Internet Gaming, Chronic Pain, and Personality

Discussion of internet gaming disorder focuses on harms to well-being and social and psychological functioning. The negative impacts on lifestyles, social relationships, and mental health of gaming too much are documented. Less discussed among the potential harms associated with internet gaming disorder are its negative effects on muscular-skeletal functioning. There is limited, but somewhat compelling, evidence for a range of such physical effects, including muscular pain in hands, wrists, and shoulders, as well as tendon injuries^1,2.

Whenever a physical problem might be related to a psychological characteristic, a question is whether the psychological characteristic is a long-lasting trait or whether it is an environmentally-induced state. Both sorts of effects have been associated with pain syndromes, and both have been associated with internet gaming disorder. The similarities between the associations in the two conditions are quite striking. They also suggest a rather complex relationship between the two, involving heightened susceptibility to the experience of stress, engagement in escape behaviours (like internet gaming disorder), and reporting pain sensations.

Similar personality factors are associated with both the report and experience of internet gaming disorder and the report and experience of chronic pain. The Big-5 personality model comprises: openness to experience (curiousness versus cautiousness); conscientiousness (organisation versus carelessness); extraversion (outgoingness versus being reserved); agreeableness (friendly versus critical); and neuroticism. Of these personality traits, neuroticism correlates positively with pathological gaming, while openness, conscientiousness, extraversion, and agreeableness correlate negatively with gaming⁴. When these traits are examined, relative to chronic pain, people with chronic pain tend to score highly on neuroticism^5,6. Moreover, both extraversion and openness negatively correlate with the experience of pain⁶. Taken together, these results suggest the personality traits associated with internet gaming and chronic pain are similar to one another. One possibility leading from these concordances is that levels of pain-reporting and internet gaming disorder are not causally related, but rather both the product of a third factor—personality.

Of course, many avenues could be explored in terms of these relationships. However, the finding regarding neuroticism may be particularly important for understanding why both internet gaming disorder and chronic pain syndromes could have similar roots and motivations—and suggest there is more occurring here than mere correlation. It gives insight into why the psychology of those with internet gaming disorder leads them to report pain more often (irrespective of their actual physical activity), and drives them to engage in activities that will likely lead to injury through overuse of muscle groups.

This explanation revolves around the suggestion that those high in neuroticism tend to be more avoidant of aversive stimulation—including life stress—and engage in activities of both thought and deed to avoid these stresses⁷. The use of internet games and the report of pain may be both, in some part, escape strategies from stress. Certainly, pain has been analysed as an escape/avoidance response to stress⁷. This does not mean that such reported pain is not experienced or real—it just has a different origin than a purely physical trauma. Similarly, researchers have suggested that internet gaming is a stress-escape response⁸. This would explain the joint emergence of gaming and pain reports, but it does not explain entirely the full relationship, as the lowered levels of stress felt while engaging in gaming may serve to keep players online⁸—making it more likely that they will do physical injury¹.

What is the evidence for these suggestions? Those with repetitive strain injuries⁹ and those engaging in excessive gaming¹⁰ report high levels of everyday stress. Moreover, individuals reporting chronic pain demonstrate a greater tendency to avoid such stressors and harms¹¹. This resonates with findings suggesting those displaying problematic internet gaming are particularly avoidant of stress-inducing situations, and demonstrate lower resilience to stress¹². The relationship between the presence of stress in the immediate environment of individuals, and the report of pain by those with chronic pain syndromes, has been illustrated experimentally¹³. Participants reporting repetitive strain, due to computer use, were divided into two groups; one group was exposed to a stressful situation while using the computer, and the other was not. The stressed group reported greater pain, and demonstrated more physiological signs associated with pain experience. A similar effect has been found for those with internet gaming problems, with those reporting more everyday stress gaming more¹⁰, and feeling more stress after gaming¹².

The parallels between the personality factors, and their interactions with the immediate context, appear striking for chronic pain and internet gaming problems. Sensitivity to stress due to neuroticism may drive both internet gaming and the experience of chronic pain. These similarities may be underpinned by a similar mechanism—avoidance of stress. Given this, it may not be surprising that high levels of pain are shown by those who engage in internet games—because their personalities provoke both of these responses, and drive them to engage in more of the physical activity which will produce the injuries of which they complain.