After a burn injury, more than 90 percent of patients experience some form of stress, and as many as one-third of patients develop post-traumatic stress disorder. Wound care for burns — including cleaning wounds, scraping the skin and changing dressings — can be painful and distressing for patients, many of whom report itching, pain, nightmares and anxiety during treatment. Patients being treated for burns are often prescribed opioids, but some continue to experience pain, even as their dose of opioids is escalated.
Brigham investigators have teamed up to test out a new intervention to see if they can help ease some of the distress during dressing changes and help reduce the need for high-dose opioids. Using olfactory virtual reality (VR), they will immerse patients in a virtual world that engages their vision— and their sense of smell.
“Distraction can be a highly effective tool. Our goal is to rigorously test just how effective it can be for patients experiencing pain, anxiety and trauma after a burn injury,” said Anupama Mehta, MD, the medical director for the Burn Center in the Division of Trauma, Burn and Surgical Critical Care and Emergency General Surgery. “If successful, this will represent a truly multi-disciplinary effort to help our patients.”
An Immersive Experience
A week before the end of his residency at Johns Hopkins Medicine, Jason Ross, MD, now a member of the Brigham’s Department of Anesthesiology, Perioperative and Pain Medicine, got a call from the burn unit at Johns Hopkins. His colleagues there had heard about a project he was working on that explored whether a VR platform that included scents could help improve pain tolerance for patients with chronic pain and avoid the need for sedation. Ross talked with his colleagues about the technology’s potential to help burn patients, especially during dressing changes, but the timing was challenging since he would be departing soon. But the call stuck with him. When he arrived at the Brigham, he wasted no time in pursuing a collaboration at his new institution.
“As soon as I got my Brigham email address, I emailed Dr. Mehta about teaming up to help patients,” said Ross. “And Dr. Mehta immediately wrote back to say yes.”
Previous studies have examined whether VR can help reduce pain during wound cleaning, especially among children. But olfactory VR has not been studied in this context. Ross and Mehta thought that the added element of scent might help make the VR experience more immersive for patients and further reduce pain levels and opioid requirements. But the path forward for testing this idea was uncertain. Then an email about a “Shark Tank” came into Ross’ inbox.
“I remember thinking, ‘Our project is right up the Shark Tank alley — this is what we should go after,’” said Ross.
The Brigham Research Institute’s Health & Technology Innovation Awards (informally known as the “Shark Tank”) fund innovative and high-risk/high-impact projects in the basic, clinical, digital and translational realm. Since 2012, more than $1 million has been distributed to Brigham investigators.
Ross and Mehta worked with the Brigham’s Digital Innovation Hub to refine their pitch and presented their project at the fall 2021 Shark Tank to an audience of internal reviewers and philanthropic supporters. Their project, titled “Can Olfactory Virtual Reality reduce opioid consumption and improve tolerance in burn patients undergoing dressing changes?” came in second place.
How It Works
Ross and Mehta are getting ready to launch a pilot project and will enroll eligible patients into a randomized trial. Half of patients will receive standard-of-care treatment while the other half will put on a device developed by the company OVR Technology, which is comprised of a traditional VR headset along with an olfactory plug in. Patients can then pick the virtual world that appeals to them. These worlds might include a forest where a participant can pick up a flower and sniff it or a beach scene where a participant can smell the ocean.
The study’s primary outcome will be opioid/narcotic reduction with the use of olfactory VR. Secondary outcomes will include subjective patient measures including anxiety.
“Burns can produce a lot of pain and anxiety, and there’s a pre-anticipatory aspect to wound care,” said Mehta. “Being immersed in virtual reality may help patients during this stressful time.”
Both Ross and Mehta note that their project’s progress to date has been thanks to cross-disciplinary collaborations between their departments — surgery and anesthesia — and enthusiasm across members of patient care teams.
“We’ve heard from nurses who are especially excited about this work,” said Mehta.
And their Shark Tank success has led to new potential collaborators.
“After we took second place, I got an email from a computer scientist who wrote to say they had an idea I might be interested in,” said Ross. “And you just never know — that idea might lead you to something entirely new.”