Q&A: Higher physical activity levels linked to stronger pain tolerance

Key takeaways:

• A study of more than 10,000 adults showed those who were physically active had higher pain tolerance.
• It is the first population-based study to examine the link between physical activity and pain tolerance.

Individuals with varying degrees of physical activity levels had greater pain tolerance compared with those who were sedentary, according to a recent study published in PLoS One.

“As large studies on [physical activity (PA)] interventions are lacking, a population-based approach to assessing whether a population change of PA is related to subsequent pain tolerance could provide important basic knowledge,” Anders Pedersen Årnes, a PhD student from the department of pain at University Hospital of North Norway, and colleagues wrote.

Thus, the researchers conducted a prospective study to determine how PA levels impact pain tolerance over time, and whether factors like gender and clinical pain further influenced the potential links.

Årnes and colleagues examined 2007-2008 and 2015-2016 survey data on 10,732 Norwegian individuals who self-reported their PA. The researchers analyzed pain tolerance through the cold-pressor test (CPT), in which participants put their hands in cold water for as long as possible.

Participants who had a high, consistent PA level over the two surveys lasted about 20.4 seconds (95% CI, 13.7-27.1) longer during the CPT than those in the consistently sedentary group, according to the researchers.

Overall, pain tolerance was 7%, 14% and 16% higher among participants in the light, moderate and vigorous leisure-time PA groups compared with sedentary participants.

The researchers noted that the positive associations may possibly diminish over time because of factors like aging; however, the findings “might suggest increasing PA levels as a possible nonpharmacological pathway toward reducing or preventing chronic pain.”

Healio spoke with Årnes to learn more about the link between PA and pain tolerance, notable findings regarding chronic pain effects and more.

Healio: What led you to examine potential pain tolerance associations with PA?

Årnes: A number of small studies point toward our ability to process pain signals as a possible contributing cause of chronic pain because that often is seen to behave differently in those with chronic pain to those without. Because PA also appears to be a useful tool for preventing and treating chronic pain, we are trying to figure out whether this effect on pain tolerance could be one of the mechanisms through which PA protects against chronic pain. This study is the first to look at how PA relates to pain sensitivity over time in a population-based setting.

Healio: Were there any results that were expected or notable?

Årnes: We expected to find clear differences in pain tolerance across activity levels. Unexpectedly, chronic pain did not seem to diminish the effect of PA on pain tolerance, which appeared just as strong for those with pain as for those without. Furthermore, there was no difference between women and men, which was surprising. We expected to see smaller effects for women, but that was not the case here. Finally, we found quite large effects of the most active vs. the least active participants; close to 60 seconds average for the sedentary group vs. higher than 80 seconds tolerance for the most active participants. That is sizeable.

Healio: What should clinicians take away from your research?

Årnes: Whether to “push through the pain” in exercise with painful conditions is a much-discussed topic in the field. I have the impression that this can be acceptable for many types of persistent pain, with the possible exception of the types of chronic pain that are principally characterized by a disturbance in processing of pain signals, such as fibromyalgia. In all cases, it can generally be advisable to have a more gradual approach and ensure that your level of activity does not worsen symptoms before attempting to increase amount or intensity. Our results seemed to be just as strong for those with pain as for those without, although a change in individual PA level for people with chronic pain could benefit from guidance by an experienced clinician.

Healio: What comes next regarding your research on pain tolerance associations?

Årnes: This spring, we will be submitting a follow-up study showing how the effect PA on pain tolerance influences our risk of chronic pain. That is, could pain tolerance be one of the mechanisms through which PA protects against chronic pain? Stay tuned!

References:

• Årnes A, et al. PLoS One. 2023;doi: 10.1371/journal.pone.0285041
• Physical activity linked to higher pain tolerance. https://www.eurekalert.org/news-releases/989565. Published May 24, 2023. Accessed June 6, 2023.