Pain tolerance: The Brave Little Sportsman

5. September 2012
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The perception of pain is individual, but performance athletes in pain often seem very "gritty" or courageous. In actual fact sport changes pain tolerance, a study at Heidelberg University has found.

Athletes have a higher pain tolerance than people who are only slightly active. They often go up to and even beyond the threshold of pain, in order to achieve their goals. Even if they are injured, it seems only to inspire some of them even more. How is that possible? There is a strong suspicion that pain is perceived and in particular processed differently from most of us. This has been confirmed by a recent meta-analysis of studies on the topic.

Athletes keep on going

Jonah Tesarz and his team members at the University of Heidelberg recently examined the available studies on the subject in a meta-analysis. Studies on pain perception of athletes had previously arrived at no consistent results and were sometimes even contradictory. Underpinning them were measures of pain tolerance and pain threshold among athletes in comparison to people of normal activity acting as controls. The types of sport practiced by the athletes included endurance sports, ball sports and strength sports. Overall, 15 studies were usable in the end with almost 900 participants, twelve studies of which examined pain tolerance and nine pain threshold. The 568 athletes were made up of people who exercised at least six hours per week. Sensitivity to pain was investigated by holding the hand in cold water or by pinching the fingers.

Athletes showed a uniformly higher pain tolerance than did control persons. The extent of the “pain endurance” here depended however on the form of sport in which they participated. Endurance athletes for instance uniformly possessed a moderate pain tolerance. Ball athletes generally reported the highest pain tolerance, something which puts a different spin on that which some football players perhaps make it appear to be. Yet the results varied significantly among them.

Paincoping as therapy?

Why endurance athletes differ from ball-playing athletes in their pain tolerance is unclear. Perhaps endurance athletes may be more alike in terms of their physical and psychological profiles while ballplayers differ here more frequently. No differences were able to be discerned in pain threshold. This is defined as the minimum intensity of a stimulus which is perceived as painful. So athletes feel pain from the same point onward as do normally active people.

Regular exercise according to the study is associated with a significant increase in pain tolerance. This is especially important to the medical clinic with respect to patients with pain problems. Many studies have already been able to show a positive effect of exercise on pain patients. An improved quality of life and improvement of function without improved Pain Scores can be shown. Maybe it makes sense as part of the physical therapy of these patients to focus on the development of pain coping strategies, in order to influence the tolerance of pain rather than only tackling the area of direct influence on the pain threshold.

First, however, the precise relationship between physical activity and modification of pain perception would need to be resolved, says Tesarz, so that psychological factors and neurobiological processes which play a role can be identified. The observation that the perception of pain can be modified with sports is probably a promising approach which involves non-invasive pain management of patients with chronic pain – with few side effects.

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