Cold Pressor Pain Research Articles

Effects of Manipulated Cognitive and Attributional Set on Pain Tolerance

The effects of cognitive set and attributional set on cold-pressor pain tolerance were investigated. Fifty subjects were given a series of projective tests that were used to manipulate the feedback they received concerning their ability to control their pain. The cognitive set was manipulated by telling the positive groups (Pos) that they had the ability to deal with external stress while the negative groups (Neg) were informed that they had difficulty dealing with external stress. The attributional set was manipulated by telling subjects that the task they were about to perform depended on the person performing it (Int) or on external factors (Ext). The results indicated that the Pos groups showed a longer duration in cold water and a strong tendency to rate the pain as less compared to the Neg groups. Int also yielded greater pain tolerance than Ext. The discussion focuses on the importance of mental attitude above and beyond any specific coping techniques.

Midazolam does not influence intravenous fentanyl-induced analgesia in healthy volunteers

The effects of saline and intravenous midazolam (0.5, 1, and 2 mg per 70 kg) in combination with intravenous fentanyl (0.1 mg/70 kg) were examined on pain induced by a cold pressor test. Healthy volunteers (six females, six males) were enrolled in a prospective, double-blind, randomized, crossover trial in which mood and psychomotor performance were also examined. Five minutes and 135 min postinjection subjects immersed their forearm in ice cold water for 3 min while assessments of pain were recorded. During the first immersion, subjects reported significantly lower pain intensity and bothersomeness ratings after having been injected with fentanyl, relative to the saline condition, but the addition of midazolam neither increased nor decreased pain reports. During the second immersion (approximately 2.5 h postinjection) pain ratings did not differ between the drug and saline conditions. Mood-altering and psychomotor-impairing effects of the drug combination were dose related. We conclude that midazolam at the doses and route of administration tested neither potentiates nor decreases the analgesia produced by fentanyl in a cold-pressor pain assay.

Effects of oral morphine on cold pressor tolerance time and neuropsychological performance

We investigated the analgesic effects of escalating doses (0.214, 0.286, 0.357, and 0.429 mg/kg) of oral morphine on tolerance to painful cold pressor in a double-blind, active placebo-controlled (diphenhydramine) study in 45 normal volunteers. The highest dose of morphine administered is equivalent to the starting dose recommended by the Agency for Health Care Policy and Research for the management of cancer pain and acute postoperative pain. We assessed analgesia in terms of cold pressor tolerance time and self-reported ratings of pain intensity and unpleasantness. Subjects receiving the highest dose of oral morphine showed significantly higher tolerance time than subjects receiving diphenhydramine. Neither morphine or diphenhydramine significantly reduced ratings of pain intensity and unpleasantness. Neuropsychological testing revealed that the two highest doses of morphine impaired the episodic retrieval of a word list, but the same doses did not affect motor, perceptual, or attentional tasks.

The influence of warning signal timing and cognitive preparation on the aversiveness of cold-pressor pain

This study examined the role of prior warning time, cognitive preparation and self-efficacy in the reaction to cold-pressor pain that has a substantial stimulus duration and leaves a residual effect. Forty-eight, paid, male subjects were randomly assigned to one of 3 cognitive preparation groups: (1) Training group, provided with a self-instructional booklet of pain control techniques, (2) Citizenship group, to control for reading a booklet, and (3) Control group with no advanced preparation. Warning times used on a within-subjects basis were 0, 30, and 180 sec prior to immersion of their arms in cold water. Results indicated that overall, the 180 sec warning time yielded the lowest pain ratings. Warning time had no effect on duration in water for subjects who underwent training, but the 30 sec and 180 sec warning time yielded longer duration in water, for subjects in the other groups. The Training group preparation was effective in raising perceived self-efficacy for coping with pain which, in turn, was found to be correlated with pain tolerance. Perceived self-efficacy was also found to have an effect on heart rate with high scorers yielding a lower reaction upon immersion into the cold water compared to the low scorers. The results point to the need to consider the effect of the stimulus characteristics and the centrality of perceived self-efficacy when preparing a subject prior to pain stimulation.

Effects of subanesthetic concentrations of nitrous oxide on cold-pressor pain in humans

Nitrous oxide (N 2O) has analgesic properties as determined in both animal and human research. In the present study, we sought to determine whether N 2O given in subanesthetic concentrations would reduce cold pressor (CP)-induced pain. A crossover, double-blind study was conducted in 10 healthy volunteers. Each subject participated in four separate sessions, and in each session the effects of one of four concentrations of N 2O in oxygen (0, 20, 30, and 40%) were assessed. The duration of inhalation was 40 min, and within each session, subjects immersed their nondominant arm in water (2–3 °C) twice for 3 min (at 10 and 30 min intrainhalation). Pain intensity, the degree to which the pain was bothersome (measured on a verbal scale of 0–10, 0 = “ not at all” and 10 = “ dextremely” painful/bothersome), and pain quality [measured by the short-form McGill Pain Questionnaire (SF-MPQ)] were assessed during the forearm immersion. Mood effects were measured with the use of visual analogue scales (VAS) in the presence and absence of pain. Self-reported pain intensity and bothersomeness, SF-MPQ ratings of “sharp pain” and “throbbing pain”, and VAS rating of “unpleasant bodily sensations” were significantly reduced by N 2O ( p < 0.05) in a concentration-dependent manner. Nitrous oxide had a number of effects on mood (e.g., increased VAS ratings of “stimulated”, “high”, “coasting”, “carefree”, and “having pleasant bodily sensations”). The cold-water immersion also influenced mood, but had little impact on modulating N 2O effects. Results from our study indicate that the CP test is a sensitive assay to measure the analgesic properties of subanesthetic concentrations of N 2O in humans.

Cold-pressor pain tolerance in opiate and cocaine abusers: Correlates of drug type and use status

The objective of this study was to describe pain tolerance in drug abusers. Research suggests that drug dependence and pain perception share common neuroanatomical and neurophysiological substrates; thus the abuse of psychoactive drugs was hypothesized to relate to pain tolerance. We examined cold-pressor pain tolerance in 122 male, current and former opioid and cocaine abusers, across use status and primary drug of abuse. Descriptive analyses showed that the ratio of pain-sensitive to pain-tolerant persons was considerably higher than that described in the normative cold-pressor pain literature. Two-way analysis of variance revealed a significant main effect for using status, indicating that current drug use is associated with decreased pain tolerance. The main effect for drug type approached significance, implying that persons who abuse opioids manifest less pain tolerance than cocaine users. The findings emphasize the importance of studying pain tolerance and drug abuse as interrelated phenomena.

Coping with Cold-Pressor Pain: Effects of Mood and Covert Imaginal Modeling

Thirty volunteers participated in cold-pressor pain hand-immersions to investigate the effects of moods on imaginai model interventions. Participants (N = 30) were randomly assigned to one of three treatments. Pleasant and unpleasant imageries induced participant mood states. Participants experienced either (a) pleasant imaginai scenes followed by imaginai models, (b) unpleasant imaginai scenes followed by imaginai models or, (c) no intervention. Two-way repeated measures analyses of variance (ANOVAS) and a one-way multivariate analysis of variance (MANOVA) were conducted. Unpleasant mood induction participants reported more negative moods (i.e., sadness, worry) than no treatment controls. Pleasant mood induction participants reported a significant decrease in anger. Pleasant mood induction participants showed significant increases in pain tolerance after treatment. Other groups showed nonsignificant differences in ability to tolerate pain. Hypotheses are given for the results. Results suggest that pleasant moods may have beneficial effects on pain coping interventions.

Borderline personality disorder and laboratory-induced cold pressor pain: Evidence of stress-induced analgesia

Behavioral neuroscience findings regarding stress-induced analgesia may be an appropriate model for the paradoxical effects of self-mutilative pain of patients with borderline personality disorder (BPD). We hypothesized that BPD patients would show an exaggerated antinociceptive effect from an uncontrollable cold pressor stress, compared to persons with other personality disorders or to a nonpsychiatric control group. This hypothesis was supported. Limitations of the study and directions for future research are discussed.

The relationship between children's coping styles and psychological interventions for cold pressor pain

This study examined the hypothesis that matching pain management interventions to children's preferred coping methods would increase pain tolerance and decrease self-reported pain during the cold pressor pain paradigm. Children aged 8–10 years were classified as ‘attenders’ (focusing on the stimulus) or ‘distractors’ (focusing away from the stimulus) based upon their spontaneous coping responses during a baseline exposure to the cold pressor. Children were then randomly assigned to 1 of 3 intervention conditions (sensory focusing, imagery, or no intervention) and completed the cold pressor procedure again 2 weeks later. A significant interaction was found between coping style and intervention. Children who were classified as distractors demonstrated greater tolerance when taught to use imagery techniques (a ‘matched’ intervention). Although pain ratings tended to be lower for distractors using imagery, the significant interaction resulted from an increase in ratings for the distractors using sensory focusing (i.e., a ‘mismatched’ intervention). Results suggest that, for distractors, interventions that are consistent with natural coping methods are most effective in enhancing abilities to cope with pain, while a mismatched intervention reduces coping abilities. The findings also suggest further study regarding how to provide effective pain intervention with attenders, since neither intervention enhanced coping in this group.

Pain Attenuating Effects of Preferred Versus Non-preferred Music Interventions

This study investigated effects of preferred and non-preferred music in alleviating cold-pressor pain. Pre-(i.e. baseline measurement) and posttest ice-water hand immersions were experienced by 80 participants. Participants were randomly assigned to one of four treatment groups. Group I listened to their preferred music, group II was exposed to non-preferred music, group III received no music intervention in the presence of an experimenter (control I), and group IV experienced an absence of music intervention in the absence of an experimenter (control II). Univariate repeated measures analyses of variance (ANOVA) and planned comparisons indicated that preferred music was effective in increasing pain tolerance. Non-preferred music and controls did not show an increased pain tolerance. Further, the absence of the experimenter heightened participants' experienced pain. Other groups (group I, II and III) did not experience significant changes in their subjective reports of pain from preto posttests.

Hemispheric activation, affective judgments, and pain perception.

This study utilized a unique contact lens method to examine the influence of right hemisphere processing on affective judgments and pain perception. Under conditions of unilateral visual stimulation, participants completed affective ratings of films and underwent a cold pressor pain task. The goal was to examine differences in affective judgments of films projected to one or the other hemisphere and to examine the influence of this unilateral visual stimulation on pain sensitivity. The results failed to replicate a previous finding of differential affective judgments under conditions of right and left visual stimulation. Nonetheless, in female subjects, unilateral visual stimulation was significantly associated with pain lateralization. This finding is discussed in terms of attentional processes in pain perception and limitations of the current lens design.

Delayed costs of suppressed pain.

The study demonstrates that the rebound effect of thought suppression (Wegner, 1989) has an analog in the experience of somatic discomfort. During a cold-pressor pain induction, 63 Ss were instructed either to concentrate on their room at home (distraction), to pay close attention to their hand sensations (monitoring), or to remove awareness of those sensations from mind (suppression). Two min of postpressor pain ratings showed that monitoring produced the most rapid recovery from the pain and that suppression produced the slowest. Suppression also contaminated the interpretation of a subsequent somatic stimulation; later in the experimental hour, Ss who had suppressed their cold-pressor discomfort rated an innocuous vibration as more unpleasant than did other Ss. The strategies are discussed for their necessarily distinct processes of goal evaluation and their possibly differential drain on perceived coping capacities.

Effect of temporomandibular disorder pain duration on facial expressions and verbal report of pain

This study investigated how specific expressive behaviors (verbal report of pain level and the frequency of emitting specific non-verbal facial expressions of pain) may change over the course of a chronic pain condition. Based on the concept of chronic pain behaviors, we hypothesized that both verbal and non-verbal behavior would increase with duration of pain. Thirty-six women with chronic temporomandibular disorder (TMD) pain (duration over 6 months) were compared with 35 recent onset cases (first episode, duration $ ̌ = 2 months). Subjects completed questionnaires assessing depression, anxiety, somatization, daily hassles and pain coping strategies. They were videotaped during a resting baseline and 2 painful conditions: experimental cold pressor pain and the clinically relevant pain of palpation of the masticatory muscles and temporomandibular joint; tapes were coded for facial expression using the Facial Action Coding System. Visual analog scale (VAS) ratings of the aversiveness and intensity of ongoing TMD pain were collected at baseline, and similar ratings of cold pressor and clinical examination pain were gathered after the painful stimulus. Recent onset and chronic cases did not differ on self-report measures of anxiety, depression, somatization or daily stress. Coping strategies were also similar, although chronic cases showed a greater tendency to catastrophize. Self-report measures of ambient facial pain, as well as the pain of clinical examination and cold pressor stimulation, revealed no significant differences between the 2 groups. In contrast, rates of pain facial expression were significantly higher for chronic cases under all conditions of the experiment, including baseline. The findings suggest that verbal and non-verbal expressions of pain may be differentially reinforced over the course of a chronic pain condition, such that non-verbal pain facial expressions become more frequent with time, while verbal reports of pain remain relatively constant.

Responsiveness to laboratory pain in women as a function of age and childbirth pain experience

Pain responsiveness was investigated experimentally as a function of age and childbirth pain experience. Sensitivity to cold pressor-induced pain was assessed through threshold, tolerance, and visual analog pain ratings. It was hypothesized that childbirth pain experience would mostly modify experimental pain judgment, in accordance with the adaptation-levels model. That is, childbirth pain would be used as an “anchor” in evaluating other painful events. Fifteen parous women were compared to 12 nulliparous women of the same age (mean age: 35 years) as well as to 15 nulliparous younger women (mean age: 24 years). This comparison was undertaken in order to distinguish the effects of age, which was found to correlate with pain threshold. Analysis of variance comparing the three groups of women was performed on each of the three cold pressor measures. A significant effect was found for pain threshold. Multiple comparisons indicated that parous women had a higher pain threshold than both groups of nulliparous women which did not differ from one another. Thus, painful childbirth experience is sufficient to raise cold pressor pain threshold. This finding has never before been reported in the pain literature. It is consistent with anecdotal reports from parous women who, when providing cold pressor pain judgments, say that “nothing compares to labor pain.”

Exercise-induced analgesia: fact or artifact?

This study critically examines the reported exercise-induced analgesia effect in view of the potential stress-induced analgesia of pain testing itself. Two designs were used to test whether previous findings of analgesia were induced by the exercise procedures or by the stress of the pain testing procedures themselves used in such experiments. In the first design, post-test cold pressor pain ratings were obtained from college students following exercise (bicycle ergometry) and two control tasks (minimal exercise and non-exercise). No significant differences between these groups were found. In the second design, exercise and non-exercise groups pre-exposed to cold pressor pain testing were compared to groups that were not pre-exposed to pain testing. There were no significant effects for exercise; however, significant analgesia effects for pain test pre-exposure were demonstrated. Therefore previous research claiming exercise-induced analgesia may have confounded the effects of exercise with the effects of pre-exposure to pain testing itself.

Segmental inhibition of laser-evoked brain potentials by ipsi- and contralaterally applied cold pressor pain

An experiment was designed to quantify the inhibitory effect of cold pressor pain (ice water immersion) on brain potentials evoked by acute laser-induced pain. One hand (including the C7 dermatome) was immersed into ice water and simultaneously the laser-evoked brain potentials were elicited consecutively from the right and left lower forearms within the C7 dermatomes. The cold pressor pain was continuously rated on a visual analogue scale (VAS). The size of the averaged brain potentials evoked from the ipsi- and contralateral C7 dermatomes were reduced significantly during cold pressor pain. The largest decrease was obtained for the potentials evoked within the C7 dermatome ipsilateral to the cold pressor pain. The size (power) of the brain potentials to individual stimuli could be measured and was correlated to the intensity of the cold pressor pain (VAS score). During the onset phase of cold pressor pain, there was a decrease in power of the individual brain potentials evoked from the C7 dermatome contralateral to the cold pressor pain but the potentials, evoked from the C7 dermatome ipsilateral to cold pressor pain, were decreased more. The overall rating of the laser-induced pain intensity showed that the perceived intensity was lowest when evoked from the dermatome concurrently exposed to cold pressor pain.

A Psychophysical Comparison of Sensory and Affective Responses to Four Modalities of Experimental Pain

It is generally accepted that the sensory and affective components of pain may be differentially associated with various acute and chronic diseases, and that some treatment regimens are best directed toward certain aspects of the pain experience. In addition, experimental animal models have been described that presume to assess either the sensory-discriminative aspects of phasic pain or the affective responses associated with tonic pain. The present psychophysical experiment directly compares the perceived intensity and unpleasantness of sensations evoked by four types of experimental noxious stimuli: contact heat, electric shock, ischemic exercise, and cold-pressor pain. A novel pain measurement technique is described that incorporates unbounded magnitude-estimation/category scales; this technique allows precise ratio responses, while minimizing within- and between-subject variability. We observe that, relative to the perceived intensity of the individual stimuli, subjects consistently differentiate among the degrees of unpleasantness evoked by the four stimulus modalities. Ischemic exercise and cold-pressor pain evoke higher estimates of unpleasantness, and thus may better mimic the pain of chronic disease. The relative unpleasantness produced by contact heat is significantly less than that of the other modalities tested, and therefore contact heat stimuli may be ideally suited for assessing sensory-discriminative aspects of pain perception. Possible neurophysiological mechanisms underlying the observed differences in perceived unpleasantness are discussed in relation to the growing body of literature concerning tonic and phasic pain stimuli.

Blood Pressure Reactivity and Perception of Pain During the Forehead Cold Pressor Test

The relationship between blood pressure reactivity and the perception of pain was examined during a series of three forehead cold pressor tests given every other day to a group of 18 male college students. Subjects classified as high reactors on the basis of peak increases in mean blood pressure during cold pressor tests perceived the cold pressor stimulus as more painful than subjects classified as low reactors. The propensity to rate the cold pressor stimulus as painful was positively correlated with the individual level of blood pressure reactivity (baseline-free partial r = .62). Intra-individual correlations between pain and blood pressure responses were unrelated to subjects' reactivity status. Across the 3-min test, correlations between pain and blood pressure reactivity (with the effects of baseline blood pressure levels partialled out) were significant only during periods when levels of responses were relatively high. The heart rate responses were unrelated to pain ratings. Generalizability theory was applied to the analysis of temporal stability of cold pressor reactions. Both blood pressure and pain responses were highly reproducible across three sessions, appearing to express stable individual differences. The efficacy of 800 mg oral ibuprofen in controlling the cold pressor pain was also tested. Analgesic activity of the drug during the cold pressor test could not be demonstrated.

Hypnotic analgesia: EEG changes during cold pressor pain as moderated by hypnotic susceptibility level

Hypnotic analgesia: EEG changes during cold pressor pain as moderated by hypnotic susceptibility level

Effects of active alert and relaxation hypnotic inductions on cold pressor pain.

Effects of active alert and relaxation hypnotic inductions on cold pressor pain.