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OPINION 2.12.2021 Alexiei Dingli Prof Alexiei Dingli is a Professor of AI at the University of Malta and has been conducting research and working in the field of AI for more than two decades, assisting different companies to implement AI solutions. He forms part of the Malta.AI task-force, set up by the Maltese government, aimed at making Malta one of the top AI countries in the world P ain is a feeling which we all experi- ence at one point or another in our lifetime. It starts from the very be- ginning; when we take the first steps, we wobble around the home and eventually fall to the floor. A signal of pain shoots up towards our brain, and we instinctively start crying. In reality, pain serves a critical func- tion. It's a defence mechanism that informs our brain that something is wrong. e intensity of the pain further accentuates the urgency of the situa- tion. Can you imagine a circumstance where you touch a hot surface and your brain doesn't inform you about the damage sustained by your tissues due to the heat? It would simply be disastrous, if not fatal, for your well-being. However, there are situations where we need to manage the pain, like in cas- es where someone is taking a particular treatment. e traditional approach to suppress the pain is to take pain kill- ers. However, this might not always be a viable solution since medications might have other side effects on the patient. An alternative to medicines is an approach referred to as Distraction erapy (DT). With such a therapy, the patient can cope with painful or difficult procedures simply by focusing his mind on something else. Such an approach is widely used and considered an effective and readily available pain management intervention. e reasons for its growing popularity are various: • It is fun since it usually involves games or other sorts of entertain- ment. • One does not need to spend a for- tune to use it. • Different medical trials proved its effectiveness. • e patient suffers from no side effects since he is not ingesting anything. • It helps build courage, especially with the little ones and eventually even improves their endurance to pain. One of the most promising DT ap- proaches so far makes use of Virtual Re- ality (VR). Researchers at the University of Washington created a virtual envi- ronment called Snow World to relieve patients who suffered burns. e chosen theme depicts a cold cli- mate, thus conditioning the patient's brain to think they are experiencing freezing temperatures. By doing so, the pain produced as an effect of the burns is severely reduced, in some cases reaching 50%. So the Epic Foundation for Good and the University of Malta engaged in a three-year project called Morpheus to investigate the task and potentially im- prove the results obtained by the Uni- versity of Washington. e researchers noticed that the original VR experience did not give much importance to the pa- tient's feelings. Was he excited, bored, or just going through the experience? is consideration is fundamental to ensure that the experience is more effec- tive. In fact, in the field of digital games, we usually refer to it as flow. Flow theo- ry describes a state of concentration or complete absorption with the activity at hand. So imagine you decide to do some gardening on a lovely summer's day. You plan to spend a few minutes, but without realising it, that handful of minutes turn into hours. You would just have experienced flow! So the idea behind the project was to use the VR experience to induce that state in the patient. We did this by utilising smartwatches to read the patient's biological information, such as the heartbeat. rough this data, the Artificial Intelligence (AI) system could predict what the person is feeling. Whether he's enjoying himself or if he's bored. With this information in hand, the AI would then affect the VR expe- rience in real-time by slowing it down or speeding it up to ensure maximum engagement. e VR system implemented was a rollercoaster game whereby the play- er goes around a mystical island filled with creatures. We converged on such an experience after we conducted var- ious experiments with children. We asked them to play different commer- cial games, and by using an Electroen- cephalogram (EEG), we managed to read brain signals to determine which of those games was the most stimulating. Following that, we designed our game and tried it out with various consenting adults who voluntarily agreed to expe- rience some minimal pain. e tricky part of the experiment was that we had to induce pain without, of course, hurt- ing the players. To do so, we prepared ice buckets and asked them to immerse their hands until they couldn't with- stand the pain. We then measured their resistance without the VR, with a simu- lator similar to the SnowWolrd VR and our system. e results obtained from such exper- iments were great. Whereas the Univer- sity of Washington VR system reached 50%, our Morpheus system pumped that up by 30%, thus achieving 80% pain distraction. After these results, we are deploying it at the Oncology centre to allow pa- tients to use it. Of course, this is just the beginning, and we hope to bring more respite to people who are suffering, thus helping them lead a better life free from pain and dream of a brighter future. Freedom from pain Movie 'distraction therapy' improves children's experience of radiation

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