Distraction has been proven to be an effective tool for pain management. Maureen Saguna meets Alexiei Dingli and Luca Bondin to learn more about Morpheus, an application they are developing that will use a combination of virtual reality and artificial intelligence to improve the lives of young patients.

Sometimes, the simplest ideas are the most effective, and if those ideas are backed by science, then you have a winning combination.

A team of academics at the University of Malta took a simple theory and ran with it, coming up with an innovation which should improve the quality of life of many patients.

Alexiei Dingli, a professor at the Department of Artificial Intelligence, and his team are developing an application named Morpheus, which will help reduce pain in patients without the use of medication. The app will be downloadable on smartphones and will work in tandem with a VR (virtual reality) set and a smartwatch to distract the user from pain.

Pain is generated when sensory receptors send a message to the brain which, in turn, creates the sensation of pain perceived and distraction reduces the level of pain perception. The pain is still there but the brain’s resources are taken up by the focus on whatever is causing the distraction.

The idea of distraction as a pain management technique is not novel and there are several case studies where it has been proven to reduce pain perception by up to 50 per cent.

“It was used with burn treatment patients, who need to have their dressing changed every day, a painful process,” Dingli explains.

“In their case, their VR set put them in a snowy environment to counteract for the burning feeling the treatment created.”

Another case study was conducted at Stanford Medical School in the US, where the professor first came across the concept. At Stanford, VR sets are used to distract children while routine painful procedures and treatments are carried out. For example, these sets help the young patients ‘escape’ temporarily to an underwater world.

Dingli goes on to note that Morpheus will go beyond the Stanford method.

“Unfortunately, the worlds of medicine and IT do not intersect much. At Stanford, they had come up with a similar idea from a medical standpoint and had just got a game off the shelf,” he says.

“We are taking the concept they came up with and using IT to take it further. Since we are customising our application to the needs of the user, we are hoping it will have an even better result in pain management.”

The idea of distraction as a pain management technique is not novel and there are several case studies where it has been proven to reduce pain perception by up to 50 per cent

The application is being built by Luca Bondin, another member of the Department of Artificial Intelligence, and Fabrizio Calì from the Department of Digital Arts.

“We’ll be using biosensors like smartwatches which read biological information. This will lead us to effective computing,” Dingli says.

“The game will change and adapt to what the patient would be feeling at that moment. If a child is bored, for instance, the game will become more exciting. If he’s very excited or anxious, it will slow down and become more calming.”

The team is currently approaching the end of the first year of three and are close to finalising the first iteration of the app. They are currently conducting experiments with a group of 20 healthy children who are testing out the prototype by playing three different virtual games while their heart rate, brain wave patterns and skin temperature are monitored.

“These are all signals which are indicative of how a person might be feeling. Once we have those results, we will be in a position to decide whether our initial approach – we had decided to use an infinite runner type of game – is the best choice. We might find out that an open world type of game is more suited to our purposes. Once this phase is completed, we will be able to focus more on other aspects, like the graphics and design of the game.”

Dingli also hopes that the game will be more engaging than the ones used at Stanford.

“When you play a game, you reach a ‘state of flow’. What our game will do is draw the user back into that state every time he or she resurfaces from it. It will be automatic, so the user won’t even notice,” he says.

“The combination of heart rate and heart rate variability [the variation in the time interval between heartbeats] will give us a clear picture of the state of mind of the patient,” Bondin adds.

“Then, we will train the AI in the application to decipher a pattern and that pattern will be used by the app to modify the game accordingly. The patient will use it for a few minutes initially, during which time the application will calculate the parameters as baselines. This will be the first level of the game. Then, once the person continues playing, the app will have enough information to go by.

“We are also working on creating variety by having different skins change according to the time of the year. So, the surroundings might have trees with falling leaves in autumn or Christmas decorations in December. This will keep it fresh and interesting.”

Medicine has come a long way in the past 20 years, with a vast variety of painkillers available both by prescription and over the counter. Morpheus, however, will offer many advantages over medication. To start with, it’s a safe method to reduce pain.

“Right now, most methods involve medicines which have side effects, unlike this method we are proposing,” Dingli says.

“Apart from the risk of side effects, medication carries the risk of your body getting used to it. The game we are creating skirts that issue because it is ever-evolving, so the patient never knows what to expect next. Infinite runner games, which is the kind of game we are planning to have as the main game, offers a world that is constantly changing and the path never ends.”

Another benefit is that there is no risk of any reactions in the patient’s body, unlike the risk carried by medication.  Perhaps the most important advantage of all is the elimination of the risk of addiction to medication. Addiction to painkillers of various kinds, also known as the opioid epidemic, has claimed tens of thousands of lives in the US over the past decade.

The first users of Morpheus will be young patients at Sir Anthony Mamo Oncology Centre. The team then plans to introduce it at Mater Dei Hospital, and eventually, the app will be available to download by anyone.

Vodafone Malta Foundation - which is now known as Epic for Good -  is covering the costs of research and development as well as providing a number of free headsets for the hospitals mentioned.

Funding was made available through the Research, Innovation and Development Trust (RIDT) at the University of Malta (UoM), a joint initiative between the government of Malta and the UoM aimed at attracting private investors to fund research at the university.

Alexiei Dingli is a professor at the Department of Artificial Intelligence at the University of Malta and Luca Bondin is a research support officer within the same department.

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