Abstract
Exercise-induced hypoalgesia (EIH), or the inhibition of pain following physical exercise, has been demonstrated in adults, but its mechanisms have remained unclear due to variations in methodology. This study aimed to address methodological imitations of past studies and contribute to the literature demonstrating the generalizability of EIH to brief submaximal isometric exercise and cold pressor pain. Young adults (n = 134) completed a baseline cold pressor trial, maximal voluntary contraction (hand grip strength) assessment, 10-min rest, and either a 2-min submaximal isometric handgrip exercise or a sham exercise in which no force was exerted, followed by a cold pressor posttest. Results indicated that cold pressor pain tolerance significantly increased during the exercise condition, but not during the sham exercise condition. Exercise did not affect pain intensity and marginally affected pain unpleasantness ratings. These findings suggest that submaximal isometric exercise can improve cold pressor pain tolerance but may have an inconsistent analgesic effect on ratings of cold pressor pain.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
The primary dependent variable of interest in the present study was pain tolerance. It has been argued that assessing pain intensity and unpleasantness ratings concurrent with cold water immersion may interfere with pain tolerance assessment by either decreasing pain tolerance by drawing attention to pain, or increasing pain tolerance by distracting from the painful stimulus (von Baeyer et al. (2005). Therefore, we elected to assess pain intensity at the end of the cold pressor trial, which is consistent with the methodology used by Vaegter et al. (2014).
References
Bement, M. H. (2009). Exercise-induced hypoalgesia: An evidence-based review. In K. A. Sluka (Ed.), Mechanisms and Management of Pain for the Physical Therapist. Seattle, WA: International Association for the Study of Pain Press.
Bement, M. H., Drewek, B., & Hunter, S. K. (2014). Men report greater pain relief following sustained static contractions than women when matched for baseline pain. Journal of Motor Behavior, 46(2), 107–113. doi:10.1080/00222895.2013.872078
Bingel, U., Schoell, E., Herken, W., Buchel, C., & May, A. (2007). Habituation to painful stimulation involves the antinociceptive system. Pain, 131, 21–30. doi:10.1016/j.pain.2006.12.005
Black, C. D., Huber, J. K., Ellingson, L. D., Ade, C. J., Taylor, E. L., Griffeth, E. M., et al. (2016). Exercise-induced hypoalgesia is not influenced by physical activity type and amount. Medicine and Science in Sports and Exercise. doi:10.1249/MSS.0000000000001186
Craig, C. L., Marshall, A. L., Sjostrom, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., et al. (2003). International Physical Activity Questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise, 195, 1381–1395. doi:10.1249/01.MSS.0000078924.61453.FB
Droste, C., & Greenlee, M. W. (1992). Comments on padawer and levine [letter]. Pain, 48, 241. doi:10.1016/0304-3959(92)90173-9
Ellingson, L. D., Koltyn, K. F., Kim, J. S., & Cook, D. B. (2014). Does exercise induce hypoalgesia through conditioned pain modulation? Psychophysiology, 51, 267–276. doi:10.1111/psyp.12168
Farasyn, A., & Meeusen, R. (2003). Pressure pain thresholds in healthy subjects: Influence of physical activity, history of lower back pain factors and the use of endermology as a placebo-like treatment. Journal of Bodywork and Movement Therapies, 7(1), 53–61. doi:10.1016/S1360-8592(02)00050-5
Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Rahim-Williams, B., & Riley, J. L. (2009). Sex, gender, and pain: a review of recent clinical and experimental findings. The Journal of Pain, 10, 447–485. doi:10.1016/j.jpain.2008.12.001
Fingleton, C., Smart, K., & Doody, C. (2016). Exercise-induced hypoalgesia in people with knee osteoarthritis with normal and abnormal conditioned pain modulation. Clinical Journal of Pain. doi:10.1097/AJP.0000000000000418
Gajsar, H., Titze, C., Hasenbring, M. I., & Vaegter, H. B. (2016). Isometric Back Exercise Has Different Effect on Pressure Pain Thresholds in Healthy Men and Women. Pain Medicine. doi:10.1093/pm/pnw176
Gurevich, M., Kohn, P. M., & Davis, C. (1994). Exercise-induced analgesia and the role of reactivity in pain sensitivity. Journal of Sports Sciences, 12, 549–559. doi:10.1080/02640419408732205
Hagströmer, M., Oja, P., & Sjöström, M. (2006). The International Physical Activity Questionnaire (IPAQ): A study of concurrent and construct validity. Public Health Nutrition, 9(6), 755–762. doi:10.1079/PHN2005898
Hardy, C. J., & Rejeski, W. J. (1989). Not what, but how one feels: The measurement of affect during exercise. Journal of Sport and Exercise Psychology, 11, 304–317. doi:10.1123/jsep.11.3.304
Hoeger Bement, M. K., DiCapo, J., Rasiarmos, R., & Hunter, S. K. (2008). Dose response of isometric contractions on pain perception in healthy adults. Medicine and Science in Sports and Exercise, 40, 1880–1889. doi:10.1249/MSS.0b013e31817eeecc
Hoffman, M. D., & Hoffman, D. R. (2007). Does aerobic exercise improve pain perception and mood? A review of the evidence related to healthy and chronic pain subjects. Current Pain and Headache Reports, 11, 93–97. doi:10.1007/s11916-007-0004-z
Hoffman, M. D., Shepanski, M. A., Ruble, S. B., Valic, Z., Buckwalter, J. B., & Clifford, P. S. (2004). Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain. Archives of Physical Medicine and Rehabilitation, 85, 1183–1187. doi:10.1016/j.apmr.2003.09.010
Janal, M. N., Colt, E. W. D., Clark, W. C., & Gusman, M. (1984). Pain sensitivity, mood and plasma endocrine levels in man following long distance running: Effects of naloxone. Pain, 19, 13–25. doi:10.1016/0304-3959(84)90061-7
Kodesh, E., & Weissman-Fogel, I. (2014). Exercise-induced hypoalgesia–interval versus continuous mode. Applied Physiology, Nutrition, and Metabolism, 39(7), 829–834. doi:10.1139/apnm-2013-0481
Koltyn, K. (2000). Analgesia following exercise. Journal of Sports Medicine, 29, 85–98. doi:10.2165/00007256-200029020-00002
Koltyn, K. (2002). EIH and the intensity of exercise. Journal of Sports Medicine, 32, 477–487. doi:10.2165/00007256-200232080-00001
Koltyn, K. F., & Arbogast, R. W. (1998). Perception of pain after resistance exercise. Journal of Sports Medicine, 32, 20–24. doi:10.1136/bjsm.32.1.20
Koltyn, K. F., Brellenthin, A. G., Cook, D. B., Sehgal, N., & Hillard, C. (2014). Mechanisms of exercise-induced hypoalgesia. The Journal of Pain, 15, 1294–1304. doi:10.1016/j.jpain.2014.09.006
Koltyn, K. F., & Umeda, M. (2006). Exercise, hypoalgesia, and blood pressure. Sports Medicine, 36, 207–214. doi:10.2165/00007256-200636030-00003
Koltyn, K. F., & Umeda, M. (2007). Contralateral attenuation of pain after short-duration submaximal isometric exercise. Journal of Pain, 8, 887–892. doi:10.1016/j.jpain.2007.06.003
Kosek, E., & Lundberg, L. (2003). Segmental and plurisegmental modulation of pressure pain thresholds during static muscle contractions in healthy individuals. European Journal of Pain, 7, 251–258. doi:10.1016/S1090-3801(02)00124-6
La Motte, R. H., & Campbell, J. N. (1978). Comparison of the responses of warmth and nociceptive C fiber afferents in monkey with human judgments of thermal pain. Journal of Neurophysiology, 41, 509–528.
Lemley, K., & Hoeger Bement, M. (2009). Do opioids alone explain EIH? Pain management special interest group. Orthopaedic Physical Therapy Practice, 21, 168–170.
Lemley, K. J., Hunter, S. K., & Bement, M. K. (2015). Conditioned pain modulation predicts exercise-induced hypoalgesia in healthy adults. Medicine and Science in Sports and Exercise, 47, 176–184. doi:10.1249/MSS.0000000000000381
Meeus, M., Roussel, N. A., Truijen, S., & Nijs, J. (2010). Reduced pressure pain thresholds in response to exercise in chronic fatigue syndrome but not in chronic low back pain: An experimental study. Journal of Rehabilitation Medicine, 42, 884–890. doi:10.2340/16501977-0595
Melrose, D. (2005). Gender differences in cardiovascular response to isometric exercise in the seated and supine positions. Journal of Exercise Physiology, 8, 29–35. doi:10.1097/00005768-199705001-00998
Mitchell, L. A., MacDonald, R. A., & Brodie, E. E. (2004). Temperature and the cold pressor test. The Journal of Pain, 5, 233–237. doi:10.1016/j.jpain.2004.03.004
Naugle, K. M., Fillingim, R. B., & Riley, J. L. (2012). A meta-analytic review of the hypoalgesic effects of exercise. Pain, 13, 1139–1150. doi:10.1016/j.jpain.2012.09.006
Naugle, K. M., Naugle, K. E., Fillingim, R. B., & Riley, J. L. (2014a). Isometric exercise as a test of pain modulation: Effects of experimental pain test, psychological variables, and sex. Pain Medicine, 15, 692–701. doi:10.1111/pme.12312
Naugle, K. M., Naugle, K. E., Fillingim, R. B., & Riley, J. L. (2014b). Intensity thresholds for aerobic EIH. Medicine and Science in Sports and Exercise, 46, 817–825. doi:10.1249/MSS.0000000000000143
Nir, R. R., & Yarnitsky, D. (2015). Conditioned pain modulation. Current Opinion in Supportive and Palliative Care, 9, 131–137. doi:10.1097/SPC.0000000000000126
O’Connor, P. J., & Cook, D. B. (1999). Exercise and pain: The neurobiology, measurement, and laboratory study of pain in relation to exercise in humans. Exercise and Sport Sciences Reviews, 27, 119–166.
Ohnhaus, E. E., & Adler, R. (1975). Methodological problems in the measurement of pain: A comparison between the verbal rating scale and the visual analogue scale. Pain, 1, 379–384. doi:10.1016/0304-3959(75)90075-5
Petrovaara, A., Hupoaniemi, T., Viranen, A., & Johansson, G. (1984). The influence of exercise on dental pain thresholds and the release of stress hormones. Physiology and Behavior, 33, 923–926. doi:10.1016/0031-9384(84)90230-0
Price, D. D., McGrath, P. A., Rafii, A., & Buckingham, B. (1983). The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain, 17, 45–56. doi:10.1016/0304-3959(83)90126-4
Ruble, S. B., Hoffman, M. D., Shepanski, M. A., Valic, Z., Buckwalter, J. B., & Clifford, P. S. (2005). Thermal pain perception after aerobic exercise. Archives of Physical Medicine and Rehabilitation, 86, 1019–1023. doi:10.1016/j.apmr.2004.09.024
Smith, B. W., Tooley, E. M., Montague, E. Q., Robinson, A. E., Cospher, C. J., & Mullins, P. G. (2008). Habituation and sensitization to heat and cold pain in women with fibromyalgia and healthy controls. Pain, 140, 420–428. doi:10.1016/j.pain.2008.09.018
Staud, R., Robinson, M. E., & Price, D. D. (2005). Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls. Pain, 118, 176–184. doi:10.1016/j.pain.2005.08.007
Sternberg, W., Bokat, C., Kass, L., Alboyadjian, A., & Gracely, R. (2001). Sex-dependent components of the analgesia produced by athletic competition. Journal of Pain, 2, 65–74. doi:10.1054/jpai.2001.18236
Stolzman, S., & Hoeger Bement, M. (2016). Does exercise decrease pain via conditioned pain modulation in adolescents? Pediatric Physical Therapy, 28, 470–473. doi:10.1097/PEP.0000000000000312
Tabachnick, B.G. & Fidell, L.S. (2006). Using Multivariate Statistics (5th ed.). Needham Heights, MA: Allyn & Bacon, Inc.
Tang, N. K., Salkovskis, P. M., Hodges, A., Wright, K. J., Hanna, M., & Hester, J. (2008). Effects of mood on pain responses and pain tolerance: An experimental study in chronic back pain patients. Pain, 138, 392–401. doi:10.1016/j.pain.2008.01.018
Terhaar, J., Boettger, M. K., Schwier, C., Wagner, G., Israel, A. K., & Bär, K. J. (2010). Increased sensitivity to heat pain after sad mood induction in female patients with major depression. European Journal of Pain, 14, 559–563. doi:10.1016/j.ejpain.2009.09.004
Tsao, J. C. I., Seidman, L. C., Evans, S., Lung, K. C., Zeltzer, L. K., & Naliboff, B. D. (2013). Conditioned pain modulation in children and adolescents: Effects of sex and age. Journal of Pain, 14(6), 558–567. doi:10.1016/j.jpain.2013.01.010
Umeda, M., Newcomb, L. W., Ellingson, L. D., & Koltyn, K. F. (2010). Examination of the dose-response relationship between pain perception and blood pressure elevations induced by isometric exercise in men and women. Biological Psychology, 85, 90–96. doi:10.1016/j.biopsycho.2010.05.008
Umeda, M., Newcomb, L. W., & Koltyn, K. F. (2009). Influence of blood pressure elevations by isometric exercise on pain perception in women. International Journal of Psychophysiology, 74, 45–52. doi:10.1016/j.ijpsycho.2009.07.003
Vaegter, H. B., Handberg, G., & Graven-Nielsen, T. (2014). Similarities between exercise-induced hypoalgesia and conditioned pain modulation in humans. Pain, 155, 158–167. doi:10.1016/j.pain.2013.09.023
Vaegter, H. B., Handberg, G., Jørgensen, M. N., Kinly, A., & Graven-Nielsen, T. (2015). Aerobic exercise and cold pressor test induce hypoalgesia in active and inactive men and women. Pain Medicine, 16, 923–933. doi:10.1111/pme.12641
van Weerdenburg, L. J. G. M., Brock, C., Mohr Drewes, A., van Goor, H., de Vries, M., & Wilder-Smith, O. H. G. (2017). Influence of exercise on visceral pain: An explorative study in healthy volunteers. Journal of Pain Research, 10, 37–46. doi:10.2147/JPR.5121315
von Baeyer, C. L., Piira, T., Chambers, C. T., Trapanatto, M., & Zeltzer, L. K. (2005). Guidelines for the cold pressor task as an experimental stimulus for use with children. Journal of Pain, 6, 218–227. doi:10.1016/j.jpain.2005.01.349
Wagner, G., Koschke, M., Leuf, T., Schlösser, R., & Bär, K. J. (2009). Reduced heat pain thresholds after sad-mood induction are associated with changes in thalamic activity. Neuropsychologia, 47, 980–987. doi:10.1016/j.neuropsychologia.2008.10.021
Williams, D. M., Dunsiger, S., Ciccolo, J. T., Lewis, B. A., Albrecht, A. E., & Marcus, B. H. (2008). Acute affective response to a moderate-intensity exercise stimulus predicts physical activity participation 6 and 12 months later. Psychology of Sport and Exercise, 9, 231–245. doi:10.1016/j.psychsport.2007.04.002
Acknowledgements
The authors wish to acknowledge the contribution of graduate students and undergraduate research assistants who contributed to this project: Caitlin Thompson, Jessica Hoehn, Julia Zeroth, Wendy Pinder, Samantha Bento, Chad Byrd, Ian Garvey, Nicole Gosnell, Beverly Krach, Annum Rentiya, and Gideon Schrier.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Emily Foxen-Craft and Lynnda M. Dahlquist declare that they have no conflict of interest.
Human and animal rights and Informed consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
Rights and permissions
About this article
Cite this article
Foxen-Craft, E., Dahlquist, L.M. Brief submaximal isometric exercise improves cold pressor pain tolerance. J Behav Med 40, 760–771 (2017). https://doi.org/10.1007/s10865-017-9842-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-017-9842-2