pain.

Entering a rich, three-dimensional, sound-filled virtual reality might use so much of the brain's attention resources that less is available to process pain. "We're taking advantage of the malleability of human perception to deliberately divert mental resources away from the pain," Hoffman says.

Burn patients come to associate the sights and sounds of the wound treatment room with excruciating pain so that just entering the room can amplify the suffering, Hoffman says. Putting on headphones and goggles blocks the anxiety-stirring sights and sounds.

But distraction of attention appears to be the main way that virtual reality reduces pain. Hoffman's team has compared differing gear and found that the more realistic and "immersive" the gear, the greater the reduction in pain reported.

That matches McAllister's experience. His burned fingers made it difficult to hold the computer mouse during his SnowWorld experience. When the mouse slipped from his hand and he lost engagement with the snowball throwing, the pain of the procedure immediately intruded.

McAllister expects to continue intensive physical therapy for several months to regain more use of his fingers and hands. He may need additional surgery to remove scar tissue and increase joint mobility. But he's optimistic about returning to work next year.

Patterson believes virtual reality can help treat chronic pain as well. The UW researchers also developed a virtual reality program that induces hypnosis. The goal is to use post-hypnotic suggestion to change the way the brain handles chronic pain signals long after therapy sessions.

If you or someone you know suffers an injury such as third degree burns or smoke inhalation, you should call Kramer & Pollack LLP in Mineola, New York so that the personal injury attorneys in that firm can determine whether another party has legal liability for injuries suffered, and if the injured party has a strong legal case.

December 6, 2011

Severely Burned Boy Making Excellent Physical and Psychological Progress

There is an uplifting story on CNN.com today about a burn victim who is not only is healing physically from his burns, but also psychologically. Here's the proof: The boy, Youssif, was given a "certificate of citizenship" recently, which is an award for being exceptionally nice to a fellow classmate in school. Another boy got hurt, and Youssif helped the boy with his gashed arm by applying an ice pack and helping to stop the bleeding.

Youssif is proud of his award--and his family, his doctors, and his entire support system should all be proud as well. Four years ago, Youssif suffered third degree burns to his face--much of it melted, actually--during a battle among local sects in Iraq. But after dozens of surgeries in the United States, doctors have been able to reverse a lot of the horrible burn scars. Not only that, but Youssif is no longer the sad, quiet child he was in the few years after his burn injury.

Through extensive counseling with his family, he is now able to cope with the facial scars he still has from the attack, and he also has an upbeat attitude that's hard to believe. He says his looks no longer bother him, "because none of my other friends make fun of me," he says in English. His mother is so happy to see her boy like he was before he was burned. "His personality has changed so much," she told CNN.com. "The way he interacts with people, and everything else. It began as soon as he started school and realized that the children don't care about his appearance. It allowed him to have a normal life."

When CNN first aired Youssif's story in 2007, viewers around the world responded to the family's plea, donating hundreds of thousands of dollars to the Children's Burn Foundation, a Los Angeles-based foundation that took on his case.

His mental recovery has by far outpaced his physical one. He still needs more surgeries. Treating Youssif has been challenging, his doctors say, because his skin tends not to heal well. His doctors want to slow down the pace of surgeries for now to determine how his burn scar tissue and skin will develop and change as he gets older.

He loves soccer and plays on a local team. "I never used to do that in my country," he says, "because it was kind of dangerous there." He loves the ocean, which he had never seen in Iraq.

And he wants to be a doctor so he can help others when he grows up.

If you or someone you know does suffer a severe burn injury or a smoke inhalation injury, you should call Kramer & Pollack LLP in Mineola, New York so that the personal injury attorneys in that firm can determine whether another party has legal liability for injuries suffered, and if the injured party has a solid legal case.

April 21, 2010

Psychological Consequences of Burns: Long Term Rehabilitation

During this phase the patient is discharged from the hospital and starts to reenter and reintegrate into life and society. Interacting with family members, friends and the rest of the community may be difficult at first. The patient may be used to the hospital environment, leaving the hospital; they will have the fear of being rejected by the community because of their change in appearance or abilities. Other issues that face the patient during this stage are dealing with returning to work, changing their image and resuming sexual activities. Patients may develop anxiety and depression as a result of these issues.

Going through rehabilitation, exercises, dressing changes, pressure garment use, amputations, scarring and itching may all have an effect on the patient emotionally and physically.

Treatment provided in this stage begins before discharge by explaining and preparing the patient and family for the difficulties anticipated after discharge. Outpatient counseling, social skill training and support groups play a role in recovery. Family and friends' support and the patient's willingness to engage himself/ herself in society play an important role in recovery.

People are creative and can devise ways of achieving their goals when they receive the encouragement and support needed. Some patients may need more time than others to achieve their goals but every survivor can do it. Progress step by step with optimism and the right attitude, anyone can definitely get through anything.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.