Computer games as distraction from PAIN: Effects of hardware and difficulty on pain tolerance and subjective IMMERSION

Fairclough, Stephen H.; Stamp, Kellyann; Dobbins, Chelsea; Poole, Helen

doi:10.1016/j.ijhcs.2020.102427

Cited by 22 publications

(17 citation statements)

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“…The BCI-N system of this study will address a key limitation of previous EEG neurofeedback interventions, which have mostly relied on a single form of virtual interaction [ 20 , 22 , 24 ]. Studies have shown greater cortical involvement [ 32 ] and pain reduction [ 28 - 31 ] during the interactive engagement with multiple gaming scenarios than with 1 form of virtual interaction. Based on this evidence, we will use a self-developed BCI-N treatment, which consists of 3 interactive virtual scenarios in a goal-directed gaming environment.…”

Section: Discussionmentioning

confidence: 99%

“…Current BCI-N interventions for both SCI neuropathic pain [ 20 , 22 , 24 ] and chronic pain [ 25 - 27 ] have mostly relied on a single mode of virtual interaction, such as increasing or decreasing the height of a bar presented on a computer screen. However, preliminary evidence suggests that greater pain relief may be achieved from interactive, goal-directed engagement with a gaming environment, in comparison with a single virtual interaction format [ 28 - 31 ]. The increased analgesic effect may be due to the greater cortical involvement, which occurs during engagement with multiple scenarios in a goal-directed manner such as gaming [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Effectiveness of a Novel Brain-Computer Interface Neuromodulative Intervention to Relieve Neuropathic Pain Following Spinal Cord Injury: Protocol for a Single-Case Experimental Design With Multiple Baselines

Hesam‐Shariati¹,

Newton‐John²,

Singh³

et al. 2020

JMIR Res Protoc

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Background Neuropathic pain is a debilitating secondary condition for many individuals with spinal cord injury. Spinal cord injury neuropathic pain often is poorly responsive to existing pharmacological and nonpharmacological treatments. A growing body of evidence supports the potential for brain-computer interface systems to reduce spinal cord injury neuropathic pain via electroencephalographic neurofeedback. However, further studies are needed to provide more definitive evidence regarding the effectiveness of this intervention. Objective The primary objective of this study is to evaluate the effectiveness of a multiday course of a brain-computer interface neuromodulative intervention in a gaming environment to provide pain relief for individuals with neuropathic pain following spinal cord injury. Methods We have developed a novel brain-computer interface-based neuromodulative intervention for spinal cord injury neuropathic pain. Our brain-computer interface neuromodulative treatment includes an interactive gaming interface, and a neuromodulation protocol targeted to suppress theta (4-8 Hz) and high beta (20-30 Hz) frequency powers, and enhance alpha (9-12 Hz) power. We will use a single-case experimental design with multiple baselines to examine the effectiveness of our self-developed brain-computer interface neuromodulative intervention for the treatment of spinal cord injury neuropathic pain. We will recruit 3 participants with spinal cord injury neuropathic pain. Each participant will be randomly allocated to a different baseline phase (ie, 7, 10, or 14 days), which will then be followed by 20 sessions of a 30-minute brain-computer interface neuromodulative intervention over a 4-week period. The visual analog scale assessing average pain intensity will serve as the primary outcome measure. We will also assess pain interference as a secondary outcome domain. Generalization measures will assess quality of life, sleep quality, and anxiety and depressive symptoms, as well as resting-state electroencephalography and thalamic γ-aminobutyric acid concentration. Results This study was approved by the Human Research Committees of the University of New South Wales in July 2019 and the University of Technology Sydney in January 2020. We plan to begin the trial in October 2020 and expect to publish the results by the end of 2021. Conclusions This clinical trial using single-case experimental design methodology has been designed to evaluate the effectiveness of a novel brain-computer interface neuromodulative treatment for people with neuropathic pain after spinal cord injury. Single-case experimental designs are considered a viable alternative approach to randomized clinical trials to identify evidence-based practices in the field of technology-based health interventions when recruitment of large samples is not feasible. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000556943; https://bit.ly/2RY1jRx International Registered Report Identifier (IRRID) PRR1-10.2196/20979

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of the Effectiveness of a Novel Brain-Computer Interface Neuromodulative Intervention to Relieve Neuropathic Pain Following Spinal Cord Injury: Protocol for a Single-Case Experimental Design With Multiple Baselines

Hesam‐Shariati¹,

Newton‐John²,

Singh³

et al. 2020

JMIR Res Protoc

View full text Add to dashboard Cite

show abstract

“…Current BCI-N interventions for both SCI neuropathic pain [20,22,24] and chronic pain [25][26][27] have mostly relied on a single mode of virtual interaction, such as increasing or decreasing the height of a bar presented on a computer screen. However, preliminary evidence suggests that greater pain relief may be achieved from interactive, goal-directed engagement with a gaming environment, in comparison with a single virtual interaction format [28][29][30][31]. The increased analgesic effect may be due to the greater cortical involvement, which occurs during engagement with multiple scenarios in a goal-directed manner such as gaming [32].…”

Section: Changing Brain Rhythms Reduces Neuropathic Pain Following Scimentioning

confidence: 99%

“…The BCI-N system of this study will address a key limitation of previous EEG neurofeedback interventions, which have mostly relied on a single form of virtual interaction [20,22,24]. Studies have shown greater cortical involvement [32] and pain reduction [28][29][30][31] during the interactive engagement with multiple gaming scenarios than with 1 form of virtual interaction. Based on this evidence, we will use a self-developed BCI-N treatment, which consists of 3 interactive virtual scenarios in a goal-directed gaming environment.…”

Section: Overviewmentioning

confidence: 99%

Evaluation of the Effectiveness of a Novel Brain-Computer Interface Neuromodulative Intervention to Relieve Neuropathic Pain Following Spinal Cord Injury: Protocol for a Single-Case Experimental Design With Multiple Baselines (Preprint)

Hesam‐Shariati¹,

Newton‐John²,

Singh³

et al. 2020

Preprint

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UNSTRUCTURED Background: Neuropathic pain is a debilitating secondary condition for many individuals with spinal cord injury (SCI). SCI neuropathic pain often remains poorly responsive to existing pharmacological and non-pharmacological treatments. A growing body of evidence supports the potential for brain-computer interface (BCI) systems to reduce SCI neuropathic pain via electroencephalography (EEG) neurofeedback. However, further studies are needed to provide more definitive evidence regarding the effectiveness of this intervention. Objective: The primary objective of this study is to evaluate the effectiveness of a multi-day course of BCI-N intervention in a gaming environment to provide pain relief for individuals with neuropathic pain following SCI. Methods: We have developed a novel BCI-based neuromodulative (BCI-N) intervention for SCI neuropathic pain. Our BCI-N treatment includes an interactive gaming interface, and a neuromodulation protocol targeted to suppress theta (4-8 Hz) and high beta (20-30 Hz) frequency powers, and enhance alpha (9-12 Hz) power. A single-case experimental design (SCED) with multiple baselines will be used to examine the effectiveness of our self-developed BCI-N intervention for the treatment of SCI neuropathic pain. Three participants with SCI neuropathic pain will be recruited. Each participant will be randomly allocated to a different baseline phase (i.e., 7, 10 or 14 days), which will then be followed by 20 sessions of 30-min BCI-N intervention over a 4-week period. The visual analogue scale assessing average pain intensity will serve as the primary outcome measure. Pain interference will also be assessed as a secondary outcome domain. Generalisation measures will assess quality of life, sleep quality, anxiety and depressive symptoms as well as resting-state EEG and thalamic γ-aminobutyric acid concentration (GABA). SCEDs are considered a viable alternative approach to randomised clinical trials to identify evidence-based practices in the field of technology-based health interventions when recruitment of large samples is not feasible. Ethics approval: This trial was approved by the University of New South Wales (HC190411) and University of Technology Sydney (ETH19-4090) Human Ethics Committees. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000556943

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“…For example, tasks placing a high demand on central executive resources are particularly effective in diverting attention away from pain (6,7). However, studies investigating the effects of increased task difficulty in VR often rely on the manipulation of game settings, such as the speed or number of hit targets, and are therefore likely to be confounded by the participant's gaming experience and motor coordination skills (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

When Less Is More: Investigating Factors Influencing the Distraction Effect of Virtual Reality From Pain

et al. 2022

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Virtual reality (VR) is a powerful method of redirecting attention away from pain. Yet, little is known about which factors modulate the size of this distraction effect. The aim of this study was to investigate the role of cognitive load and inter-individual differences in the cognitive and affective domain on heat pain thresholds during a VR game. Ninety healthy participants (mean age ± SD: 23.46 ± 3.28; 50% identified as male and 50% as female) played a low and high load version of a VR game while heat pain thresholds and heart rate were recorded. The effects of cognitive load were assessed by computing the difference in pain thresholds between the high and low load condition for each participant. In addition, we computed the difference in heart rate variability (HRV) measures between both conditions to explore whether these would be correlated with the difference in heat pain thresholds. Prior to the VR session, participants completed questionnaires about their emotional distress, pain-related cognitions, and different executive functioning tasks. Contrary to our expectations, not all participants benefitted from a higher load in terms of distraction from pain. Logistic regression analysis revealed that participants who reported more emotional distress were more likely to exhibit higher pain thresholds in the low relative to the high load condition. Accordingly, these participants tended to show marginally higher HRV in the low compared to the high load condition. Our study demonstrates that the potential benefits of an increased cognitive load in VR on pain sensitivity depends on individual differences in affective state.

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Computer games as distraction from PAIN: Effects of hardware and difficulty on pain tolerance and subjective IMMERSION

Abstract: The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription.

Cited by 22 publications

References 69 publications

Evaluation of the Effectiveness of a Novel Brain-Computer Interface Neuromodulative Intervention to Relieve Neuropathic Pain Following Spinal Cord Injury: Protocol for a Single-Case Experimental Design With Multiple Baselines

Evaluation of the Effectiveness of a Novel Brain-Computer Interface Neuromodulative Intervention to Relieve Neuropathic Pain Following Spinal Cord Injury: Protocol for a Single-Case Experimental Design With Multiple Baselines

Evaluation of the Effectiveness of a Novel Brain-Computer Interface Neuromodulative Intervention to Relieve Neuropathic Pain Following Spinal Cord Injury: Protocol for a Single-Case Experimental Design With Multiple Baselines (Preprint)

When Less Is More: Investigating Factors Influencing the Distraction Effect of Virtual Reality From Pain

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