Cognitive Load and the Effectiveness of Distraction for Acute Pain in Children

Background:
Distraction tasks that place continuous, high demand on executive resources have been shown to reduce pain intensity and pain unpleasantness ratings in healthy adult samples. We examined the effects of a high-demand 'working memory' 1-back task compared to a low-demand 'motor control' task on pain intensity and unpleasantness ratings in healthy children. Additionally, dispositional mindfulness was examined to explore the mechanisms of distraction on the affective processing of pain.

Methods:
To examine these hypotheses 57 children (9-13 years old) experienced 3 randomly presented heat levels (not painful, slightly painful, moderately painful) during 2 distraction conditions involving different levels of cognitive load (a high load 'working memory' task and a low load 'motor' control task) in counter-balanced order. Children completed measures of dispositional mindfulness.

Results:
As predicted, children's pain intensity and pain unpleasantness ratings were lower in the high load condition compared to the low load condition. These differences were amplified in the moderately painful heat trials. In contrast to predictions, dispositional mindfulness did not significantly predict the effectiveness of distraction. Dispositional mindfulness was significantly related to measures of children's attentional and emotional control abilities; however, a serial mediation model did not produce significant indirect or overall effects to suggest a strong influence of mindfulness on the effectiveness of distraction.

Conclusions:
Results demonstrate that distraction that places high demand on executive resources is more effective for acute pain management for children. Further research is needed to explore cognitive and affective moderators of the effectiveness of distraction for children.


PMID: 33756023 DOI: 10.1002/ejp.1770