Pain perception in athletes compared to normally active controls: A systematic review with meta-analysis

• Published in: Pain (Amsterdam) Vol. 153; no. 6; pp. 1253 - 1262
• Main Authors: Tesarz, Jonas, Schuster, Alexander K., Hartmann, Mechthild, Gerhardt, Andreas, Eich, Wolfgang
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier B.V 01.06.2012; Lippincott Williams & Wilkins, Inc; Elsevier
• Subjects: Athletes; Athletes - psychology; Biological and medical sciences; Fundamental and applied biological sciences. Psychology; Humans; Illness and personality; Illness, stress and coping; Meta-analysis; Pain - physiopathology; Pain - psychology; Pain perception; Pain threshold; Pain Threshold - physiology; Pain Threshold - psychology; Pain tolerance; Perception - physiology; Psychology and medicine; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors; Systematic review; Vertebrates: nervous system and sense organs; Systematic review; Pain perception; Pain tolerance; Athletes; Pain threshold; Meta-analysis; High risk; Bias; Tolerance; Athlete; Pain; Size effect; Random effect; Perception; Models
• ISSN: 0304-3959; 1872-6623; 1872-6623
• DOI: 10.1016/j.pain.2012.03.005

Differences in pain perception between athletes and nonathletes were meta-analyzed. Available data suggest that regular physical activity is associated with specific alterations in pain perception. This study systematically reviewed differences in pain perception between athletes and normally active controls. We screened MEDLINE, Sport-Discus, EMBASE, Web of Science, PsycINFO, PSYNDEX, and the citations of original studies and systematic reviews. All studies on experimentally induced pain that compared pain perception between athletes and normally active controls were eligible. The main outcome measures were pain tolerance and pain threshold. Effects are described as standardized mean differences and were pooled using random-effects models. Fifteen studies including 899 subjects met the inclusion criteria. Twelve of these studies assessed pain tolerance, and 9 studies examined pain threshold. A meta-analysis of these studies revealed that athletes possessed higher pain tolerance compared to normally active controls (effect size calculated as Hedges’ g=0.87, 95% confidence interval [CI95] 0.53–1.21; P<0.00001), whereas available data on pain threshold were less uniform (Hedges’ g=0.69, CI95 0.16–1.21; P=0.01). After exclusion of studies with high risk of bias, differences between groups in pain threshold were not significant any longer. Our data suggest that regular physical activity is associated with specific alterations in pain perception. Psychological and biological factors that may be responsible for these alterations are discussed.