Department of Psychology, University of Maryland, Baltimore County, MD, USA.
Eur J Pain. 2021 Aug;25(7):1568-1582. doi: 10.1002/ejp.1770. Epub 2021 Apr 29.
Distraction tasks that place continuous, high demand on executive resources have been shown to reduce pain intensity and pain unpleasantness ratings in some 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.
Fifty-seven children (9-13 years old) experienced three randomly presented heat levels (not painful, slightly painful, moderately painful) during two 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, and attentional control and emotional control.
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 with 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, an exploratory serial mediation model did not produce significant indirect or overall effects to suggest a strong influence of mindfulness on the effectiveness of distraction.
Results demonstrate that distraction that places higher 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.
This study is one of the first to demonstrate that working-memory engagement can attenuate pain intensity and pain unpleasantness in children aged 9-13. The findings suggest that distraction tasks used in clinical settings for moderately painful medical procedures may benefit more children if they are adequately demanding of cognitive resources.
在一些健康成年人样本中，持续高强度地执行分散注意力任务已被证明可以降低疼痛强度和疼痛不愉快评分。我们研究了高需求的“工作记忆”1 回任务与低需求的“运动控制”任务对健康儿童疼痛强度和不愉快评分的影响。此外，还研究了特质正念，以探讨分散注意力对疼痛情感处理的影响机制。
57 名儿童（9-13 岁）在两种分散注意力条件下经历了三种随机呈现的热水平（无痛、轻度疼痛、中度疼痛），这两种条件涉及不同水平的认知负荷（高负荷“工作记忆”任务和低负荷“运动”控制任务），以平衡的方式呈现。儿童完成了特质正念、注意力控制和情绪控制的测量。
正如预期的那样，与低负荷条件相比，儿童在高负荷条件下的疼痛强度和疼痛不愉快评分较低。在中度疼痛热试验中，这些差异更为明显。与预测相反，特质正念并不能显著预测分心的效果。特质正念与儿童注意力和情绪控制能力的测量结果显著相关；然而，探索性的序列中介模型并没有产生显著的间接或总体效应，这表明正念对分心效果的影响不大。
结果表明，对执行资源要求较高的分心对儿童急性疼痛管理更有效。需要进一步研究以探索认知和情感因素对儿童分心效果的调节作用。
这项研究是首次证明工作记忆参与可以减轻 9-13 岁儿童的疼痛强度和疼痛不愉快的研究之一。研究结果表明，如果分散注意力任务对认知资源有足够的要求，那么在临床环境中用于中度疼痛医疗程序的分散注意力任务可能会使更多的儿童受益。
