Real Pain Dulled In Virtual Worlds

26199 writes "The BBC is reporting on a novel use of Virtual Reality: as a distraction for burn victims who suffer excruciating pain during daily dressing changes. What's most interesting is that it actually works. Another use of VR discussed is in the treatment of patients suffering Post Traumatic Stress Disorder; memories can be relived until they are accepted."

Comments

like dentists used to do with white noise

[johnjosephbachir]

iirc, dentists used to do something similar. patients would wear headphones while procedures were being done. i think they would play some sort of white noise.

j

Re:like dentists used to do with white noise

[gid13]

I have a feeling white noise would cause me a lot less trauma than those terrible radio stations that are always on in dentists' offices. Is it too much to ask to hear Comfortably Numb? It's THEMATIC, dammit!

Re:like dentists used to do with white noise

[fenix down]

The dentist I used to go to had the little CD/tape/radio boom box right there in the room. You could bring in whatever you wanted if he was going to do something that would take awhile.

Then they switched insurance companies on me and now I have to go to this 90 year old guy who's a half-hour away and keeps stabbing holes in my cheek with the tooth-buffer thing.

Re:like dentists used to do with white noise

[shigelojoe]

My dentist always played construction sounds over the headphones. You know, jackhammers, chainsaws, stuff like that.

After a while I got tired of it, so a switched to a different dentist. This one only asks me "Is it safe?" before he polishes my teeth, which isn't too bad I suppose.

Amazing...

[Vthornheart]

This could present some fascinating implications for medicine... Post Traumatic Stress Disorder is often one of the more difficult psychological disorders to treat, and is pretty much tops in the category of "anxiety-related" disorders. It would be a wonderful thing if it actually is useful in treatment.

Re:Amazing...

[fpga_guy]

I have a friend who works on a similar idea in the rteatment of schizophrenia and other hallucinatory mental illnesses.

They use VR and graphics technology to simulate the visual and auditory hallucinations that sometimes accompany these diseases. NewScientist had a small writeup

Re:Amazing...

[UpnAtom]

Post Traumatic Stress Disorder is often one of the more difficult psychological disorders to treat,

Difficult for whom to treat in what way?

PTSD is one of the easiest to treat in my experience (7 years as a clinical hypnotherapist). You know exactly what the problem is (recurring memories), and you know what the therapeutic outcome is (ability to remember whilst remaning calm). Where's the difficulty?

and is pretty much tops in the category of anxiety-related disorders.

tops??? Who modded this up?

It would be a wonderful thing if it actually is useful in treatment.

The drug companies have a near stranglehold over psychiatry. Without big money to fund the trials and marketing, it will never reach mass-usage.

Safe?

[CelticWhisper]

Call me a skeptic, but it seems like there's still a lot of room for potential damage from this. PTSD patients reliving memories until they're accepted? Doesn't that seem a little like forced traumatic recollection? I mean...yes, I'm sure it would have some desensitizing factor, but is that really a good thing? I don't necessarily know that I'd be jumping to sign up...

Re:Safe?

[Vthornheart]

Well, the trick of PTSD is that, for most people, the daily struggle to not remember (and avoid things that remind them) is much more traumatic. Imagine walking down a street, and a certain type of tree or smell in the air sets you off. Between having that and having one extremely painful session of emotion-dulling via reliving the experience, I'll take emotion dulling. At least it will bring a somewhat permanent conclusion.

This is, of course, assuming that it actually WORKS. =)

Re:Safe?

[venicebeach]

Exposure therapy is not pleasant, but it does tend to work. I don't know much about PTSD, but for anxiety disorders and phobias exposure is quite effective and virtual reality techniques have been becoming more and more popular for this. For treating someone with public speaking anxiety it's easier to get a virtual audience than to arrange for a bunch of people in a room...

Re:Safe?

[farquharsoncraig]

I mean...yes, I'm sure it would have some desensitizing factor, but is that really a good thing?

It's not the desensitizing factor, but rather the acceptance/understand factor. It would be a dissapointing tragedy of the worst kind indeed were you not able to, over the course of your life, eventually overcome and have sovereign dominion over your own body and mind.

Re:Safe?

[chazwurth]

I guess that depends what you mean by 'work.' I personally don't like the idea of getting over an emotional trauma by 'desensitizing' myself to it, as the article seems to suggest. Maybe I'm being sentimental, but it seems to me that what allows us to grow from painful experiences is having to come to terms with them, not getting desensitized.

Physical pain (like that of the burn victims) is one thing; emotional pain is something else entirely.

Re:Safe?

[harvardian]

I took an anxiety disorders class with one of the most famous voices in PTSD (McNally), so IANAP but IW a student of a psychologist.

One of the aspects of virtual reality treatments for phobias (we didn't study its use for PTSD) is that the patient is always accompanied by their psychologist, and they always have the option of opting out, even mid-simulation. And a nice fact of psychology is that if you have a feeling of control (whether you have control or not), you're less likely to run away. So while many may be too fearful to go through with the treatment, it happens in a supportive, controled environment, and that can be very helpful. The result may well be better than what we've got now, since PTSD's not easy to treat.

Re:Safe?

[Vthornheart]

Aye, PTSD is a type of Anxiety disorder... (I did a report on it once =) =) ) Treatments that work for Anxiety Disorders in general will tend to work for PTSD. PTSD is a hard one though, because of the things that can set it off, and how (at least up to now) the reliving of experiences had to be done pretty much in the domain of the mind or with a psychiatrist.

Re:Safe?

[useosx]

I really think I am going to regret bringing this up on Slashdot, as it is inevitably going to be misinterpreted.

But... victims of sexual abuse sometimes sometimes end up having sexual fantasies about that abuse.

I recommend the following three articles by Betty Dodson as she, I think, understands the issue well. WARNING EXPLICIT CONTENT for those who care.

Re:Safe?

[orthogonal]

Physical pain (like that of the burn victims) is one thing; emotional pain is something else entirely. reason an organism feels physical pain, and the reason it feels emotional pain are pretty much the same: both serve to signal to the organism that its current activity, in its current environment, is detrimental to the organism. A burning pain in my finger tells me that either I should modify my activity -- by moving the finger --, or the the environment -- by moving the stove-top the finger is touching.

Similarly, emotional pain -- feelings of guilt, or rejection, or etc., -- exist pretty much to tell me that I'm earning the ire of my fellows, and that my ancestors became my ancestors by virtue of not doing those ire-raising things. Those organisms that too often ignored pain, either physical or emotional, of course failed to become ancestors by virtue of that, and so the genes for ignoring pain tend not to have propagated as much as the genes for heeding pain.

So if physical pain and emotional pain exists to do the same thing -- essentially behavior modification -- and if evidence exists that they are produced by the same structures in the brain, why do we tend to take for granted that they are not the same things?

Part of the reason, of course, is that emotional pain can last far longer than (many forms of) physical pain. My guess is that this is partly because emotional behaviors -- such as social awkwardness or shyness -- are resistant to change, and part -- as with grief -- is due to reinforcement by memory. I'll further guess that this reinforcement by memory is to some degree an "unintended" side effect of the greater precision of human memory.

Why are certain social behaviors resistant to change? Probably this is also an evolutionary adaptation -- research on pecking order in primates suggests that there are genetic components to social dominance hierarchies (proximally mediated by hormones, so that changes in hormone level by human researchers can subvert the hierarchy). Why is it adaptive to reinforce the social hierarchy even to the point of making the subordinates feel "bad"? Because feeling bad is preferable to challenging the hierarchy and literally having your head torn off. A geek who asks a girl who's "out of his league" for a date may only risk being laughed at today, but his reluctance may stem from an ancestor whose penalty for flirting with her might well have been death at the hands of the alpha male.

But I also suspect that the main reason that we see physical and emotional pain as being different is that we see emotional pain as uniquely human, something that separates us from "the animals". This desire for separation from "animals" (scare quotes because, of course, humans are a kind of animal and not an image of God) seems to be a strongly engrained trait at least in the Judeo-Christian tradition -- as is the traditional Judeo-Christian belief in mind-body dualism. Since we know that animals feel physical pain but are less informed about the animals' psychological worlds, it perhaps predictable that we would see emotional pain as uniquely human and thus unconnected with "animalistic" physical pain, a malady of some uniquely human "soul" rather than the mundane -- literally mundane, earthly -- body.

But both Judeo-Christian dualisms -- soul/body and human/animal -- are found to have less and less justification the more we learn about the brain and its genetic basis; I think the dichotomy of "physical" and "emotional" pain will similarly go away as we learn more about how the brain constructs pain.

Re:Safe?

[orthogonal]

Please ignore the above comment in favor of the corrected comment below; I must learn not to post after having three beers, as I tend to mismatch HTML tags.

As a bonus for your patience, I've added a few links that lend support for the idea that physical and emotional pain are similar.

Physical pain (like that of the burn victims) is one thing; emotional pain is something else entirely.

There was a recent study (posted here?) that suggests that both physical and emotional pain are produced by the same mechanisms in the brain.

When you think about this, it makes sense: why would the organism produce -- and "pay" both the additional R&D on a species level, and the additional "construction" costs on an individual level -- an entirely separate faculty rather than adapt on already at hand?

Not only that, the reason an organism feels physical pain, and the reason it feels emotional pain are pretty much the same: both serve to signal to the organism that its current activity, in its current environment, is detrimental to the organism. A burning pain in my finger tells me that either I should modify my activity -- by moving the finger --, or the environment -- by moving the stove-top the finger is touching.

Similarly, emotional pain -- feelings of guilt, or rejection, or etc., -- exist pretty much to tell me that I'm earning the ire of my fellows, and that my ancestors became my ancestors by virtue of not doing those ire-raising things. Those organisms that too often ignored pain, either physical or emotional, of course failed to become ancestors by virtue of that, and so the genes for ignoring pain tend not to have propagated as much as the genes for heeding pain.

So if physical pain and emotional pain exists to do the same thing -- essentially behavior modification -- and if evidence exists that they are produced by the same structures in the brain, why do we tend to take for granted that they are not the same things?

Part of the reason, of course, is that emotional pain can last far longer than (many forms of) physical pain. My guess is that this is partly because emotional behaviors -- such as social awkwardness or shyness -- are resistant to change, and part -- as with grief -- is due to reinforcement by memory. I'll further guess that this reinforcement by memory is to some degree an "unintended" side effect of the greater precision of human memory.

Why are certain social behaviors resistant to change? Probably this is also an evolutionary adaptation -- research on pecking order in primates suggests that there are genetic components to social dominance hierarchies (proximally mediated by hormones, so that changes in hormone level by human researchers can subvert the hierarchy). Why is it adaptive to reinforce the social hierarchy even to the point of making the subordinates feel "bad"? Because feeling bad is preferable to challenging the hierarchy and literally having your head torn off. A geek who asks a girl who's "out of his league" for a date may only risk being laughed at today, but his reluctance may stem from an ancestor whose penalty for flirting with her might well have been death at the hands of the alpha male.

But I also suspect that the main reason that we see physical and emotional pain as being different is that we see emotional pain as uniquely human, something that separates us from "the animals". This desire for separation from "animals" (scare quotes because, of course, humans are a kind of animal and not an image of God) seems to be a strongly engrained trait at least in the Judeo-Christian tradition -- as is the traditional Judeo-Christian belief in mind-body dualism. Since we know that animals feel physical pain but are less informed about the animals' psychological worlds, it perhaps predictable that we would see emotional pain

Re:Safe?

[wideBlueSkies]

Well, running around in downtown Manhattan every day it's kind of hard to not remember.

After all this time I still look up and expect to see those 2 buildings. Then I remember seeing the plane hit and all the fire.

I don't think memories like this are supposed to go away.

wbs.

Re:Safe?

[Tsu Dho Nimh]

"What helps is a private talk with a friend or mom, lot of sleep and active program. I can't see how virtual reality videogame-like setting can do any good for PTSD." PThen you've never really had PTSD ... by definition, it's something that time, supportive friends and activity can't help you deal with in a few months. It's not the presence of bad memories and flashbacks, it's their continued and incapacitating existence screwing up your life months later.

Re:Safe?

[chazwurth]

I have to disagree. I'm pretty sure the reason I see physical and emotional pain as being different is because they don't feel anything alike one another; they're so dissimilar from a phenomenological perspective as to be almost incomparable. The only reason I can see to call them both 'pain' is because they are generally both unpleasant. Thus I think that as we move into the future, and dualisms are, as you put it, found to have less and less justification -- not that they've had any for the last few hundred years -- my view of physicality vs. emotion will change not at all. Learning about how the brain constructs pain is academic. Feeling pain is not, and I'm not going to talk about two distinctly (experientially) different feelings the same way regardless of what the brain is doing. This is because I'm not doing science when I'm worrying about my feelings, and there's no reason I should be.

Don't get me wrong -- I'm not a dualist from a metaphysical perspective. But we simply don't experience what we call 'physical' and 'mental' events the same way, and that lends a hell of a lot more than judeo-christian mumbo jumbo to the list of dualist arguments. It also means that behaviorist and other reductionist arguments are extremely unsatisfying where talk about feelings is concerned -- yeah, it's just great that their philosophical agenda is so pure and clean and right, but they're a million miles away from anything that anyone actually feels.

Re:Safe?

[orthogonal]

I have to disagree. I'm pretty sure the reason I see physical and emotional pain as being different is because they don't feel anything alike one another; they're so dissimilar from a phenomenological perspective as to be almost incomparable. ...I'm not doing science when I'm worrying about my feelings, and there's no reason I should be.

Ah I get it.

You're one of those people who believes that you're conscious!

I mean, actually conscious, as opposed to being a pre-programmed, deterministic zombie with the illusion of consciousness a thin veneer painted over the ad hoc, jury-rigged, machinery of your essentially robotic being.

Well!

I'll have you know that I'm self-aware enough to know that my "self" is a mere convenient illusion. I know I'm a zombie, an empty mask on a ballistic trajectory through the world, a trajectory determined aeons before my birth by chemical interactions in my ancestor's genes.

So there!

Re:Safe?

[Jad LaFields]

Well, I think the idea is that you don't have post-traumatic stress syndrome because you aren't paralyzed and completely overcome every time you walk by ground zero. People with this syndrome don't need the memories necessarily to "go away", just not be incapacitating.

IANAPsychiatrist.

Detachment from Reality

[laymil]

So what happens when they come to rely on these techniques - people develop addictions to VR, just like they develop addictions to painkillers?

Sounds scary to me. Picture a person who can't live in the outside world because they have developed a psychological disorder based on the fact that the outside world only gives them pain.

Or the Slashdot reader who wants to experience VR so badly that he lights himself on fire...
that last one is definitely more likely, isn't it?

Re:Detachment from Reality

[Vthornheart]

Some would say that people already suffer from the new disorder you describe.

Like all medications, however, it stands to be abused. It's really up to the user to monitor themselves, or a doctor if such a system could be devised.

Re:Detachment from Reality

[harvardian]

It's not like patients take their VR machines home with them and dope up when their doctor isn't looking :-P

In all seriousness though, it's not like the simulation is of Cindy Crawford consoling you about your amazingly traumatic experience. It's an ACTUAL SIMULATION of your amazingly traumatic experience. How likely is it that people would turn away from normal life for the comfort of that?

Re:Detachment from Reality

[jdifool]

Try to light yourself on fire, and you then will see that even the strongest dependance to any kind of medicine will seem heavenly good compared to your fucking pain.

Those people just don't wonder. They want it.

Your reasonment is the one from a safe and non-burnt person.
You have *no* idea how these people suffer.

No offense to you, BTW.

Regards,
jdif

Re:Detachment from Reality

[CB-in-Tokyo]

While it is certainly possible to develop addictions to VR, it is a bit of a mistake to compare them to addictions to painkillers. Most of the painkillers that you hear about in terms of addiction are the in the family of natural or syntetic opioids. These drugs cause physical changes inside the body that lead to a dependency on the substance itself. This physical dependency is what is usually being talked about when you hear the term "addiction" concerning these products. This dependency can be so strong, that if you cut off the chemical altogether, the patient can die.

Having said that the problem of addiction to the VR, as you mentioned, is a real one. People become addicted to all sorts of activities, gambling, extreme sports, and sex to name a few.

VR is realtively new, and being used for a treatment for pain should undergo studies to check to see if addiction may be a problem, or if there are any other adverse effects...like the flaming slashdotter!

burns-are-serious dept.

[Anonymous Coward]

Is the dept. for this story some sort of attempt to stem the tide of "OMG VR pr0n 4 teh burn vict1mx0rz" jokes?

Somehow ...

[RPI Geek]

... this part of the article rubs me the wrong way:
In collaboration with Cornell University in New York, Hoffman has built a virtual reality programme that is a simulation of the events of 9/11 designed to desensitise the patient to the events of that day.
It just seems too "Clockwork Orange" to me... :-/

Re:Somehow ...

[westendgirl]

Unfortunately, I think CNN's constant running of WTC clips subtitled "American Under Attack" has already had this desensitizing effect. The images don't make me retch the way they used to. Is this the passage of time, or the effects of seeing the same thing several thousand times?

Re:Somehow ...

[fenix down]

No, Clockwork Orange had all that elegant Kubrick style. This looks like Microsoft Paint shit all over my Metroid cartridge.

Re:Somehow ...

[Rob Simpson]

Strangely, I find that I get more and more nauseous each time I hear the expression "9/11"... maybe it's the negative reinforcement.

"In this post 9/11 world, we must-" BRZZAP!

Re:Somehow ...

[Anonymous Coward]

Actually even lower resolution graphics (which happen to be necessary to render the world at acceptable frame-rates) still evoke a substantial response from patients, and can be used to treat PTSD.

I need this for school

[Flingles]

This would be great for relieving all that "intense pain" that I experience during class/study time.

Re:I need this for school

[ColaMan]

Nah, that's just the pain of one of your neurons struggling to bridge the 4-inch gap to the neuron on the other side of your head ;-P

"c'mon , feel the burn! no pain no gain!"

Dulls the Pain of Social Rejection

[spun]

Scientists today discovered that Virtual Realities can dull the excruciating pain of social rejection suffered by millions of geeks and nerds on a daily basis. It also helped them recover from the Post Traumatic Stress of Wedgies, Wet Willies and the dreaded Rear Admiral. Lead Scientist Nelson Muntz claims 9 out of 10 nerds enjoyed a Virtual Rear Admiral far more than the real version.

Re:Dulls the Pain of Social Rejection

[real_smiff]

I'm British and i know what a Wedgie is, but i've never (AFAIK) experienced a Wet Willie - care to enlighten me? :) Also have you heard of the Atomic Wedgie - it's when they manage to get your paints hooked right over your head. Painful - i've heard, and yes, it *is* possible. Plus of course, there's always Posting - three men, two legs (apart), one post.

Re:Dulls the Pain of Social Rejection

[XorNand]

1. Gratuitously slobber on your index finger.
2. Insert said digit into closest, unsuspecting victim's ear.
3. Rotate wrist.
4. Cackle madly when they convulse at the sheer digust and horror of having to endure contact with your bodily fluids.

Re:Dulls the Pain of Social Rejection

[CB-in-Tokyo]

1. Gratuitously slobber on your index finger.
2. Insert said digit into closest, unspecting victim's ear.
3. Rotate wrist.
4. Cackle madly when they convulse at the sheer digust and horror of having to endure contact with your bodily fluids....

5. ...Profit???????

I wonder...

[bersl2]

if this means that in the distant future, I won't occupy the whole nursing staff for 15 minutes, while they try to give me a shot?

Yes, I still have this childish behavior, because I don't like needles, and I don't like going into shock, which is what happens every time; yet, I don't want to be a nuisance.

My arm is hurting right now, just thinking about this whole topic...

Re:I wonder...

[achurch]

Close your eyes (so you don't see the needle) and bite your tongue (fight pain with pain). I used to scream like the devil, until my mom taught me that; works for me every time.

Both sides shown

[Mikmorg]

Just remember, as with all emergant technologies, there are ups and downs, depending at who's disposal the technology is used. This could be, and sounds like it is, helpful towards medical purposes, and as others have mentioned, sure it could have problems with making a person desensitized.

I say, give it time, take it slowly, and just hope for the best.

Speaking of downsides, I can't imagine what the government is thinking about doing with this sort of stuff :P

Hmmm ...

[rholliday]

Now, I wonder how interactive these VR sessions are. Could the burn patients injure themselves by getting too into it? How "real" are these memories for the PTS patients? Will they fell like observers, or participants?

Why not slashdot

[foidulus]

Why not just have them read slashdot at -1, that usually makes me forget about my painful, painful life....ow...existance

Spooky coincidence...

[wiresquire]

Here I was reading Tad Williams Otherland where one of the characters (Orlando Gardiner), is very ill and spends most of his time in a virtual world as an escape from reality.

Is this science following fiction ?

Re:I believe we already have a cure...

[Vthornheart]

That also poses a point about the great benefits for Burn Victims... I've been focusing on the PTSD part of it a bit too much...

Finding a way to distract patients from pain is a far greater solution than medication. No side effects, no expensive or addictive substances to use (well, those who really like MMORPGs would disagree with my "addictive" statement, but...), and in general would be preferred over medication.

I mean, this daily dressing routine... it takes only a fraction of the day. Giving them morphine for it then ruins the majority of their day, as they spend it in a near-lifeless stupor. And without anything, those few minutes of the day would no doubt be torturous...

Distraction

[ChimpyMonkey]

..how is this any different from when you were a child, your mother distracting you from injuries with a lollie/toy? I know it used to work on me, and it sure works on my girls. It seems a bit of a reach to claim this is anything new.

Everyone is talking about addicition

[juebay]

I am fearing that the sue-happy United States will take this too far someday. "Yes. I am suing the following landmarks: Colorado River, Niagra Falls, Victoria Falls, and the Atlantic Ocean shore located 2 miles south of Atlantic City for knowing full well the use of white noise generated at these locations were addiciting but still distributing these addicting items to minors, the handicapped, and the elderly"

Re:I believe we already have a cure...

[Anonymous Coward]

Ok troll.

I can tell you I just got out of the hospital after having a tension pnuemothorax (life threatening)and I can tell you that morphine is about as useless as a nun with two tits. Might as well just smoke some 7up (the *good* addicts will know what I mean).

Morphine is useless. It does nothing but make you want better drugs. The pain is still there. A good hit of some BC Bud would do much better. Plus, I can't walk straight after morphine.

Doom 2 did it for me

[sam0ht]

When my mouth was aching like hell after a trip to the awful dentist (orthodontist), playing iD's finest kept my mind off the pain very effectively. No time to whimper when you're fragging your friends :)

Re:I believe we already have a cure...

[beaverfever]

"It's called morphine."

Wow - that's quite a medical breakthrough you have made. I'm sure the global medical community would like to hear more about this as it seems this idea never occured to them to use painkillers before.

Okay, enough with the sarcasm. If you had paid closer attention while reading the article you would recall this:

"Dr Hunter Hoffman, research fellow at the Harborview Medical Center in Seattle, has tested his virtual worlds on victims of burns injuries who suffer excruciating pain during their daily dressing changes which conventional drug therapy fails to control."

That's gotta be a lot of pain.

Funny enough...

[sunbeam60]

I had a HGNS while taking my JKL, so HYSA and he LPHN'ed me.

Try it in OB/GYN!

[sssmashy]

"Pain requires conscious attention. Humans have a limited amount of this and it's hard to do two things at once," he said.

I truly relish the day they give this VR "distraction therapy" to women giving birth...

Wife: OH MY GOD, THE PAIN!

Husband: Keep pushing, love! Keep pushing!

Wife: I AM! I'm trying, but he won't come out! Enough of this natural childbirth shit, I WANT AN EPIDURAL... oooh... hey, look over there...

Anxious Husband: What? What is it, honey?

Wife: it's a polar bear!

experience on a small scale

[beaverfever]

Dr Hoffman believes pain contains a significant psychological element which is why distracting thoughts by virtual reality lends itself so well to pain control.

"Pain requires conscious attention..."

I've bought into this idea ever since the day I was curious and watched a mosquito land on my shoulder, get into its stance and pierce my skin. I was really shocked at how much it hurt in that one instance.

This has been going on for quite a while

[FisterBelvedere]

I remember seeing a report on this probably around 10 years ago. The technology was in its infancy but was being used to adjust people with a fear of heights. A link with information along these lines (found it in 2 seconds on google) is here:

Here

even the screencaps look the same as in the story I remember, and they appear to have the look of 10 year old renderings.

What's the big deal?

[stephanruby]

Numbing the pain of not having a girlfriend. I've been doing this myself for years.

Why the memory generation won't work

[Lordofohio]

The memory playback is a nice (but scary) idea, but I don't think it could ever be implemented correctly. If the plan is to play memories until a patient accepts what happened, a new memory program/video/experience would have to be generated for every patient.

A shooting victim would need a different experience than a burning building survivor, who would need a different experience than the train wreck survivor that comes in the next day. Since the situations would have to be fairly specific for each individual case, this would be nearly impossible to implement.

Also, if each different video/experience is produced, why not play it on a television? Even a big screen, if you want. I know the goal of the VR is to immerse the subject in the virtual world, but I don't know that it would be that much more effective than good old fashioned photos, videos, and psychiatry.

The undertreatment of pain problem

[ortholattice]

While VR pain relief may work to some degree initially, once the novelty wears off, or on an off-day when you just can't get interested in its "game", you'll probably find yourself screaming with pain.

Should I ever find myself in such an unfortunate situation, may God have mercy on me and set me up with an MD who will prescribe adequate opioid pain relievers. Currently that is the only thing that works, period.

Too often these days MDs are paranoid about prescribing opioid pain killers, what with the DEA breathing down their necks. See The DEA's Disastrous War Against Pain-Treating Drugs for example. It is customary to encourage the patient to grin and bear it or to seek pain relief through alternative therapies like meditation etc.

I myself have had minor surgery were they'll give you plenty of local anesthetic during the actual procedure; then they send you home with instructions to take tylenol. When the anesthetic wears off, the pain kicks in. It is only by whining and complaining that they'll prescribe an opioid painkiller, and unless you go to the ER (and sometimes even if you do) you'll be in pain for hours more until all the paperwork and procedures are done to get the prescription filled.

Chronic pain patients are in a real bind these days. They cruelty towards them by denying them long-term opioid pain relief is unspeakable.

What is a rear admiral?

[Anonymous Coward]

Taken from http://www.snpp.com/guides/rear.admiral.html

OK, so everyone was asking what the hell a rear admiral was. It was
first mentioned in 1F04, last year's hallowe'en special.

> Bart: Milhouse...Milhouse, wake up, quick! Look out the window.
>Milhouse: No way, Bart. If I lean over, I leave myself open to wedgies,
> wet willies, or even the dreaded rear-admiral!
>-- Covering his ass, so to speak, "Treehouse of Horror IV"

Bill Oakley, who _wrote_ that part of the script with Josh Weinstein,
emailed me the definitive answer as to what a rear admiral is.

>Regarding "Rear Admiral," I think the answer is probably as
>disappointing as you feared it might be: it doesn't exist. Here is
>the actual first draft script excerpt from the Halloween show:
>
> BART
>Milhouse. Milhouse, wake up. Quick, look out the window.
> MILHOUSE
>No way, Bart. If I lean over and put my face against the window,
>you're gonna smash it, or maybe pinch my butt real hard.
>
>This was the first draft. In re-writing it, the writers wanted to go
>for something a little funnier, something that would sound like it was
>from the family of "flying wedgie," "purple nurple," etc. Someone, I
>do not remember who, said "Rear Admiral." It sounds real, having the
>word "rear" in it, but it was manufactured to sound real. As far as we
>know, it doesn't really exist.

virtual world view

[tloh]

One of my friends is a practitioner of Christian Science. If I understand what he tells me, Christian Science teachs that we experience the world because we choose to give it all a realty. In other words, it's all in your head. Most would agree there is some figuratively truth to this, but Christian Science takes it literally and uses the idea as the central component of their system of health and well being by wrapping this metaphysical layer around the bible. I wonder how he would react to the article. On the one hand, there is validation in the fact that we can channel positive perception into better health and healing. On the other hand, Christ and Christianity is completely unnecessary as implemented by the doctors featured in the article. I've tried to point out you don't need the biblical stuff in numberous conversations, but now there is something concrete I can show him.

Post Traumatic Stress and other usages of VR

[rpiquepa]

It just happened I wrote yesterday about the usages of VR to treat fears. A company named Virtually Better, based in Georgia, creates virtual environments mixing video images and computer-generated ones to help people deal with their fears and anxieties. In this article, the New York Times (free registration) writes this costs only 10 percent more than conventional therapy. The newspaper adds that therapists using this system claim a success rate exceeding 90 percent. Virtually Better "has created scenes of a glass elevator and a bridge to address fear of height, an airplane cabin for those who fear flying and a thunderstorm to diminish fear of bad weather." Other environments address the treatment of substance addiction or of post-traumatic stress. A (Virtual) Therapist's Dream contains selected excerpts. It also includes images on the virtual airplane environment.

Lucid Dreams would be better and more realistic

[Anonymous Coward]

Lucid Dreams would be better than VR, and more realistic.

These are dreams where you are aware that you are dreaming, so one of the things you can do with them is this 'therapy' mentioned in this story. Even Dr Laberge mentioned a similar therapy.

See www.ld4all.com for further information.

reliving

[Tom]

Oh yes, reliving a traumatic experience is one great way to cure people.

The approach is quite controversial in psychology. There is enough indication that it will only dull instead of cure, and that in some cases it will increase the trauma.

Survivor Guilt

[malia8888]

Some years ago I wrote a small book for the V.A. for spouses and children of veterans with PTSD. I found in talking to soldiers and other victims of PTSD that survivor guilt was such a crippling part of the disorder. So, I found this snippet encouraging in the article: One patient overcame her sense of guilt at running away from the scene and failing to help others who subsequently died.

If this treatment can truly help deal with survivor guilt, then it is a very useful therapy.

Memories can be relived until they are accepted

[RyatNrrd]

We found nuclear weapons in Iraq.
We found nuclear weapons in Iraq.
We found nuclear weapons in Iraq.

Thank You!

[Anonymous Coward]

What a wonderful link/s!

I was sexually abused repetdedly by my family dentist when I was six (he used a gas hose placed behind my head, but near my face, I can still hear the hissing sound...), I'm now 49, and have been dealing with the repercussions of those terrifying encounters for decades without actually realizing it (since my parents wouldn't believe that he was using gas on me, and I didn't know how to say I was being abused).

Since I started working with a good therapist my life has just blossomed!

But those fantasy's since I started to deal with this stuff... wow... and weird, to be sure!

Glad to know I can get through it all, and move on.

And that I'm not a nutter.

Anyhow... thanks for the links, lots of neat stuffff here.

Thanks a lot!

Opiate Withdrawl

[The Tyro]

Is not usually life-threatening (you'll certainly wish you were dead while you're going through it, but you don't usually die).

Much more dangerous are the withdrawl syndromes associated with Alcohol and Benzos (diazepam, lorazepam, alprazolam... aka Valium, Ativan, and Xanax, respectively). Those folks have a much harder go of it than heroin and painkiller addicts, at least physiologically speaking... they get autonomic hyperactivity, refractory seizures, hallucinations... there's a very significant mortality if not medically treated.

Stimulants tend not to have such a severe withdrawl syndrome, at least in a life-threatening sense. I'm referring to cocaine, methamphetamine... there's a crash when you come down, and they can deplete your body's stores of catecholamines and other neurotransmitters, leading to periods of agitation, depression, insomnia, etc, but that's typically after longer term use.

A psychological addiction to VR should be a very minor issue compared to any of the above.

They can knock themselves out

[The Tyro]

as far as I'm concerned... if a VR simulation takes a patient's mind off their pain, God bless 'em.

Listen... I've spent my share of time in burn units, where the morphine flows like a mighty river; VR is far preferable to using drugs, with all their attendent side-effects. Also, contrary to popular wisdom, addiction isn't usually a problem... only a very very small percentage of burn unit denizens ever develop an addiction to their narcotics after they recover, and there's large studies and good research to back that up... anyone who tells you that narcotic use for severe pain makes normal people into addicts is about 20 years out of date.

Honestly, we already use a pharmacological variant of VR in pediatric burn units... it's called Ketamine (or "Special K" to all you ravers out there stupid enough to use it). Ketamine creates a dissociative anesthesia, and is sometimes used in kids who are having their dressings changed.... it's not really recommended in adults because it can produce extremely vivid hallucinations... most kids I've used it on report nothing, or just say "I had a bad dream."... gotta love kids. I personally think the difference in experience between pedi & adult has to do with the amount of bad things adults carry around in their subconscious... there's something to be said for innocence.

Whether it's distraction (I use that on kids all the time), the gate theory of pain, or whatever. If it works, I say use it... it's certainly preferable than risking the side-effects of mega-doses of narcotics.

Neurolinguistic programming

[Mxyzptlk]

Have you heard about NLP (neurolinguistic programming)? NLP is a therapy method which is based on reliving a traumatic period - and yes, this is used on PSTD patients, such as refugees from war ravaged countries (see Dr. Richard Bolstad's work), or rape victims. The basic idea of NLP is that the patient replays the traumatic event inside his/her head multiple times, while varying the playback speed, colours, pitch of the sound et cetera. The goal is to replay the event in such a way that it is so ridiculous, that you cannot help laughing at it, thereby creating a more positive (or less negative) feeling towards the traumatic event.

So:
- NLP has been shown to work very well, and
- NLP is very similar to the VR technique in that you relearn your response to a traumatic event with more positive feelings.

By the way - where did you learn to program? You should get your money back...

Re:Neurolinguistic programming

[cr0sh]

I have three books on NLP - Frogs into PRINCES (by Richard Bandler and John Grinder - ISBN 0-911226-19-2), TRANCE-formations (by same - ISBN 0-911226-23-0), and Using Your Brain for a CHANGE (by Richard Bandler - ISBN 0-911226-27-3). These were all published between 1979-1985 - and are easily among the most strange of books I have in my occult collection.

I found them at a garage sale at a house in Escondio, CA - being sold by a family that as far as I could tell, spoke no english at all. The titles and the covers looked interesting, and the subtitles detailing "Neuro-Linguistic Programming" seemed like they would fit right into my occult collection anyhow, so I purchased them.

As I said, the covers were interesting - all of the book's covers have a strange, near psychedelic flavor to them - fanciful images of dragons and wizards (though the last book, which has the latest publication date, drops this look in favor of a more refined outdoor scene of gloomy mountains in the backdrop, a green meadow with colorful flowers and a waterfall in the foreground, with a "transparent" profile of a person where everything is tinted "lighter" through it). I only got about halfway through what I thought was likely the first book (being of the earliest publication date), "Frogs into PRINCES". I believe this to be the only book I have ever read that screwed with my mind, in a very strange way.

As I was reading it, I was also trying to use some of the techniques, because they seemed like very powerful tools, for both internal and external use. As an example, one of these tools involved recognizing body language, and using that in opposition to what you were saying (simple example, nodding your head "yes" while discussing something in a negative tone, or disagreeing with someone) - this was a tool by which you could convey information to others to stimulate them to perform certain things in a certain manner. There were other techniques of a similar nature, some which you could use internally.

As I read, my SO (now my wife) was telling my that I was changing - that I acted differently since starting to read the book. She asked me to stop reading the book, which I did, because I could feel this change as well - and it bothered me. After I stopped reading the book, I felt that a curtain or something had lifted, like a slight fog or something.

Now, I realize that this is just a anecdotal story, and that it carries no weight from an objective standpoint - take it as you will. I have kept these books, though, and I intend one day to try reading them again, knowing my prior experience.

What you describe of NLP I never got to in the books - perhaps it was in a later chapter or in one of the other volumes which I didn't read? The technique, though, sounds like something from NLP. I still don't know what or why these books are - they seem like self-help books, but if they tend to affect others like they did me, I wonder just what NLP really is about - and what its ultimate use could be? Personally, I wasn't looking for a self-help or self-change book - but I was interested in the idea of "hacking my mind", so to speak (yeah, I know that sounds like a contradiction. I was only looking for changing myself in a controlled manner for the hell of it and to learn how to do it in a different manner, not because I felt I needed it - probably not a good reason, now that I look back on it)...

Tell me

[The Tyro]

you should see it from my perspective... I often get patients who have chronic pain, and show up in my ER looking for medication refills.

I often can't help them, or at least, not the way they want... some of these people are prescribed monster doses of Oxycontin, MS-contin, Methadone, you name it. I treat acute pain in the ER, but I can't refill someone's 90-count bottle of 80mg Oxycontin tablets; it's inappropriate practice. I'm not trained or credentialed in chronic pain management, I've never seen the patient before, will probably never see them again, and those kind of medications at that kind of dose require follow-up (something I'm not set up to do), adjustments, documentation, etc... and I don't need to get "interviewed" by the DEA any more than the next doc. Ironically, some time ago the feds hauled away a physician in an area where I was practicing... then all his patients couldn't get their medications any more, and started coming to the ER looking for refills. Unfortunately, I'm ill-equipped to fill that void.

Chronic pain is a real problem, not only for the docs who run the pain clinics and take care of these folks (they're well-advised to keep impeccable records), but for guys like me who get caught in the middle.

And dont even get me started with the addicts and abusers who doctor shop... using the exact same stories as the chronic pain folks in an effort to get their party supplies for the weekend... those gomers are the bane of my existence.

Pffffft...

[Gil2796]

This is old news! Every /.er knows that the Internet takes the mind away from the pain of real-world existence.

Resume therapy!

Pain vs. pain

[achurch]

But I also suspect that the main reason that we see physical and emotional pain as being different is that we see emotional pain as uniquely human, something that separates us from "the animals".

I can't speak for anyone else, but I always saw it as the difference between a point source (physical pain) and lack thereof (emotional pain). I agree some people may take the human/animal point of view, but I wouldn't go so far as saying that physical and emotional pain are "the same". To put it in /. terms, Windows and Linux are both "produced" by the same hardware, and have the same general purpose--but I don't think anyone would claim they're the same thing!

As far as souls go, I'm reserving judgement for now--ask me again when you've got a human backup system working. ;)

Been there (Burn units) and this is GOOD!

[Tsu Dho Nimh]

I've worked in burn units, and had a couple of deep tissue burns as a kid, and even if this only works on 5% of the patients, it's worth using, starting NOW!

• It doesn't add anything to the load of medications they are already on.
• It has little chance of undesireable side effects, such as the breathing depression of opiates.
• If it minimizes stress, it minimizes the biochemical load of stress hormones that interfere with healing.
• It gives the patient control over something in an otherwise helpless situation (you have very few choices in a burn unit except maybe what to order for lunch, and that's hospital food)
• It gives sensory stimulation in a very DULL environment of limited visitors, staff in biosuits for your protection ... nothing to do but think about how bad it hurts, contemplate your chances of permanent disfigurements, and hurt

Creating more VR worlds for those that aren't helped by the action games would be a logicla next step.

It's retraining your brain to NOT panic

[Tsu Dho Nimh]

PTSD patients reliving memories until they're accepted? Doesn't that seem a little like forced traumatic recollection?

It works because it is under the PATIENT'S control. They can rerun the images, repeatedly stopping at a spot that makes them uncomfortable until they are comfortable there, then run a bit farther the next time. Similar to the "fear of flying" seminars that start with looking at pictures of planes. You help them push into an uncomfortable zone until they learn that fear won't kill, it's just unpleasant, and the memories no longer trigger excessively strong emotions.

There is a portion of your brain called the amygdala that triggers fear way under the level of consciousness. It has a hair-trigger in persons with phobias and PTSD. It can be retrained to stop sounding the alarm so quickly, which is what various "exposure" therapies and hypnosis do.

desensitized != no emotions

[Tsu Dho Nimh]

"I personally don't like the idea of getting over an emotional trauma by 'desensitizing' myself to it, as the article seems to suggest. "

The term "desensitized" has a specific meaning in psychiatry and psychology: it does not mean "callous" or "indifferent". It means that a certain stimulus no longer creates as strong an emotional reaction as it once did. And for PTSD and phobias, those emotions are so strong and incapacitating (they replay at the original intensity or even higher, and with the added fear of another attack or flashback) that the patient is unable to come to terms with them until they are desensitized.

Messing peoples lives up

[aminorex]

Why mess up peoples lives with this therapeutic
crap when there are perfectly good drugs available
that cure the problem?

also

[SolemnDragon]

i'm on the other side: i'm a patient who works with other patients. Fibromyalgia, for example. And the first thing that they come crying for is, "How do i get my doctor to prescribe pain meds?"

The first answer that we have to give- HAVE to, because we don't know them, either, is, "You don't."

Plain and simple, unless they are doing EVERYthing else- the physical therapy, the exercise, the effort, the tests for concurrent/comorbid conditions, they shouldn't be given pain meds. It's a tough rule but a vital one, because it pushes them into a relationship with the doc, so that they can get checked out, make sure that they aren't just doc shopping.

And we tell them that if the doc gives them a scrip on their first visit, something's wrong. We have to tell them the order of things that will be tried, and explain that some of them might help. It's hard because the perception in this country is that there's a pill for every problem, and with pain meds, that's just not always the case. When they get to the pain med stage, and find themselves with side effects, some of them get angry, because they wanted it to just be all better, why would these meds be held back unless they really fixed everything?

But that's not how it works. So we end up with people getting depressed, and even when we explain all this up front, it still goes that way for some people. For others, the pain meds work, and we wish that they could actually get them when they needed them to start with, without all the secret personality testing.

This looks like it's a great idea. One thing that i have to say for biofeedback and other therapies- they work on the biofeedback level, but they also work because they are something different. they can distract the person from their pain long enough for them to focus elsewhere, and if you're going to learn to live with chronic pain, that's a very important skill.

I think this is a great idea. I know that they did a study a long time ago showing that people who exercised to music or some other distraction felt less workout pain than people who focused solely on their workout. I use that study all the time.

I'll be very hapy when this makes it to take-home stage, and i'll be interested in seeing if it can be combined with workout equipment, for example, for some of the physical therapy that some of my fellow patients have to go through. When they haven't moved much for awhile, i get to see people cry when they try to start up again. And it's not because they're wimps, it's that extra 300-400% of pain chemicals along with the muscle atrophy.

sol

Yeah, well duh.

[SyniK]

School sucks.
I'll play a game instead.

Work sucks.
UT2K4 is nice.

Girls are EViL...
(X-Com) UFO is a nice distraction.

Etc, etc, etc. Gamers have known the escapist and therapeutic benefits of games for years :).

If VR can heal, it can harm.

[yeggman]

I think a case can be made that First Person Shooters are VR. And from the articles descriptions of the VR they use with patients, I'd say PFSs are a hell of a lot more sophisticated than what their using on patients. So what are the effects on the human mind of going through 4 hours of virtual war a few nights a week? I think it's only a matter of time before we start seeing gamers come down with Post Traumatic Stress Disorder. I should know I game. Have you had trouble sleeping after a long night of gaming? Can't close your eyes with out images of fire fights coming to your mind?
Doesn't sound like a healthy mind to me.
All things in moderation.

It has nothing to do with VR...

[DynaSoar]

... it has to do with attention, specifically divided and focused attention. I've replicated some VR experimental work using VR vs. other techniques for redirecting attention. The techniques work according to how deeply the person can immerse themselves into the alternate stimulus context. Hypnosis is extremely good, but some people are better at hypnosis than others. Manipulating a physical object is exactly as effective as manipulating an object in VR (I got the same results with $20 worth of wooden blocks that someone else got with an SGI Indigio and complete submersion VR tank, worth $40K).

The one technique I haven't got to try yet is implicit learning under anesthesia, which seems to work like hypnotic suggestion, but doesn't rely on the person's own ability; it works the same for everyone.

Whenever you see any study claiming "VR does so and so" question why it took VR to do so, and what else might also work. There's nothing magical about VR that almost certainly can't be done as well for cheaper.