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For future interventions, we recommend the use of GCS to mitigate SS with similar intermittent stimulation programs. These programs have a crucial advantage as they are easily integrated into the simulator setup without the necessity of generating a complicated experimental design to stimulate during the curves.

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Background: This review discusses the findings in the literature on pain and distraction tasks according to their sensory modality. Distraction tasks have been shown to reduce (experimentally induced) acute pain and chronic pain. This can be influenced by nature and by the sensory modalities used in the distraction tasks. Yet the effect on reducing pain according to the sensory modality of the distraction task has received little attention. Methods: A bibliographic search was performed in different databases. The studies will be systematized according to the sensory modality in which the distraction task was applied.Results: The analyzed studies with auditory distractors showed a reduction of acute pain in adults. However, these are not effective at healthy children and in adults with chronic pain. Visual distractors showed promising results in acute pain in adults and children. Similarly, tactile and mixed distractors decreased acute pain in adults. Conclusion: Distraction tasks by diverse sensory modalities have a positive effect on decreasing the perception of acute pain in adults. Future studies are necessary given the paucity of research on this topic, particularly with tactile distractors (there is only one study). Finally, the most rigorous methodology and the use of ecological contexts are encouraged in future research. &

We have provided evidence on the effectiveness of two different stimuli as countermeasures against simulator adaptation syndrome (SAS). We concluded that the positive impact of body sway might play a role in SAS and therefore encourage the use of stimuli which influence the balancing ability to mitigate the symptoms of SAS.

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