In a virtual world, flying through snow-covered canyons filled with snowmen, penguins and igloos can alleviate pain. No longer do burns singe the skin when they are cleaned — a distracted mind ceases to concentrate on the throbbing.

This virtual world free of burn pain was something two UW- affiliated psychologists, Hunter Hoffman and David Patterson, imagined and created.

Their collaborative project, called SnowWorld, is tested on burn patients at Harborview Burn Center.

“Burn pain is considered one of the most excruciating types of pain and it is one of the most challenging to treat,” Hoffman said.

About 70 Harborview burn patients, both children and adults, have experienced SnowWorld during wound care. SnowWorld is the first virtual world custom-designed for burn patients, and it has been surprisingly effective, Hoffman said.

When burn patients enter SnowWorld, they put on a high- resolution virtual-reality helmet that seemingly transports them from a medical room to a snow-covered canyon where icicles and snowflakes loom in the distance. With a remote control in hand, the patient flies a fighter jet, navigating through the snow- covered valley, and throws snowballs at snowmen who appear as the patient flies past. Soothing music plays in the background, and the patients become immersed in the coolness of a world much less painful than the “real world.”

“The snow is supposed to put out the fires of their pain,” Hoffman said.

Patients often re-experience the original injury when their bandages are removed and their wounds are cleaned. Most burn centers make it a high priority to keep wounds clean and free of infection, which is necessary in order to graft skin. But while opiods, morphine-related chemicals, are successful in controlling burn pain during the time patients spend resting, there isn’t an effective medication to reduce the amount of pain experienced during daily wound care, Hoffman said.

The logic behind virtual reality as treatment is that patients will get so absorbed in the other world — in this case, SnowWorld — that their attention will be drawn away from the pain, Patterson explained. Pain requires conscious attention, of which humans have only a limited amount. When patients are immersed in a virtual world, less attention available to process the pain signals they are receiving.

“It [is] similar to watching a really good movie where you get so absorbed that you forget everything else,” said Patterson.

There are a number of ways to measure pain, one of the most obvious being to ask patients how much pain they are experiencing by using several standardized pain scales. However, Hoffman and Patterson found asking: “How much time did you spend thinking about your pain?” was an effective measurement.

Hoffman recalled one particular patient, a rebellious teenage boy, who had a particularly interesting response to this question. The teenager, having been told he would be released from the hospital several days prior, was upset he could not go home. He was also irritated by his wounds, which prompted him to try SnowWorld during his physical-therapy session.

Before entering the virtual world, he criticized the questions the doctors asked him. However, after experiencing SnowWorld, he not only answered their question, but unknowingly proved how powerful the virtual world was by heatedly replying: “How am I supposed to know how much pain I was in? I was in that virtual world!”

Although virtual reality has been found to be so effective that no pain is felt, the body’s threshold for pain does not increase.

“There is a clever British journalist that once said, ‘It is a weapon of mass distraction.’ There is a fair amount of truth to that,” Patterson said.

Anne Schmidt, research coordinator for Patterson, has been recruiting burn patients for SnowWorld studies for the past three years. Since she has close contact with patients, she has noticed their excitement in using SnowWorld. It takes their mind off the pain, and they don’t dread their daily treatments.

“Oftentimes with therapy, the patients don’t want to go and don’t look forward to it. This is positive reinforcement for them,” Schmidt said.

While the majority of patients have been responding positively to SnowWorld, it is still in the transitional phase between research and practice, Hoffman said. Most patients use SnowWorld for five to 10 minutes during a 30-minute wound-care session, which prevents motion sickness and enables patients to compare their levels of pain during wound care both with and without virtual reality.

The next step, said Patterson, is to immerse the patient in SnowWorld for the entire session.

Hoffman is an experimental psychologist at the UW Human Interface Technology Laboratory, and Patterson is a clinical psychologist at Harborview Burn Center. They met in 1997, and first discussed the applications of virtual reality to alleviate pain.

While both men are psychologists, they lend much different, yet essential, expertise to their research. Hoffman’s background is in experimental studies with pain, while Patterson oversees the application of virtual reality to the actual patient population. The team is, in fact, the first to conduct research using virtual reality for the treatment of pain.

The team has recently received a substantial amount of funding for its project, which will help improve SnowWorld and develop new worlds. Donators include the Paul Allen Foundation, National Institutes for Health, Washington State Council of Firefighters, and National Institute of Disability and Rehabilitation Research.

They hope more virtual worlds will allievate not only acute pain, but chronic pain, and expect worlds to be more widespread for acute pain such as wound care, childbirth and dental pain in only a few years. Chronic-pain applications, however, will take longer, as treatments for acute pain are still in the process of being researched.

“The really exciting thing is that burn pain is a model for treating more severe types of chronic pain,” Patterson said. “Chronic pain is a real drain issue on people and the economy, and costs the United States billions of dollars a year from people suffering.”