Working memory and visual discrimination distraction tasks improve cold pressor pain tolerance in children.

OBJECTIVE: Distraction is a well-established pain management technique for children experiencing acute pain, although the mechanisms underlying the effectiveness of distraction are not well understood. It has been postulated that engagement of executive functions, such as working memory, may be a critical factor in attenuating pain via distraction. To test this hypothesis, we compared a 1-back task requiring engagement of working memory with a simple visual discrimination task demanding focused attention, but lower cognitive load (0-back). METHOD: Seventy-nine children (6-12 years old) underwent a baseline cold pressor trial followed by cold pressor trials in which they completed the visual discrimination and 1-back tasks in counterbalanced order. Executive functioning ability was assessed via the Wechsler Intelligence Scale for Children (5th Edition) working memory subscales and by parent report on the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF®2). RESULTS: Children's pain tolerance improved in both the visual discrimination and 1-back conditions though a differential response to the 2 tasks was not observed. Age moderated the relation between executive functioning and response to distraction; older children with better executive functioning skills demonstrated greater improvements in both distraction interventions. CONCLUSIONS: Findings demonstrate the benefits of both visual discrimination and working memory distraction tasks for elementary-aged children experiencing acute pain. Further research is required in order to elucidate the role of executive functioning skills and cognitive load in enhancing distraction analgesia in children, with particular focus on determining optimal load and task difficulty in light of emerging executive functioning abilities in this age group. (PsycINFO Database Record (c) 2019 APA, all rights reserved).