One of the most frequent, yet challenging secondary problems experienced by children who require rehabilitation from disabling conditions is pain. Pain occurs at rest and/or with rehabilitation activities and arises in both chronic settings (e.g., cerebral palsy) and subacute settings (e.g., repetitive wound care and physical therapy during extended treatment of cutaneous burns). Conventional pharmacologic analgesic strategies, although widely used and efficacious in children with acute pain, are avoided in these chronic and subacute settings due to associated complication (e.g. tolerance) and lack of efficacy (development of central neuropathic pain syndromes). This project will explore two non-pharmacologic analgesic techniques for children ages 8-20 years, emphasizing 1) virtual reality (VR) analgesia, a highly innovative technology with newly demonstrated efficacy in such settings, and 2) its novel combination with hypnosis. The analgesic mechanisms of VR and hypnosis are incompletely understood, although they share a common thread distraction of conscious attention from environmental stimuli, leaving less of this cognitive resource to devote to pain perception. The goal of this project is to develop a program that will effectively investigate the analgesic mechanisms and optimize the clinical use of VR and combined VR/hypnosis in disabled children with pain and/or who require rehabilitation activities.
The specific aims of the project are 1) to develop an effective, multidisciplinary group capable of posing and answering appropriate study questions with tangible outcome measures, 2) to design and fabricate VR hardware ad software, and develop VR protocols necessary to address mechanistic questions and perform future clinical trials, and 3) to perform pilot clinical studies to assess the efficacy of repetitive application of VR, and to investigate the efficacy of and the interactions between VR and hypnosis when used simultaneously. The anticipated immediate benefits of this project include establishing the specialized research team and equipment necessary to perform future mechanistic studies and clinical trials of VR and VR/hypnosis, as well as collect pilot clinical data to direct future investigations. Long-term benefits include the establishment of indications and clinical protocols for the use of VR and/or hypnosis in the treatment of rehabilitation-induced and disability-related pain in this challenging patient population, with more widespread application to a variety of age groups, greater ease of use, and potential economic benefit.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21HD040954-03
Application #
6644786
Study Section
Special Emphasis Panel (ZHD1-RRG-K (16))
Program Officer
Quatrano, Louis A
Project Start
2001-09-03
Project End
2005-08-31
Budget Start
2003-09-01
Budget End
2005-08-31
Support Year
3
Fiscal Year
2003
Total Cost
$227,400
Indirect Cost
Name
University of Washington
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Keefe, Francis J; Huling, Dane A; Coggins, Michael J et al. (2012) Virtual reality for persistent pain: a new direction for behavioral pain management. Pain 153:2163-6
Hoffman, Hunter G; Chambers, Gloria T; Meyer 3rd, Walter J et al. (2011) Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Ann Behav Med 41:183-91
Schmitt, Yuko S; Hoffman, Hunter G; Blough, David K et al. (2011) A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns. Burns 37:61-8
Maani, Christopher V; Hoffman, Hunter G; Morrow, Michelle et al. (2011) Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. J Trauma 71:S125-30
Sharar, Sam R; Miller, William; Teeley, Aubriana et al. (2008) Applications of virtual reality for pain management in burn-injured patients. Expert Rev Neurother 8:1667-74
Sharar, Sam R; Carrougher, Gretchen J; Nakamura, Dana et al. (2007) Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Arch Phys Med Rehabil 88:S43-9
Hoffman, Hunter G; Richards, Todd L; Van Oostrom, Trevor et al. (2007) The analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments. Anesth Analg 105:1776-83, table of contents
Hoffman, Hunter G; Richards, Todd L; Bills, Aric R et al. (2006) Using FMRI to study the neural correlates of virtual reality analgesia. CNS Spectr 11:45-51
Patterson, D R; Hoffman, H G; Palacios, A Garcia et al. (2006) Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain. J Abnorm Psychol 115:834-41
Patterson, David R; Wiechman, Shelley A; Jensen, Mark et al. (2006) Hypnosis delivered through immersive virtual reality for burn pain: A clinical case series. Int J Clin Exp Hypn 54:130-42

Showing the most recent 10 out of 16 publications