Distraction Analgesia Research Articles

Augmented and Virtual Reality Applications in Rhinology: A Scoping Review.

Virtual reality (VR) and augmented reality (AR) are innovative technologies that have a wide range of potential applications in the health care industry. The aim of this study was to investigate the body of research on AR and VR applications in rhinology by performing a scoping review. PubMed, Scopus, and Embase. According to PRISM-ScR guidelines, a scoping review of literature on the application of AR and/or VR in the context of Rhinology was conducted using PubMed, Scopus, and Embase. Forty-nine articles from 1996 to 2023 met the criteria for review. Five broad types of AR and/or VR applications were found: preoperative, intraoperative, training/education, feasibility, and technical. The subsequent clinical domains were recognized: craniovertebral surgery, nasal endoscopy, transsphenoidal surgery, skull base surgery, endoscopic sinus surgery, and sinonasal malignancies. AR and VR have comprehensive applications in Rhinology. AR for surgical navigation may have the most emerging potential in skull base surgery and endoscopic sinus surgery. VR can be utilized as an engaging training tool for surgeons and residents and as a distraction analgesia for patients undergoing office-based procedures. Additional research is essential to further understand the tangible effects of these technologies on measurable clinical results. Laryngoscope, 134:4433-4440, 2024.

Augmented and Virtual Reality Applications in Facial Plastic Surgery: A Scoping Review.

Augmented reality (AR) and virtual reality (VR) are emerging technologies with wide potential applications in health care. We performed a scoping review of the current literature on the application of augmented and VR in the field of facial plastic and reconstructive surgery (FPRS). PubMed and Web of Science. According to PRISMA guidelines, PubMed and Web of Science were used to perform a scoping review of literature regarding the utilization of AR and/or VR relevant to FPRS. Fifty-eight articles spanning 1997-2023 met the criteria for review. Five overarching categories of AR and/or VR applications were identified across the articles: preoperative, intraoperative, training/education, feasibility, and technical. The following clinical areas were identified: burn, craniomaxillofacial surgery (CMF), face transplant, face lift, facial analysis, facial palsy, free flaps, head and neck surgery, injectables, locoregional flaps, mandible reconstruction, mandibuloplasty, microtia, skin cancer, oculoplastic surgery, rhinology, rhinoplasty, and trauma. AR and VR have broad applications in FPRS. AR for surgical navigation may have the most emerging potential in CMF surgery and free flap harvest. VR is useful as distraction analgesia for patients and as an immersive training tool for surgeons. More data on these technologies' direct impact on objective clinical outcomes are still needed. N/A Laryngoscope, 134:2568-2577, 2024.

The role of the male rat infralimbic cortex in distraction analgesia

Cognitive interventions, including distraction, have been successfully utilized in the manipulation of experimental pain and the treatment of clinical pain. Attentional diversions can reduce the experience of pain, a phenomenon known as distraction analgesia (DA). Prior research has suggested that variations in stimulus intensity may influence the magnitude of DA. However, the neural substrates of DA remain largely unknown. Converging evidence suggests that the infralimbic cortex (IL) in the brains of rats may contribute to the phenomenon of DA. The function of the rat IL in DA has never been directly investigated, therefore, this study sought to identify the role of the IL at two levels of noxious stimulus intensity among brain-intact and IL lesioned male rats within an established rat model of DA. A distractor object reduced formalin-induced nociceptive behavior in brain-intact rats, and this DA effect was detectable during low- (0.5% formalin) and high-intensity (1% formalin) stimulation. IL lesion resulted in a near-complete elimination of the DA effect and an overall reduction in formalin pain. These results provide the first known evidence that (i) the IL is involved in processing DA in rats, (ii) the IL contributes to formalin-induced nociceptive behavior irrespective of distraction, and (iii) a high-intensity stimulation was generally more susceptible to DA than low-intensity stimulation. These findings may further inform the mechanisms and future development of non-pharmacological strategies to reduce pain.

Preserved distraction analgesia but greater impact of pain on task performance in older adults compared with younger subjects.

In this study, we compared two working memory conditions to study the analgesic effect of a distraction in elderly vs young people and the effect of pain on performance on the distracting task. Younger (n=27) and older (n= 34) subjects performed 1- and 2-Back working memory tasks, representing low and high cognitive loads, respectively. Infrequent, brief hot nociceptive and cold non-nociceptive stimulations were delivered 100 ms before visual N-Back stimuli. Contact heat-evoked and cold-evoked potentials (N2P2 component) were analyzed in the absence of cognitive tasks and during the N-Back tasks. We compared the pain and cold intensity ratings and reaction times in trials preceded by nociceptive and cold stimulations and in trials not preceded by thermal stimulations between groups and between N-Back conditions. In both groups, performing the 1- and 2-Back working memory tasks reduced the perceived intensity of nociceptive and cold stimuli. In elderly subjects performing 2-Back memory tasks, response times to trials after nociceptive stimulation were longer than those to trials after cold or non-stimulation. By contrast, thermal stimulations had no effect on reaction times in young subjects. The amplitude of the N2P2 component was lower in the older than in the younger group in the absence of a cognitive task. In the older group, N-Back tasks had no effect on the N2P2 amplitude, whereas they reduced N2P2 amplitude in the young. Distraction analgesia is preserved in elderly subjects. However, this successful pain modulation seems to be accompanied by performance costs in the distracting tasks.

Role of vocal distraction analgesia on pain management in the office hysteroscopy procedure: a randomized controlled studya

Role of vocal distraction analgesia on pain management in the office hysteroscopy procedure: a randomized controlled studya

Hypnotic Enhancement of Virtual Reality Distraction Analgesia during Thermal Pain: A Randomized Trial

ABSTRACT Excessive pain during medical procedures is a pervasive health challenge. This study tested the (additive) analgesic efficacy of combining hypnotic analgesia and virtual reality (VR) pain distraction. A single blind, randomized, and controlled trial was used to study 205 undergraduate volunteers aged 18 to 20. The individual and combined effects of hypnotic analgesia (H) and VR distraction on experimentally induced acute thermal pain were examined using a 2 X 2, between-groups parallel design (4 groups total). Participants in groups that received hypnosis remained hypnotized during the test phase pain stimulus. The main outcome measure was “worst pain” ratings. Hypnosis reduced acute pain even for people who scored low on hypnotizability. As predicted, H+ VR was significantly more effective than VR distraction alone. However, H+ VR was not significantly more effective than hypnotic analgesia alone. Being hypnotized during thermal pain enhanced VR distraction analgesia.

Virtual Reality as Distraction Analgesia and Anxiolysis for Pediatric Otolaryngology Procedures.

While virtual reality (VR) has been used as analgesia and anxiolysis for invasive procedures, no literature exists on the use of VR in the pediatric otolaryngology setting. The purpose of this study was to determine the efficacy of VR in reducing pain and anxiety for pediatric otolaryngology patients. Randomized controlled trial. A total of 53 patients aged 7-17 undergoing in-office nasal endoscopies were included. Patients were randomized to receive VR or standard of care. Procedural pain, anxiety, and satisfaction scores were recorded from patients and caregivers. The physician filled out a childhood emotional manifestation scale (CEMS). Patients in VR group reported a significant decrease in pain (0.80 ± 1.06 vs. 2.26 ± 2.38, P = .018) and anxiety (9.50 ± 12.48 vs. 38.48 ± 29.83, P = .0002) and increase in procedural satisfaction (6.40 ± 0.77 vs. 4.74 ± 1.74, P = .0002) compared to patients in control group. CEMS scores were significantly reduced in VR group (5.15 ± 0.46 vs. 9.64 ± 5.66, P = .0001) and caregiver anxiety levels were significantly reduced in VR group (11.50 ± 17.67 vs. 27.39 ± 30.48, P = .041) compared to control group. There were no reported side effects. Procedural time did not significantly differ between groups. For pediatric otolaryngology patients undergoing in-office nasal endoscopies, VR is a safe and effective form of distraction analgesia and anxiolysis, significantly reducing pain and increasing procedural satisfaction for patients. In addition, VR significantly reduces anxiety for both patients and caregivers without disrupting procedural efficiency and workflow. 2. Laryngoscope, 131:E1714-E1721, 2021.

Virtual Reality as Distraction Analgesia for Office-Based Procedures: A Randomized Crossover-Controlled Trial.

The purpose of this study was to explore the use of immersive and interactive virtual reality (VR) for analgesia, anxiety reduction, and overall satisfaction in patients undergoing outpatient postoperative debridements. Randomized crossover-controlled trial. Academic outpatient clinic. Adult patients who had functional endoscopic sinus surgery and skull base surgery and were undergoing office-based postoperative nasal endoscopy and debridement were recruited and followed for 2 consecutive office visits. Participants were randomized to receive either the control or experimental analgesia for the first postoperative visit (PO1) and crossed over into the opposite treatment arm during the second postoperative visit (PO2). Outcomes included procedural pain, anxiety and satisfaction scores, procedural time, and reflexive head movements per minute (RHM). Eighty-two participants were recruited. At PO1, 39 received standard analgesia, and 43 received an immersive VR experience. At PO1, the VR group experienced significantly less anxiety (P = .043) and fewer RHM (P = .00016) than the control group. At PO2, the VR group experienced significantly fewer RHM (P = .0002). At PO2, patients who received the experimental treatment after initially receiving the control treatment had significantly decreased pain, anxiety, and RHM. This effect was not seen in the second group. Overall, 69.51% of patients felt that the VR treatment was better; 19.51% thought that it was the same; and 9.76% found it to be worse. VR technology holds promise as a nonpharmacologic analgesic and anxiolytic intervention for otolaryngology office-based procedures. Further study of VR use in other procedures is warranted. 1, randomized controlled trial.

The Role of the Cerebellum in Pain Perception: A Brain SPECT Perfusion Study in Patients with Burn Injuries.

Virtual reality (VR) is a promising tool for distraction analgesia. This study aims to compare brain perfusion patterns while patients were undergoing burn wound care in two conditions-VR distraction and control (NoVR). With IRB approval, four patients hospitalized for acute burn care (three males and one female) participated in the study. All patients underwent wound care on two consecutive days; 1 day with standard analgesia and adjunctive VR, and the other day with standard analgesia alone, otherwise the wound care was very similar. Tc-99m ethyl cysteinate dimer was injected during wound care at the time of peak pain. Subjective patient reports on a 0-10 scale of pain intensity, time spent thinking about pain, and "fun" as well as opioid equivalent usage were analyzed. Voxel by voxel subtraction analysis of brain perfusion Single Photon Emission Computed Tomography (SPECT) images was performed at the group level. Statistical significance threshold was defined as P<.05. Mean group subjective scores (VR, NoVR, statistical significance, and P-value) were observed for maximal pain intensity (9.0, 8.8, insignificant, and P = .809), time spent thinking about pain (5.2, 10.0, significant, and P = .015), and fun (6.0, 2.5, significant, and P = .012). Subtraction group analysis demonstrated VR-induced modulation of brain activity with statistically significant relative suppression of cerebellar activation in the VR compared to intense cerebellar activation in the NoVR environments. Relative decrease in cerebellar perfusion based on stringent statistical threshold in the VR environment combined with improved subjective pain experience supports the hypotheses on the role of cerebellum in perception of noxious stimuli.

Working memory and visual discrimination distraction tasks improve cold pressor pain tolerance in children.

Distraction is a well-established pain management technique for children experiencing acute pain, although the mechanisms underlying the effectiveness of distraction are not well understood. It has been postulated that engagement of executive functions, such as working memory, may be a critical factor in attenuating pain via distraction. To test this hypothesis, we compared a 1-back task requiring engagement of working memory with a simple visual discrimination task demanding focused attention, but lower cognitive load (0-back). Seventy-nine children (6-12 years old) underwent a baseline cold pressor trial followed by cold pressor trials in which they completed the visual discrimination and 1-back tasks in counterbalanced order. Executive functioning ability was assessed via the Wechsler Intelligence Scale for Children (5th Edition) working memory subscales and by parent report on the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF®2). Children's pain tolerance improved in both the visual discrimination and 1-back conditions though a differential response to the 2 tasks was not observed. Age moderated the relation between executive functioning and response to distraction; older children with better executive functioning skills demonstrated greater improvements in both distraction interventions. Findings demonstrate the benefits of both visual discrimination and working memory distraction tasks for elementary-aged children experiencing acute pain. Further research is required in order to elucidate the role of executive functioning skills and cognitive load in enhancing distraction analgesia in children, with particular focus on determining optimal load and task difficulty in light of emerging executive functioning abilities in this age group. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Virtual Reality Analgesia for Pediatric Dental Patients.

Background: Dental procedures often elicit pain and fear in pediatric dental patients.Aim: To evaluate the feasibility and effectiveness of immersive virtual reality as an attention distraction analgesia technique for pain management in children and adolescents undergoing painful dental procedures.Design: Using a within-subjects design, five patients (mean age 13.20 years old, SD 2.39) participated. Patients received tethered immersive interactive virtual reality distraction in an Oculus Rift VR helmet (experimental condition) during one dental procedure (a single dental filling or tooth extraction). On a different visit to the same dentist (e.g., 1 week later), each patient also received a comparable dental procedure during the control condition “treatment as usual” (treatment order randomized). After each procedure, children self-rated their “worst pain,” “pain unpleasantness,” “time spent thinking about pain,” “presence in VR,” “fun,” and “nausea” levels during the dental procedures, using graphic rating scales.Results: Patients reported significantly lower “worst pain” and “pain unpleasantness,” and had significantly more fun during VR, compared to a comparable dental procedure with No VR. Using Oculus Rift VR goggles, patients reported a “strong sense of going inside the computer-generated world,” without side effects. The dentist preferred having the patients in VR.Conclusion: Results of this pilot study provide preliminary evidence of the feasibility of using immersive, interactive VR to distract pediatric dental patients and increase fun of children during dental procedures.

The effects of auditory background noise and virtual reality technology on video game distraction analgesia.

Background and aims The present study was designed to evaluate the relative efficacy of two video game display modalities - virtual reality (VR) assisted video game distraction, in which the game is presented via a VR head-mounted display (HMD) helmet, versus standard video game distraction, in which the game is projected on a television - and to determine whether environmental context (quiet versus noisy) moderates the relative efficacy of the two display modalities in reducing cold pressor pain in healthy college students. Methods Undergraduate students (n=164) were stratified by sex and self-reported video game skill and were randomly assigned to a quiet or a noisy environment. Participants then underwent three cold pressor trials consisting of one baseline followed by two distraction trials differing in display modality (i.e. VR-assisted or standard distraction) in counter-balanced order. Results Participants experienced improvement in pain tolerance from baseline to distraction in both display modality conditions (p<0.001, partial η2=0.41), and there was a trend toward greater improvement in pain tolerance from baseline to distraction when using the VR HMD helmet than during standard video game distraction (p=0.057, partial η2=0.02). Participants rated pain as more intense when experienced with concurrent experimental background noise (p=0.047, partial η2=0.02). Pain tolerance was not influenced by the presence or absence of background noise, and there was not a significant interaction between display modality and noise condition. Though exploratory sex analyses demonstrated a significant three-way interaction between noise condition, sex, and display modality on pain intensity (p=0.040, partial η2=0.040), follow-up post-hoc analyses conducted for males and females separately did not reveal significant differences in pain intensity based on the interaction between noise condition and display modality. Conclusions As expected, video game distraction both with and without an HMD helmet increased pain tolerance; however, the two display modalities only marginally differed in efficacy within the population under study. The effect of auditory background noise on pain was mixed; while pain tolerance did not vary as a function of the presence or absence of background noise, the addition of noise increased pain intensity ratings. The interaction between participant sex, noise condition, and distraction modality on pain intensity trended toward significance but would require replication in future research. Implications Results suggest that video game distraction via HMD helmet may be superior to standard video game distraction for increasing pain tolerance, though further research is required to replicate the trending findings observed in this study. Though it does not appear that background noise significantly impacted the relative efficacy of the two different video game display modalities, the presence of noise does appear to alter the pain response through amplified pain intensity ratings. Further research utilizing more sophisticated VR technology and clinically relevant background auditory stimuli is necessary in order to better understand the impact of these findings in real-world settings and to test the clinical utility of VR technology for pain management relative to standard video game distraction.

Neural Mechanisms of Attentional Switching Between Pain and a Visual Illusion Task: A Laser Evoked Potential Study

Previous studies demonstrated that pain induced by a noxious stimulus during a distraction task is affected by both stimulus-driven and goal-directed processes which interact and change over time. The purpose of this exploratory study was to analyse associations of aspects of subjective pain experience and engagement with the distracting task with attention-sensitive components of noxious laser-evoked potentials (LEPs) on a single-trial basis. A laser heat stimulus was applied to the dorsum of the left hand while subjects either viewed the Rubin vase-face illusion (RVI), or focused on their pain and associated somatosensory sensations occurring on their stimulated hand. Pain-related sensations occurring with every laser stimulus were evaluated using a set of visual analogue scales. Factor analysis was used to identify the principal dimensions of pain experience. LEPs were correlated with subjective aspects of pain experience on a single-trial basis using a multiple linear regression model. A positive LEP component at the vertex electrodes in the interval 294–351 ms (P2) was smaller during focusing on RVI than during focusing on the stimulated hand. Single-trial amplitude variations of the P2 component correlated with changes in Factor 1, representing essential aspects of pain, and inversely with both Factor 2, accounting for anticipated pain, and the number of RVI figure reversals. A source dipole located in the posterior region of the cingulate cortex was the strongest contributor to the attention-related single-trial variations of the P2 component. Instantaneous amplitude variations of the P2 LEP component during switching attention towards pain in the presence of a distracting task are related to the strength of pain experience, engagement with the task, and the level of anticipated pain. Results provide neurophysiological underpinning for the use of distraction analgesia acute pain relief.

P382 Neural mechanisms of attentional switching during distraction analgesia: A single-trial laser evoked potential study

Objectives Noxious stimuli capture attention and at the same time, pain is attenuated by a concurrent cognitive task. The present study aimed to elucidate the cortical mechanisms underlying diminution of pain during attentional distraction using single-trial electrocortical and subjective responses. Methods In 24 healthy participants, a laser heat stimulus was applied to the dorsum of the left hand while subjects either viewed Rubin vase-face illusion (RVI), or focused on their pain and associated somatosensory sensations occurring on their stimulated hand. Pain-related sensations occurring on every laser stimulus were evaluated using a set of visual analogue scales. Factor analysis was used to identify the principal dimensions of pain experience. Laser evoked potentials (LEPs) were correlated with subjective aspects of pain experience on a single-trial basis using a multivariate regression model. Results Subjects anticipated and perceived smaller pain whilst focusing on RVI than on their pain-related sensations. A positive LEP component at the vertex electrodes in the interval 294–351 ms was smaller during focusing on RVI than during focusing on the stimulated hand. The attention-related amplitude changes in LEPs were accounted for by an equivalent source dipole located in posterior cingulate cortex (PCC). Single-trial variations of source activity in PCC correlated with changes in Factor 1, representing essential aspects of pain, and inversely with both Factor 2, accounting for anticipated pain, and with the number of RVI figure reversals. Discussion Single-trial analysis of LEPs and subjective responses to a noxious laser stimulus point to the possibility that the attentional switching during a distraction analgesia operates in PCC via three channels: 1. The pain modulation channel which affects the pain experience during the distraction by neural and functional connections of the posterior cingulate cortex with the anterior cingulate cortex. 2. The task engagement channel represented by reduction of the LEP potential in PCC in trials with a large number of RVIs. 3. The anticipation channel representing a contextual, top-down modulation of the distraction effect. Conclusions PCC appears to mediate the attentional switching towards the pain during concurrent, distracting task. Switching between pain and non-pain task is modulated by the strength of engagement in a cognitive-perceptual task, and by the level of anticipated pain. Significance Our findings shed light on the factors underlying distraction analgesia. The level of engagement in the non-pain task and the role of anticipation are the factors which can be boosted to strengthen the analgesia in clinical applications.

Circumplex Model of Affect: A Measure of Pleasure and Arousal During Virtual Reality Distraction Analgesia.

Immersive virtual reality (VR) distraction provides clinically effective pain relief and increases subjective reports of "fun" in medical settings of procedural pain. The goal of this study was to better describe the variable of "fun" associated with VR distraction analgesia using the circumplex model (pleasure/arousal) of affect. Seventy-four healthy volunteers (mean age, 29 years; 37 females) received a standardized, 18-minute, multimodal pain sequence (alternating thermal heat and electrical stimulation to distal extremities) while receiving immersive, interactive VR distraction. Subjects rated both their subjective pain intensity and fun using 0-10 Graphic Rating Scales, as well as the pleasantness of their emotional valence and their state of arousal on 9-point scales. Compared with pain stimulation in the control (baseline, no VR) condition, immersive VR distraction significantly reduced subjective pain intensity (P < 0.001). During VR distraction, compared with those reporting negative affect, subjects reporting positive affect did so more frequently (41 percent versus 9 percent), as well as reporting both greater pain reduction (22 percent versus 1 percent) and fun scores (7.0 ± 1.9 versus 2.4 ± 1.4). Several factors-lower anxiety, greater fun, greater presence in the VR environment, and positive emotional valence-were associated with subjective analgesia during VR distraction. Immersive VR distraction reduces subjective pain intensity induced by multimodal experimental nociception. Subjects who report less anxiety, more fun, more VR presence, and more positive emotional valence during VR distraction are more likely to report subjective pain reduction. These findings indicate VR distraction analgesia may be mediated through anxiolytic, attentional, and/or affective mechanisms.

(513) Does ethnicity associate with distraction analgesia effect in response to Capsaicin?

Distraction as a form of analgesia continues to gain attention as a plausible mechanism for pain modulation. Recent reports highlight possible individual differences in pain sensitivity, tolerance and coping strategies. However, few studies have examined differences in pain modulation by distraction analgesia. The present study investigated differences within and between ethnic groups with respect to distraction analgesia in response to noxious stimuli (capsaicin). Forty healthy volunteers participated in the study involving measuring response to noxious stimuli (capsaicin application), either in isolation or along with a cognitive distraction task (video games) in two separate sessions.

(503) Whither the twain shall meet: insomnia and distraction analgesia

(503) Whither the twain shall meet: insomnia and distraction analgesia

Distraction analgesia in chronic pain patients: the impact of catastrophizing.

Diverting attention away from noxious stimulation (i.e., distraction) is a common pain-coping strategy. Its effects are variable across individuals, however, and the authors hypothesized that chronic pain patients who reported higher levels of pain catastrophizing would derive less pain-reducing benefit from distraction. Chronic pain patients (n=149) underwent psychometric and quantitative sensory testing, including assessment of the temporal summation of pain in the presence and absence of a distracting motor task. A simple distraction task decreased temporal summation of pain overall, but, surprisingly, a greater distraction analgesia was observed in high catastrophizers. This enhanced distraction analgesia in high catastrophizers was not altered when controlling for current pain scores, depression, anxiety, or opioid use (analysis of covariance [ANCOVA]: F=8.7, P<0.005). Interestingly, the magnitude of distraction analgesia was inversely correlated with conditioned pain modulation (Pearson R=-0.23, P=0.005). Distraction produced greater analgesia among chronic pain patients with higher catastrophizing, suggesting that catastrophizing's pain-amplifying effects may be due in part to greater attention to pain, and these patients may benefit from distraction-based pain management approaches. Furthermore, these data suggest that distraction analgesia and conditioned pain modulation may involve separate underlying mechanisms.

(315) Pain modulation in chronic pain patients: the relationship of pain sensitivity, pain inhibition, and distraction analgesia

(315) Pain modulation in chronic pain patients: the relationship of pain sensitivity, pain inhibition, and distraction analgesia

Temporal summation in chronic pain patients: the impact of catastrophizing, distraction analgesia and opioid use

Temporal summation in chronic pain patients: the impact of catastrophizing, distraction analgesia and opioid use