The Impact of Observation and Distraction on Pediatric Acute Pain

Abstract

The present study was a novel exploration of the impacts of observation and distraction on acute pain outcomes in elementary school aged children. A sample of 96 children (40 girls) between the ages of 6 and 13 underwent two cold pressor trials during which pain tolerance, nervousness, pain intensity, and pain unpleasantness were assessed. The first trial served as a baseline; no intervention was conducted. During the second trial, participants were assigned to one of four experimental conditions—control (a repeat of baseline), observer present (participants completed the trial in the presence of an observer they were told was monitoring how well they performed), VR distraction (participants played Beat Saber while completing the trial) or observer present + VR (participants played the VR game while also being observed). It was hypothesized that the presence of an observer would decrease cold pressor tolerance and increase nervousness, pain intensity, and pain unpleasantness. It was also hypothesized that the use of distraction would increase cold pressor tolerance and decrease nervousness, pain intensity, and pain unpleasantness. The presence of the observer was expected to increase participant stress and result in poorer pain outcomes, whereas VR distraction was expected to result in improved pain outcomes and potentially counteract the negative impact of observation. The results revealed the expected effect of VR distraction on pain tolerance. Children who utilized VR had greater increases in pain tolerance than those children who did not utilize VR (p < .001). However, the presence of the observer did not significantly impact pain tolerance and there was not a significant interaction between observer presence and VR distraction. The expected interaction between observer presence and VR distraction was only obtained for unpleasantness. Pain unpleasantness significantly increased for those children in the observer present condition during trial 2 compared to trial 1 (p = .028) and decreased for those children in the observer present + VR condition during trial 2 (p = .025). However, unpleasantness did not decrease for those children in the VR only condition, making these findings difficult to interpret. A main effect of trial was found for nervousness such that children were more nervous during the second trial compared to the first (p = .005). Pain intensity was impacted by gender such that girls, not boys, who did not receive VR distraction experienced a significant decrease in pain intensity during trial 2 compared to trial 1 (p = .019), which was the opposite of what was expected. While observation was largely insignificant in the current study, it did have an impact on children’s pain unpleasantness; therefore, it is important to continue studying observation. It is likely that the observer was not potent enough to have a true impact on pain outcomes in the current study. Further research efforts should utilize diverse samples, multiple measurements of stress, and qualitative measures in order to allow for a more nuanced understanding of the impact of observation and distraction on pain.