The effects of auditory background noise and virtual reality technology on video game distraction analgesia

Background and aims: The present study was designed to evaluate the relative efficacy of two video game display modalities-virtual reality (VR) assisted video game distraction, in which the game is presented via a VR headmounted display (HMD) helmet, versus standard video game distraction, in which the game is projected on a television -and to determine whether environmental context (quiet versus noisy) moderates the relative efficacy of the two display modalities in reducing cold pressor pain in healthy college students. Methods: Undergraduate students (n = 164) were stratified by sex and self-reported video game skill and were randomly assigned to a quiet or a noisy environment. Participants then underwent three cold pressor trials consisting of one baseline followed by two distraction trials differing in display modality (i.e. VR-assisted or standard distraction) in counter-balanced order. Results: Participants experienced improvement in pain tolerance from baseline to distraction in both display modality conditions (p < 0.001, partial eta(2) = 0.41), and there was a trend toward greater improvement in pain tolerance from baseline to distraction when using the VR HMD helmet than during standard video game distraction (p = 0.057, partial eta(2) = 0.02). Participants rated pain as more intense when experienced with concurrent experimental background noise (p = 0.047, partial eta(2) = 0.02). Pain tolerance was not influenced by the presence or absence of background noise, and there was not a significant interaction between display modality and noise condition. Though exploratory sex analyses demonstrated a significant three-way interaction between noise condition, sex, and display modality on pain intensity (p = 0.040, partial eta(2) = 0.040), follow-up post-hoc analyses conducted for males and females separately did not reveal significant differences in pain intensity based on the interaction between noise condition and display modality. Conclusions: As expected, video game distraction both with and without an HMD helmet increased pain tolerance; however, the two display modalities only marginally differed in efficacy within the population under study. The effect of auditory background noise on pain was mixed; while pain tolerance did not vary as a function of the presence or absence of background noise, the addition of noise increased pain intensity ratings. The interaction between participant sex, noise condition, and distraction modality on pain intensity trended toward significance but would require replication in future research.