Science
3:51 pm
Sun February 12, 2012

Virtual Penguins A Prescription For Pain?

Originally published on Tue February 14, 2012 3:44 pm

For troops injured in Iraq and Afghanistan, the deepest physical pain often comes much later — weeks, or even months, after the incident. That was the case for Sam Brown, whose story appears in this month's GQ magazine.

Brown graduated from West Point in 2006. In the late summer of 2008, he was deployed to southern Afghanistan to lead a platoon. He did security for base construction and made sure the local villagers had enough food, water, and medicine.

It was hot, often mind-numbingly dull, and dusty.

"We called it moon dust," Brown tells weekends on All Things Considered host Guy Raz. "It was just this kind of powdery dust that stuck to everything. No access to showers for a couple of weeks, you know, at a time, and there were days when it peaked out at close to 130 degrees."

Before he deployed, Brown ran through a series of scenarios in his mind, scenes of what might happen to him in Afghanistan.

"Interestingly enough, the one drill I didn't run on myself was burning," he says. "That just, for whatever reason, did not cross my mind as a potential type of casualty."

Then came the day in September 2008 that his unit was called in to back up another platoon that came under attack.

"I remember everything about the day I was injured," Brown says. "We hit an IED, right as we got to their location, and that was the beginning of a new life for me."

"He's not knocked unconscious immediately," says journalist Jay Kirk, who covered the story for GQ, and reconstructed what happened to Brown that day.

"He's on fire; he's down his knees with his arms just flaming. His face is on fire, and he's trying to put himself out, you know. He's rolling around as much as he can, you know, drop and roll, but he has a tactical vest on so that's preventing him from putting himself out."

Five days later, Brown was in the intensive care unit at the Brooke Army Medical Center in San Antonio. Almost immediately, to prevent infection, he was taken to a shower room where his skin was scrubbed by nurses.

"It was as close to the same pain of being burned as I expect you could get," Brown says.

He was put on Dilaudid, Percocet and morphine, but nothing helped with the most severe spikes of pain.

While burn treatments have advanced greatly in the past decade, Kirk says pain management is still in the 19th century.

"I mean this is a drug that was invented in 1804, but there haven't really been a lot of advances in it since then," he says of morphine. "And there is a lot of negative side-effects to opioids. You know, the more pain you're in, the more you need, the more you take, the greater the tolerance is, the less it works, and it's very dangerous."

Two thousand miles away from Brown's hospital bed, two researchers at the University of Washington's Medical Center in Seattle were working with burn patients who, like Brown, weren't responding to pain medication. One of those researchers is David Patterson.

"It takes a certain amount of attention to process pain," Patterson says. "If you are able to put that attention elsewhere, there is less attention to process pain, and consequently, people will feel less pain."

Patterson and his colleague Hunter Hoffman began to experiment with virtual reality to provide that distraction.

Hoffman had designed an environment called Spider World, aimed at treating arachnophobes. By wearing special goggles, you become immersed in a world of friendly spiders and gradually lose your fear.

Paterson and Hoffman thought a similar approach could work with burn patients.

"So we created a world that was the antithesis of fire," Hoffman says. "The opposite of fire, a cool place snowmen, pleasant images, just about everything to keep them from thinking about fire."

They called it SnowWorld.

When the Army found out about SnowWorld, it decided to try it out with troops burned in battle, including Brown.

"I was quite skeptical," Brown says, "but I was also at a place where I was willing to try anything that might help."

On a scale from 1 to 10, Brown's pain level often spiked at 8 during wound cleaning and physical therapy. So he placed the goggles on and entered SnowWorld.

"It was like being, watching a B-rated Pixar film," he says. "Everything about it was just cold and cool and cartoony."

But as Brown floated along the icy canyons, pelting snowmen and woolly mammoths with snowballs, something amazing happened: He forgot about his pain.

Brown spent more than a year undergoing surgery, and in physical therapy. His face was reconstructed using harvested skin from his back. And he also reconstructed his life: He fell in love with his dietitian, Amy Larsen, also an Army officer. She is now his wife, and last September, almost three years to the day after the IED changed his life, they had a baby boy. They named him Roman.

"I still in my own mind pictured myself for a long time as I was prior to the burn," Brown says. "But I'm at a place now where I picture myself as is, and the scars are really just a great reminder of who I am, and the opportunity I've been given in life. It's sort of an external tribute, or reminder to a new life."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

GUY RAZ, HOST:

For the troops injured in Iraq and Afghanistan, the deepest physical pain often comes much later - weeks or even months after the incident. That was the case for Sam Brown, who was badly burned in Afghanistan. But before we get there, some background. Sam graduated from West Point in 2006. And in the late summer heat of 2008...

SAM BROWN: Goodness. Yeah, we don't know hot like that.

RAZ: ...he was deployed to southern Afghanistan to lead a platoon.

BROWN: Deployment is sort of the pinnacle of service. In particular, combat is somewhat glamorized by Hollywood and just, it's, you know, it's considered a patriotic activity, you know, something to be a part of. And I learned very quickly that it's not what it seems to be.

RAZ: Much of what Sam's unit did was hearts and minds stuff, checking in on locals in Kandahar to see if they had adequate water, whether they were safe. It was hot, often mind-numbingly dull and dusty.

BROWN: We called it moon dust. It was just this kind of powdery dust that stuck to everything. No access to showers for a couple of weeks, you know, at a time, and there were days where it peaked out at close to 130 degrees.

RAZ: Now, before he deployed, Sam ran through a series of scenarios in his mind, scenarios of what might happen to him in Afghanistan.

BROWN: Interestingly enough, the one drill I didn't run on myself was burning. And that just, for whatever reason, did not cross my mind as a potential type of casualty.

RAZ: Sam's story is featured in the latest issue of GQ magazine.

BROWN: I remember everything about the day I was injured.

RAZ: That September day in 2008, Sam Brown's unit was called in to back up another platoon that came under attack. They were just approaching the site in Kandahar.

BROWN: And we hit an IED, right as we got to their location, and that was the beginning of a new life for me.

JAY KIRK: He's not knocked unconscious immediately.

RAZ: That's journalist Jay Kirk, who wrote the article about Sam and reconstructed what happened that day.

KIRK: He's on fire. He's down on his knees with his arms just flaming. His face is on fire. He's trying to put himself out, you know? He's rolling around as much as he can, you know, drop and roll, but he has a tactical vest on so that's preventing him from putting himself out.

RAZ: Five days later, Sam Brown was in the intensive care unit at the Brooke Army Medical Center in San Antonio. And almost immediately, to prevent skin infection, he was taken to a shower room where his skin was scrubbed by nurses. This is a regular, often daily part of burn care.

BROWN: And it was as close to the same pain of being burned as I expect you could get, and it was a nightmare. And I thought, well, you know, when it was done, I thought, at least that's done. And the next morning, they woke me up and said they were going to do it again. And I wasn't prepared for that mentally.

RAZ: He was put on a wide variety of drugs, including morphine, but nothing could dull the pain.

KIRK: I mean, this is a drug that was invented in 1804, but there haven't really been a lot of advances in it since then. And there's a lot of really negative side effects to opioids. So, you know, there's nausea and constipation. It doesn't necessarily work on everyone, and then there's the tolerance levels. So, you know, the more pain you're in, the more you need, the more you take, the greater the tolerance is, the less it works, and it's very dangerous.

RAZ: 2,200 hundred miles away from San Antonio, two researchers at the University of Washington's Medical Center in Seattle were working with burn patients who, like Sam, weren't responding to pain medication. One of those researchers is David Patterson.

DAVID PATTERSON: It takes a certain amount of attention to process pain. And if you are able to put that attention elsewhere, there's less attention to process pain, and consequently, people will feel less pain.

RAZ: Patterson and his colleague Hunter Hoffman were experimenting with virtual reality. Hoffman had been using a computer program with arachnophobes, a program where by wearing special goggles, they become immersed in a world of friendly spiders. Patterson and Hoffman wondered whether a similar approach could work with burn patients. Here's Hunter Hoffman.

HUNTER HOFFMAN: We created a world that was the antithesis of fire, the opposite of fire, a cool place, snowmen, pleasant images, just to try to do everything to keep them from thinking about fire.

RAZ: They called it SnowWorld, and the Army was interested in trying it out with troops burned in battle, including Sam Brown.

BROWN: I was quite skeptical, but I was also at a place where I was willing to try anything that might help.

RAZ: That's because on a scale from one to 10, Sam's daily pain level often spiked at eight. So he put on the goggles and entered SnowWorld.

BROWN: It was like watching a B-rated Pixar film.

(SOUNDBITE OF MUSIC)

RAZ: Instantly, the world around him was populated with penguins and snowmen and wooly mammoths.

(SOUNDBITE OF WOOLY MAMMOTH)

BROWN: Everything about it was just cold and cool and cartoony.

RAZ: And miraculously, being inside SnowWorld dramatically reduced the pain of his physical therapy.

BROWN: Actually, they were able to move my arm and stretch it further than I had ever before to that point, and the pain was lower. So it was a very successful event.

RAZ: Sam Brown spent more than a year undergoing surgery, and in physical therapy. His face was reconstructed using harvested skin from his back. And during that time, he also fell in love. His dietitian, Amy, also an Army officer, is now his wife. And last September, almost three years to the day of his injury, they had a baby boy. His name is Roman.

BROWN: I still, in my own mind, pictured myself for a long time as I was prior to the burn. But I'm at a place now where I picture myself as is, and the scars are really just a great reminder of who I am and the opportunity I've been given in life. It's sort of an external tribute or reminder to a new life.

RAZ: Sam Brown's story is told by reporter Jay Kirk in the latest issue of GQ magazine. Transcript provided by NPR, Copyright NPR.

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