VR-FOCUS: Evaluating eye tracking during a virtual reality N-back task as a marker of cognitive load in chronic pain

Tsigarides, Jordan ORCID: https://orcid.org/0000-0001-9893-8002, Bowler, Jennifer O., Dainty, Jack ORCID: https://orcid.org/0000-0002-0056-1233, Bagnall, Anthony and Macgregor, Alexander ORCID: https://orcid.org/0000-0003-2163-2325 (2026) VR-FOCUS: Evaluating eye tracking during a virtual reality N-back task as a marker of cognitive load in chronic pain. Scientific Reports. ISSN 2045-2322

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Abstract

Immersive virtual reality (VR) is a promising medium for adaptive pain therapeutics, but objective markers of cognitive load suitable for real-time adaptation remain insufficiently characterised in chronic pain. This study evaluated whether eye tracking embedded within a consumer-available VR system provides signatures of cognitive load during a VR N-back task. A total of 84 participants (42 healthy controls, 42 chronic musculoskeletal pain) completed five levels (Baseline to 4-Back) while ocular responses were recorded. Performance declined and subjective workload increased with task level, confirming successful manipulation of cognitive demand, although performance plateaued beyond 3-Back. In mixed-effects models, larger pupil diameter and higher blink rate were associated with task level and workload, without group differences. Logistic regression using summary features discriminated 1-Back from 4-Back at near-chance levels (0.51–0.60). Time-series classifiers exploiting temporal structure performed substantially better in healthy controls (0.74–0.88) but were attenuated in chronic pain (0.58–0.65). Age alone did not appear to explain this difference, although a contribution cannot be excluded. These findings support the feasibility of VR-embedded eye tracking for cognitive load estimation in healthy adults, but performance in chronic pain is currently insufficient for reliable individual-level inference; closed-loop application in this population will require participant-calibrated models and prospective validation.

Item Type:	Article
Uncontrolled Keywords:	das to be completed,2026 ,/dt/atira/pure/keyword/DAStatement/das_to_be_completed
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School Faculty of Medicine and Health Sciences > School of Health Sciences Faculty of Social Sciences > School of Psychology
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Public Health Faculty of Social Sciences > Research Groups > Cognition, Action and Perception Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine Faculty of Medicine and Health Sciences > Research Groups > Musculoskeletal Medicine Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Depositing User:	LivePure Connector
Date Deposited:	15 Oct 2026 13:56
Last Modified:	18 Oct 2026 05:32
URI:	https://ueaeprints.uea.ac.uk/id/eprint/104796
DOI:	10.1038/s41598-026-74975-6

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