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      Are Cognitive Load and Focus of Attention Differentially Involved in Pain Management: An Experimental Study Using a Cold Pressor Test and Virtual Reality

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          Abstract

          Objective

          The aim of this study is to assess whether distraction (lack of attentional focus) and attention (cognitive load) are differentially involved in the analgesic effect of virtual reality (VR) immersions during a cold pressor test (CPT).

          Methods

          Thirty-one participants were randomly assigned to four experimental conditions (high and low cognitive load, attention with or without a reminder of the pain stimuli) and performed three CPTs. Pain was assessed based on the duration of the CPT (pain tolerance), a visual analog rating scale of perceived pain intensity during the CPT and the subjective pain scale of the Short form McGill Pain Questionnaire (SF-MPQ).

          Results

          The statistical analyses revealed that VR immersions were associated with less pain compared to the baseline (all p <0.001), but for the experimental manipulations, only the conditions where there was an increase in cognitive load (ie, from low cognitive load at Immersion 1 to high cognitive load at Immersion 2) were effective for increasing pain tolerance (significant Time X Conditions interaction). The interactions were not significant for pain intensity assessed with the VAS or the SF-MPQ.

          Conclusion

          The results suggest that increases in cognitive load play an important role in the analgesic effect of VR immersion, although the combination of attentional focus and cognitive load may be important. Suggestions are given for designing a replication study.

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          Most cited references 36

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          The effectiveness of virtual reality distraction for pain reduction: a systematic review.

          Virtual reality technology enables people to become immersed in a computer-simulated, three-dimensional environment. This article provides a comprehensive review of controlled research on the effectiveness of virtual reality (VR) distraction for reducing pain. To be included in the review, studies were required to use a between-subjects or mixed model design in which VR distraction was compared with a control condition or an alternative intervention in relieving pain. An exhaustive search identified 11 studies satisfying these criteria. VR distraction was shown to be effective for reducing experimental pain, as well as the discomfort associated with burn injury care. Studies of needle-related pain provided less consistent findings. Use of more sophisticated virtual reality technology capable of fully immersing the individual in a virtual environment was associated with greater relief. Overall, controlled research suggests that VR distraction may be a useful tool for clinicians who work with a variety of pain problems. Copyright © 2010 Elsevier Ltd. All rights reserved.
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            Distraction and coping with pain.

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              Virtual reality as an adjunctive pain control during burn wound care in adolescent patients.

              For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16-year-old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the 'real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                jpr
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                04 September 2020
                2020
                : 13
                : 2213-2222
                Affiliations
                [1 ]Department of Psychology, Université du Québec à Montréal , Montréal, QC, Canada
                [2 ]Cyberpsychology Lab, Université du Québec en Outaouais , Gatineau, QC, Canada
                [3 ]School of Psychology, University of Ottawa , Ottawa, ON, Canada
                [4 ]Research Center, Centre Intégré de Santé et de Services Sociaux de l’Outaouais , Gatineau, QC, Canada
                [5 ]Department of Psychology, Université de Sherbrooke , Sherbrooke, QC, Canada
                [6 ]Montreal Behavioral Medicine Center, Research Center, CIUSSS-NIM Hôpital du Sacré-Coeur de Montréal , Montréal, QC, Canada
                Author notes
                Correspondence: Stéphane BouchardCyberpsychology Lab, Université du Québec en Outaouais , C.P. 1250, Succ. Hull, 283 Boul. Alexandre-Taché, 2 e Étage, Local C-2500, Gatineau, QuebecJ8X 3X7, CanadaTel +1-819-595-3900 #2360Fax +1 819-595-2250 Email stephane.bouchard@uqo.ca
                Article
                238766
                10.2147/JPR.S238766
                7481270
                © 2020 Dumoulin et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 4, Tables: 8, References: 52, Pages: 10
                Funding
                Funded by: second author from the Canada Research Chairs;
                The study was conducted thanks to the financial support obtained by the second author from the Canada Research Chairs (grant no. 950-10762).
                Categories
                Original Research

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