How Video Games Can Make You Forget Pain

We speak to cognitive psychologist Hunter Hoffman about the link between video games and physical pain, and why virtual reality is a better distraction than Mario Kart.

Inside the Human Information Technology Lab at the University of Washington in Seattle, cognitive psychologist Hunter Hoffman is using video game technology to help patients forget their pain.

Hoffman is a pioneer of virtual reality therapy (VR): a distraction technique that requires patients to immerse themselves in a computer-generated environment as a way to control and overcome physical pain. The therapy is based on an influential 1965 theory by Ronald Melzack and Patrick Wall referred to as "the gate control" theory: the idea that what a person is thinking, and where their attention is directed, can influence how much pain they experience. This is where SnowWorld comes in.

SnowWorld is a virtual reality world created specifically for use with burn patients. Developed by Hoffman and colleague David Patterson with funding from Microsoft cofounder Paul G. Allen and the National Institutes of Health (NIH), the game produces the illusion of floating through an icy canyon with a frozen river and waterfall as snowflakes drift down on the scene. As patients walk through the canyon, they use a PC mouse to shoot an unlimited number of snowballs at enemies, which take the form of snowmen, igloos, robots, penguins, flying fish, and wooly mammoths; as soon as the enemies are hit, they disintegrate and reappear later on (with Paul Simon songs from the album Graceland playing in the background.) To enter SnowWorld, patients look through a pair of virtual reality goggles with a wide field of view, commonly used by the military to train forces. Patients wear noise-cancelling earphones, while specialized hardware holds the VR goggles near the patient's eyes.

A soldier at Brooke Army Medical Center trying SnowWorld pain distraction while his wound care nurse cleans his combat-related burn wound. Picture credit: Hunter Hoffman.

The game is specifically designed to help burn patients during wound care, a painful process that involves cleaning and re-administering bandages and treatments several times a week. While conducting early clinical trials with healthy volunteers, Hoffman and Patterson found a significant correlation between the potency of the illusion--how strongly the subjects felt they were immersed in the virtual world--and the alleviation of pain, administered in small doses during the trial. Using functional magnetic resonance imaging (fMRI), Hoffman and his team scanned the brains of healthy volunteers using SnowWorld to measure what effect the game had on their ability to register pain; the results showed on average 30 to 50 percent reductions in pain.

There is a limit to how much information people can process--with burn patients, playing SnowWorld leaves less attention available to process signals coming in from pain receptors, patients spend a lot less time thinking about their pain during wound care.

"Expecting pain is one way psychological factors can amplify or increase how much pain a patient can experience," Hoffman says. "The logic behind virtual reality pain distraction is based on a very old concept….as old as using a baby rattler to distract a baby from crying. I think most distractions are simply not compelling enough to compete with pain for attention at the level we are seeing VR work. There is a limit to how much information people can process. With burn patients, playing SnowWorld leaves less attention available to process signals coming in from pain receptors; patients spend a lot less time thinking about their pain during wound care."

Hoffman first became interested in blurring the distinction between reality and virtual reality during his time as a pre-graduate assistant of Marcia Johnson, a memory researcher at Princeton University. Johnson originated a theory called "source monitoring," centered on figuring out how people remember if something really happened, or if they only imagined it did. When he began work at the Human Information Technology Lab in Seattle, Hoffman began using virtual reality to test his theory that the stronger the illusion of going into a virtual world, the more attention would be devoted to that information. This idea parallels the argument that video games, as a form of interactive media, are more immersive than noninteractive media such as films, books, or music.

But Hoffman discovered that consumer video games just aren't immersive enough to do the trick. In an experiment using two teenagers suffering from severe burns, Hoffman and Patterson had both patients play Mario Kart 64 and Wave Race 64 on the Nintendo 64, as well as a virtual reality game called SpiderWorld, an earlier version on SnowWorld designed to help phobic patients overcome their fear of spiders by slowly introducing them to the arachnids in a virtual kitchen environment. (Both patients played while undergoing wound care.) What Hoffman and Patterson found was that both patients experienced a reduction in pain and time spent thinking about pain when playing SpiderWorld than when playing the Nintendo titles.

"Although Nintendo can hold a healthy player's attention for a long time, the illusion of going inside the two-dimensional video game was found to be much weaker than the illusion of going into virtual reality. The ability to give users the sense that they are 'somewhere else' can be of great value in a medical setting.

"While the graphics are better in video games than in SnowWorld, the high immersion of the VR system is thought to be the key difference. The wide field of view VR goggles stimulate both central and peripheral visual fields and block patients from being able to watch their wound care or to even see the hospital room."

SnowWorld may be graphically crude, but it works.

After seeing the effects of VR, Hoffman and his team decided to kick it up a notch and create SnowWorld. Currently, Hoffman uses VR to treat three types of patients: burn victims, phobia sufferers, and those affected by post-traumatic stress disorder, afflicting a large number of US military personnel returning from Iraq or Afghanistan. For phobia sufferers and post-traumatic stress disorder, Hoffman uses VR exposure, which works oppositely to VR distraction by gradually exposing patients, via a virtual environment, to the object or situation they are avoiding, be it a spider, a plane, or, in the case of post-traumatic stress disorder, the memory of a traumatic event.

"Hundreds of thousands of soldiers return with some major psychological problems that need to be treated," Hoffman says. "For example, if a soldier sees a terrorist blow up civilians in Iraq, those images can haunt the soldier later, causing nightmares and a wide number of other symptoms. Combat-related post-traumatic stress disorder is known to be unusually challenging to treat. If successful, VR could help hundreds if not thousands of lives of young US troops with psychological issues that need to be addressed to accelerate their reintegration into society."

Encouraged by their results with SnowWorld, Hoffman, Patterson, and UW anesthesiologist Sam Sharar MD are seeking funds to develop SnowWorld 2.0: SuperSnowWorld, which will add lifelike human avatars, a multiplayer option (so two patients or a patient and a caregiver can play together), as well more enemies (monstrous insects and animated sea creatures are at the top of the ideas list). Hoffman is confident that with more research and clinical trials, VR therapy can one day be used regularly to help treat a wide range of anxiety disorders, from phobias to more severe cases of post-traumatic stress disorder, as well as alleviating pain in medical procedures, surgery rooms, physical and post-injury therapy, right down to everyday pains and fears, such as a trip to the dentist.

"The illusions produced by these programs are nowhere near as sophisticated as the world portrayed in films like The Matrix. Yet virtual reality has matured enough so that it can be used to help people control their pain and overcome their fears. As the technology continues to advance, we can expect even more remarkable applications for virtual reality in the years to come."

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71 comments
irishdude199210
irishdude199210

[This message was deleted at the request of the original poster]

Lord_Straffan
Lord_Straffan

When my lung collapsed I was in the hospital for several months. The games on my iphone helped keep my mind off of the discomfort from the tubes in my chest. There's no doubt in my mind that video games can help patients forget their pain.

Ghosthunter54
Ghosthunter54

I think this sounds pretty great. I hope they keep taking this farther and helping people. Video games are fun and all, but it looks like they're becoming something more good than just fun, and that's definitely a good thing.

deviant74
deviant74

when i decided to stop smoking I played links golf for 2 days.

mdboomer
mdboomer

Listening to Paul Simon usually induces not reduces pain!

James00715
James00715

I've long known this about video games. Many times while sick playing video games seemed to make me feel better than if I just watched TV. It distracted my brain so much it couldn't worry about my symptoms.

JabbaRancor
JabbaRancor

What needs to be realized here is that SnowWorld is NOT a game. It is a VR simulator. Not a game. Call of Duty, Mario Kart, Mass Effect, Tetris will not do what this kind of VR does. The snowballs are provided for interactions, but this is no game. It's goal is to distract the user by putting them in another reality, the VR. Games do not do this. So stop saying "I would get high score" and "I played games once and I forgot about my cold."

JabbaRancor
JabbaRancor

@Evilnator GQ. It was in a recent issue.

JabbaRancor
JabbaRancor

@RealHarry The original version was in GQ; very similar articles, same guy that got interviewed. Not necessarily original.

JabbaRancor
JabbaRancor

@irishdude199210 A. "experienced a reduction in pain and time spent thinking about pain when playing SpiderWorld than when playing the Nintendo titles" so no, you still feel pain when playing your games. Ever been punched during a game? You still feel it, stupid. The difference between VR and video games is that the VR tricks you into thinking you're there. B. alcohol essentially shuts down your brain when you drunk too much; much different that the type of pain and distraction they are discussing...and that person you know is an idiot.

irishdude199210
irishdude199210

Playing games will take your mind off the pain, simple. It's like being drunk, you don't think about any pain that's been inflicted on you (mainly because your mind will be elsewhere :P ) thus you don't feel it. I know someone who broke both their ankles while they were drunk and they didn't realise it until the next day. And they were in tremendous pain that day.

gino_pachino
gino_pachino

to forget that you get gun shooted ....nothing is better then playing a shooting game and shoot other :)

JeffreyJohnson
JeffreyJohnson

I hate to be "that guy," but I'm just going to point out that the gate control theory of pain is not using distraction to control pain. It's a theory that involves pain receptors and mechanoreceptors feeding into an inhibitory interneuron to inhibit and innervate it respectively. I don't want to delve to far into specifics, but it is why mild pain can be alleviated by rubbing the skin around it but intense pain is only made worse. Distraction works wonders when it comes to controlling pain, but it has nothing to do with gate control theory. =\

Blitzman
Blitzman

This is a GREAT article - thanks for this view into ways our medium is expanding and helping folks in need!! Very much appreciated read!

Sahle123
Sahle123

If I was a kid and I knew about this, I'd probably start burning my arm everyday so I could skip school to go to the hospital and play video games. xD

neowolph
neowolph

I have Ehlers Danlos and my spine & SI are riddle with arthritis (and more...). I normally have to reposition myself often due to pain but can get so focused on a game or movie/tv show that when it ends or something pulls my attention away from it, I realize I have been in the same position for far too long and the pain is drastically increased from it. This is a common thing discussed on chronic pain forums and message boards, it is definately possible to distract the brain from the pain.

gokileviathan
gokileviathan

@PeterInFire You sound like you DON'T understand psychology nor the works of the Brain, therefore you misunderstood the puropse of using VR gaming in hospitals today.

DarknautXXX
DarknautXXX

I had chronic headaches a few years ago so bad that I couldn't even concentrate on reading a few sentences in a book much less do anything else. Video games were one of the few things I could enjoy because they helped me focus. Unlike reading, where you have to imagine everything that is happening in the novel, video games can meet you half way. You push a button (action), your character jumps (reaction). Since you get a sort of immediate "reward" for your action, it helps keep you interested and focused.

RealHarry
RealHarry

Props to Laura Parker, for continuing to write interesting real world gaming articles.

Kleeyook
Kleeyook

I wish dating sims would be like this!

BertisAU
BertisAU

Release date for SnowWorld?

Evilnator
Evilnator

Amazing article as usual Laura, where do you find all this awesome stuff?

stick2zero
stick2zero

You see Video games benefit everyone..

GunnyHath
GunnyHath

These guys fight and die to protect your country, and that's the best you can come up with? Kudos on the idea, but shell out a few bucks and get some real hardware and textures in there..

endorbr
endorbr

Easy. Because video games are AWESOME.

hunter8man
hunter8man

Not only for physical pain, but it helps a lot with depression as well.

PeterInFire
PeterInFire

well i like playing games but in reality they are nothing than just colours and staff making you feeling something etc....i hardly believe what the article says would help me in those cases!pain is actually inevitable!

Hellsasin
Hellsasin

Well dunno bout the physical pain but when i am sick it usually makes me ignore it e.g i have a fever and its cold, i play some games and i forget im cold. Seems like a plausable theory

DawnForMe
DawnForMe

I dont think that any of this stuff works when you are going to get kicked in head, then continuosly kicked on the ground to the solar plexus JUST SAYIN...

Hurvl
Hurvl

Forget pain? The most common thing I forget when playing is hunger. Meditation and hypnosis are also ways to forget or reduce the feeling of pain, but this seems much more fun.

Mc_Trickz
Mc_Trickz

Such a great idea man,love it

dxdevilex0
dxdevilex0

I can't even feel my hands when I'm playing my 3DS because I have huge hands.

KnightSparda
KnightSparda

You're making really good articles, Laura. Great job...!

unbentonslaught
unbentonslaught

They should have the patients play Dear Esther, there aren't many games that are as immersive as that

SciFiCat
SciFiCat

I would love to see dedicated game developers lending a hand to these researchers to help them achieve better, more immersive simulations so those patients can cope with their treatments even more effectively. ThatGameCompany - makers of Flower and the upcoming Journey would fit perfectly for such a project.

Cupi91
Cupi91

This method of distracting a patient with additional information that changes the focus of his attention can be adequately used for controlling that nerve impulse that moves from receptor to corresponding center in brain used to transcribe that particular information, and this part is included in the gate theory. So basically all the information that comes from outside world ( pain, touch, temperature, color of object..) can be overwritten by information that is considered more important by cognition. And being so that our bran can process about 4bit\per sec information ( example:we are able to count about seven objects the moment we see them) so its not hard to overwrite it. The problem of Hoffman is that he uses the gate theory to overwrite information that comes from within cognition which is the case with post traumatic stress disorder and some phobias, and in doing so he risks development of more serious neurotic disorder. A common problem with all psychological theories is in trying to make their meaning universal.

SANDMAN201
SANDMAN201

I bet I could get the high score on that game.

johnd13
johnd13

If only my dentist had one of those...

PixelBully
PixelBully

What ever these heroes need they deserve it and then some.

Sepewrath
Sepewrath

The theory does make sense, pain is just the brain responding to a stimulus, distract the brain and lessen its abilities. That's pretty cool research.

WildVanilla22
WildVanilla22

Im happy to see that video games help people... im wishing all the best for the patients.

damnstraight003
damnstraight003

Very very cool... hopefully experiments like this can make people take video games more seriously.

Super-Poke-Bros
Super-Poke-Bros

Interesting... I actually had a stem cell transplant this week, so I'll be staying in the hospital for a long time....a very long time. The hospital here has a Wii and PS3 in the room, and I can ask to borrow some games anytime (movies and books, too). Personally, playing didn't relieve the pain much (I get morphine for that :|), but video games are definitely relaxing for me and they help cure the boredom of staying in one room for so long.