Higher Pain Threshold Research Articles

Parental-reported pain insensitivity in Dup15q.

Parents of children with chromosome 15q duplication syndrome (Dup15q) have anecdotally reported high pain threshold as a feature of the disorder. The purpose of this study was to document parental-reported estimates of the frequency of high pain tolerance and the stimuli that fail to evoke a normal pain response. We sent an online survey to 840 families with children with Dup15q to explore the frequency and clinical manifestations of high pain threshold. There were 216 respondents (25.7%). A high pain threshold was reported in 87% of children at some time. There was a trend (p=0.06) for high pain threshold to be more commonly observed among children with the isodicentric (85.6%) and other genetic variants (95%) than interstitial (69.6%) duplications. There was no association between reports of high pain threshold and reports of an intellectual disability (91% of cases), autism spectrum disorder (83% of cases), or self-injurious behavior (40% of cases). Reports included many dramatic cases such as severe burns, broken bones, and electrical traumas, which were associated with little or no evidence of a painful stimulus. A high pain threshold is reported in other disorders associated with intellectual disability and autism; the underlying mechanism in Dup15q and other disorders remains undefined.

Pain threshold - measure of pain sensitivity or social behavior?

The aim was to examine the effect of the experimenter?s social status and its interaction with participant?s gender on pressure pain threshold. Both male and female students participated in the study (N = 96) and were evenly assigned into two groups which differed only in the professional status of the experimenter who was a professor (higher status) in one group and a student (lower status) in the other. The factorial ANOVA revealed statistically significant and large main effects of the experimenter?s status and the participants? gender, indicating higher pain thresholds in male participants and in the higher status experimenter group. Although both males and females had higher pain thresholds when measured by a higher status experimenter, a statistically significant interaction revealed that status affected male participants more so than females. The obtained results are probably due to social behaviour, emphasizing relevance of the experimenter?s and participants? characteristics in pain measurement.

The Effects of Imagery on Muscle Performance and Pain Perception Associated with Delayed-Onset Muscle Soreness

Research has indicated that imagery may aid in recovery from injuries and reduce the perception of pain in athletes during and after competitions. There is little research concerning acute pain and soreness, such as delayed-onset muscle soreness (DOMS). The purpose of this investigation was to determine whether the use of guided imagery for healing will affect soreness, pressure pain threshold (PPT), and muscle performance associated with DOMS. It was hypothesized that those who listened to a healing imagery script following inducement of DOMS would report less soreness, higher pain threshold, and have better muscle performance than a control group. Participants (thirty-eight) completed two days of testing with 48 hours between them. At the end of the first day, DOMS was induced by performing 6 sets of 15 reps of isokinetic eccentric exercise at -1.05 rad/sec. 20 participants listened to a healing imagery script 10 times within the 48 hours after inducement of DOMS while 18 listened to relaxing music. Each day consisted of tests of soreness, PPT, vertical jump, and a Wingate test. Healing imagery had no significant impact on perception of soreness, PPT, or vertical jump. The healing imagery group performed significantly better than the control group on the Wingate test in minimum power and power drop results following DOMS. Thus, it appears that imagery could impact long duration anaerobic performance as opposed to short duration explosive performance. Further research is needed to determine if healing imagery can improve performance on longer anaerobic and possibly aerobic activities. Additionally, it is possible that the limited exposure to the imagery in this investigation limited its ability to impact muscle performance and pain perception.

Repetetive self-Injury and the body self.

The assessment of differences in body self and pain thresholds between people inflicting self-injuries in a repetitive manner and those, who do not engage in such behavior. The participants were selected through screening and purposive sampling (the study group consisted of 34 people: 29 women, 5 men; and the control group of 32 people: 28 women, 4 men). The Tension Situations Questionnaire and the Inventory of Questions Concerning Self-injury were used in the study. These measures served to assess the presence and circumstances of self-injury. TempTest apparatus (measuring sensitivity to pain) and the Body Self Questionnaire were also used. Individuals inflicting self-injury are characterised by higher indices of body self maladaptiveness than individuals from the control group. In the study group, disorders were found in such aspects of body self as: the perception of sensations, the interpretation and regulation of emotions and physical needs, emotional attitude to body, and the sense of body identity. Women inflicting self-injuries had a higher pain threshold than women from the control group, the reverse pattern was observed in the group of men. However, due to the small size of the male group, the obtained result should be treated with caution. The study showed, that the distorted aspect of personality - the body self - is the important risk factor for the repetetive self-injuries. The lowered pain threshold in men engaging in self-harm, in combination with the increased threshold of pain in self-injuring women is surprising result and demands further investigation.

HYPERTENSION AND PAIN THRESHOLD

The paper considers the relationship between pain threshold and blood pressure (BP) in acute and chronic pain syndrome. Both experimental and clinical studies have established that elevated BP is accompanied by a higher pain threshold in acute pain (hypertension-related hypoalgesia). Epidemiological findings have shown that the prevalence of different pain syndromes is significantly lower in hypertensive patients than in individuals without hypertension. At the same time, there is evidence that elevated BP can, on the contrary, reduce pain thresholds and make prognosis worse in patients with chronic pain syndromes.

Low-dose progestin-releasing contraceptives are associated with a higher pain threshold in healthy women

To determine the pain thresholds of women taking different formulations of hormonal contraceptives. Cross-sectional study. Basic health care unit. Eighty-nine healthy nonusers and 188 users of hormonal contraceptives. Subject interviews were followed by the application of a semistructured questionnaire, including a psychometric assessment with the Beck Depression Inventory and the State-Trait Anxiety Inventory. After the interview, a 10-mL peripheral blood sample was collected. Pain thresholds were obtained by performing pressure algometry. Serum concentrations of E2, P, and T (free fraction) were determined via chemoluminescence. The menstrual cycle phase was determined according to hormonal level and identification of an LH surge in urine. Pain threshold was evaluated with a dynamometer applied to the forearm skin of the nondominant limb and abdominal wall. Progestin-only contraceptive users showed a higher pain pressure threshold in the forearm (2.94 ± 0.96 vs. 2.74 ± 0.89 vs. 2.62 ± 0.92) and right (2.11 ± 0.87 vs. 1.83 ± 0.81 vs. 1.78 ± 0.77) and left abdomen (2.12 ± 0.88 vs. 1.79 ± 0.76 vs. 1.73 ± 0.70) than did combined hormonal contraceptive users and nonusers of hormonal contraceptives, respectively. Users of contraceptives that continuously release etonogestrel (subcutaneous implant, vaginal ring) or levonorgestrel (intrauterine devices) had higher pain thresholds. Women who used hormonal contraceptives enabling continuous release of etonogestrel or levonorgestrel tended to have higher pain thresholds than did nonusers of hormonal contraceptives.

Paradoxical Pain Perception in Posttraumatic Stress Disorder: The Unique Role of Anxiety and Dissociation

Posttraumatic stress disorder (PTSD) and chronic pain often co-occur and exacerbate each other. Elucidating the mechanism of this co-occurrence therefore has clinical importance. Previously, patients with PTSD with chronic pain were found to demonstrate a unique paradoxical pain profile: hyperresponsiveness together with hyposensitivity to pain. Our aim was to examine whether 2 seemingly paradoxical facets of PTSD (anxiety and dissociation) underlie this paradoxical profile. Patients with PTSD (n = 32) and healthy control individuals (n = 43) underwent psychophysical testing and completed questionnaires. Patients with PTSD had higher pain thresholds and higher pain ratings to suprathreshold stimuli than control individuals. Pain thresholds were positively associated with dissociation levels and negatively associated with anxiety sensitivity levels. Experimental pain ratings were positively associated with anxiety sensitivity and negatively related to dissociation levels. Chronic pain intensity was associated with anxiety, anxiety sensitivity, and pain catastrophizing. It appears that reduced conscious attention toward incoming stimuli, resulting from dissociation, causes delayed response in pain threshold measurement, whereas biases toward threatening stimuli and decreased inhibition, possibly caused by increased anxiety, are responsible for the intensification of experimental and chronic pain. The paradoxical facets of PTSD and their particular influences over pain perception seem to reinforce the coexistence of PTSD and chronic pain, and should be considered when treating traumatized individuals. PerspectiveThis article provides new information regarding the underlying mechanism of the coexistence of PTSD and chronic pain. This knowledge could help to provide better management of PTSD and chronic pain among individuals in the aftermath of trauma.

Prader-Willi syndrome: a review of clinical, genetic, and endocrine findings.

IntroductionPrader-Willi syndrome (PWS) is a multisystemic complex genetic disorder caused by lack of expression of genes on the paternally inherited chromosome 15q11.2-q13 region. There are three main genetic subtypes in PWS: paternal 15q11-q13 deletion (65–75 % of cases), maternal uniparental disomy 15 (20–30 % of cases), and imprinting defect (1–3 %). DNA methylation analysis is the only technique that will diagnose PWS in all three molecular genetic classes and differentiate PWS from Angelman syndrome. Clinical manifestations change with age with hypotonia and a poor suck resulting in failure to thrive during infancy. As the individual ages, other features such as short stature, food seeking with excessive weight gain, developmental delay, cognitive disability and behavioral problems become evident. The phenotype is likely due to hypothalamic dysfunction, which is responsible for hyperphagia, temperature instability, high pain threshold, hypersomnia and multiple endocrine abnormalities including growth hormone and thyroid-stimulating hormone deficiencies, hypogonadism and central adrenal insufficiency. Obesity and its complications are the major causes of morbidity and mortality in PWS.MethodsAn extensive review of the literature was performed and interpreted within the context of clinical practice and frequently asked questions from referring physicians and families to include the current status of the cause and diagnosis of the clinical, genetics and endocrine findings in PWS.ConclusionsUpdated information regarding the early diagnosis and management of individuals with Prader-Willi syndrome is important for all physicians and will be helpful in anticipating and managing or modifying complications associated with this rare obesity-related disorder.

Individuals with agenesis of the corpus callosum show sensory processing differences as measured by the sensory profile.

Given reports of high pain thresholds and reduced auditory response in individuals with agenesis of the corpus callosum (AgCC), this study investigated whether affected participants report atypical experiences and behaviors on a well-established sensory processing measure. Fourteen participants with AgCC (ages 11-59) completed the Adolescent/Adult Sensory Profile (Brown & Dunn, 2001). Sensory profile scales were classified as "Atypical" if they were more than 1 standard deviation from the mean. Fifty-seven percent of participants with AgCC reported reduced sensory registration as compared to an expected 16% of the normative sample. Similarly, 50% of the AgCC participants reported atypically increased auditory processing difficulties. Using a well-established sensory processing questionnaire, participants with AgCC reported measurable differences in multiple aspects of sensory processing. The most notable difference was in the quadrant of low sensory registration, suggesting that individuals with AgCC may require sensory information to be presented more slowly or at a higher intensity for adequate processing. The sensory modality that was most affected was the auditory system, which is consistent with increased rates of language disorders and autism spectrum disorders in this population. Understanding sensory processing in individuals with AgCC can both elucidate the role of interhemispheric transfer in the development of intact sensory processing as well as contribute to our knowledge of the role of the corpus callosum in a range of disorders in which sensory processes are impacted. (PsycINFO Database Record

Anti-Hypertensive Treatments and Hypertension-Associated Hypoalgesia Evaluated by Auto-Algometry

Background: Auto-algometry has been previously proposed as a toll to evaluate hypertension-associated hypoalgesia. The aim of the present work was to confirm the robustness of this method and to evaluate other possible variables associated with hypertension and hypoalgesia. Methods: All routinary ambulatory data were collected from 111 hypertensive subjects along with the evaluation of pain threshold assessed with the auto-algometer. Results: The results confirmed the sensibility of the auto-algometer in revealing the hypertension-associated hypoalgesia and revealed unexpected higher pain thresholds in patients consuming angiotensin receptor 1 antagonists compared to patients consuming other medications. Conclusion: The results encourage the use of the auto-algometer to study unexplored mechanisms involved in hypertension and in hypoalgesia.

Attention bias modification and its impact on experimental pain outcomes: Comparison of training with words versus faces in pain.

The aim of this study was to compare the effectiveness of training participants' attention towards or away from painful faces versus pain-related words on pain outcomes on an acute experimental pain paradigm. Participants were randomized to receive either training towards or away from painful faces or words. Following training, participants completed the cold pressor task. The results confirm that attention bias modification produced the predicted changes in attentional biases. Clear training effects were observed for words and faces, such that attentional biases changed in the predicted direction on the stimuli presented during the training. However, for those trained on words, training effects also generalized to face stimuli. As predicted, those who received training away from painful stimuli took longer to report pain (higher pain threshold) during the cold pressor task, and this effect was more pronounced for those trained on words. Contrary to expectations, those trained on faces (regardless of training direction) reported less pain than those trained on words. There were no differences between the groups for pain tolerance (length of time participants were able to keep their arms in the cold pressor). These findings confirm that attentional biases are modifiable, and impact (in the expected manner) how quickly participants perceive pain. Further, exposure to painful faces resulted in additional benefits to the level of pain reported. However, we were unable to confirm that change in attentional biases was the mechanism of change.

Perception of venipuncture pain in children suffering from chronic diseases.

BackgroundVenipuncture pain in children results from a variety of co-factors which increase the intensity of the nociceptive stimulus. Among them, anticipatory anxiety plays an important role. Children with chronic diseases undergo invasive procedures and venipuncture more often than other children. Some healthcare professionals still believe that children who are repeatedly exposed to painful procedures, such as children with chronic diseases, gradually increase their pain tolerance and that, as a result, they have a higher pain threshold than children with no chronic diseases. The purpose of this study was to assess whether a difference exists in the perception of venipuncture pain between children with chronic diseases and children with no previous health problems nor experience of venipuncture.MethodsA cross-sectional study was carried out using the Wong and numeric pain scales and the Observational Scale of Behavioral Distress (OSBD) for the assessment of behavioral distress. A group of children with chronic diseases and a group of children with no previous health problems nor experience of venipuncture, aged 4 to 12 years, both boys and girls, were observed during a standardized venipuncture procedure.ResultsThe study included 230 children in total: 82 of them suffered from chronic diseases and had already experienced venipuncture at least once, while the remaining 148 children had no previous experience of venipuncture. The children with chronic diseases reported more pain (median pain score of 8 on the Wong or numeric scales,) and showed more signs of behavioral distress (median score of 27 on the OSBD) than non-chronic children (median pain score of 2 on the Wong/numeric scales, p = 0.00001; median OSBD score 5, p = 0.00001).ConclusionsOur study suggests that children with chronic diseases have a lower pain threshold than children of the same sex and age who experience venipuncture for the first time.

Genetic and phenotypic diversity of NHE6 mutations in Christianson syndrome.

Recently, Christianson syndrome (CS) has been determined to be caused by mutations in the X-linked Na(+) /H(+) exchanger 6 (NHE6). We aimed to determine the diagnostic criteria and mutational spectrum for CS. Twelve independent pedigrees (14 boys, age = 4-19 years) with mutations in NHE6 were administered standardized research assessments, and mutations were characterized. The mutational spectrum was composed of 9 single nucleotide variants, 2 indels, and 1 copy number variation deletion. All mutations were protein-truncating or splicing mutations. We identified 2 recurrent mutations (c.1498 c>t, p.R500X; and c.1710 g>a, p.W570X). Otherwise, all mutations were unique. In our study, 7 of 12 mutations (58%) were de novo, in contrast to prior literature wherein mutations were largely inherited. We also report prominent neurological, medical, and behavioral symptoms. All CS participants were nonverbal and had intellectual disability, epilepsy, and ataxia. Many had prior diagnoses of autism and/or Angelman syndrome. Other neurologic symptoms included eye movement abnormalities (79%), postnatal microcephaly (92%), and magnetic resonance imaging evidence of cerebellar atrophy (33%). Regression was noted in 50%, with recurrent presentations involving loss of words and/or the ability to walk. Medical symptoms, particularly gastrointestinal symptoms, were common. Height and body mass index measures were below normal ranges in most participants. Behavioral symptoms included hyperkinetic behavior (100%), and a majority exhibited high pain threshold. This is the largest cohort of independent CS pedigrees reported. We propose diagnostic criteria for CS. CS represents a novel neurogenetic disorder with general relevance to autism, intellectual disability, Angelman syndrome, epilepsy, and regression.

Pain analgesia among adolescent self-injurers

Although non-suicidal self-injury (NSSI) involves self-inflicted physical harm, many self-injurers report feeling little or no pain during the act. Here we test: (1) whether the pain analgesia effects observed among adult self-injurers are also present among adolescents, and (2) three potential explanatory models proposing that habituation, dissociation, and/or self-criticism help explain the association between NSSI and pain analgesia among adolescents. Participants were 79 adolescents (12–19 years) recruited from the community who took part in a laboratory-based pain study. Results revealed that adolescent self-injurers have a higher pain threshold and greater pain endurance than non-injurers. Statistical mediation models revealed that the habituation and dissociation models were not supported; however, a self-critical style does mediate the association between NSSI and pain analgesia. The present findings extend earlier work by highlighting that a self-critical style may help to explain why self-injurers exhibit pain analgesia. Specifically, the tendency to experience self-critical thoughts in response to stressful events may represent a third variable that increases the likelihood of both NSSI and pain analgesia. Prospective experimental studies are needed to replicate and tease apart the direction of these associations, and may provide valuable leads in the development of effective treatments for this dangerous behavior problem.

Difference in perception of heat and the thermal grill illusion (TGI) in relation to the expression of the serotonin transporter and the effect of cutaneous capsaicin sensitization on the TGI

Abstract Aims The aims of this study are to investigate the differences in (1) heat pain threshold, (2) pain and temperature perception of the TGI and (3) the sensation of capsaicin between subjects with high and low expression of the serotonin transporter (5-HTT). In addition the effects of capsaicin sensitization on the thermal grill illusion are studied. Methods A total of 80 healthy subjects are selected on the basis of their tri-allelic 5-HTTLPR genotype. Threshold for heat pain is examined and pain and unpleasantness of cutaneous capsaicin application are rated on visual analog scales (VAS). The sensory dimensions of the TGI (before and after capsaicin) is determined i.e. description of temperature (burning hot, hot, neutral, cold or freezing cold) and potential pain and intensity of cold and warmth are rated on respective VAS-scales. Results The study is ongoing. We expect that the low expression group has a higher heat pain threshold and rates the TGI and capsaicin less painful. The capsaicin sensitization lowers the heat pain threshold and increases the cold pain threshold. Therefore we hypothesize a lower rating of the TGI, determined as a lower heat VAS-score. Conclusions No conclusions yet. Preliminary results from the study will be presented at the SASP14.

Factors associated with the modulation of pain by visual distortion of body size

Modulation of pain using visual distortion of body size (VDBS) has been the subject of various reports. However, the mechanism underlying the effect of VDBS on pain has been less often studied. In the present study, factors associated with modulation of pain threshold by VDBS were investigated. Visual feedback in the form of a magnified image of the hand was provided to 44 healthy adults to examine changes in pain. In participants with a higher pain threshold when visual feedback of a magnified image of the hand was provided, the two-point discrimination threshold decreased. In contrast, participants with a lower pain threshold with visual feedback of a magnified image of the hand experienced unpleasant emotions toward the magnified image of the hand. Interestingly, this emotional reaction was strongly associated with negative body consciousness in several subjects. These data suggested an analgesic effect of visual feedback in the form of a magnified image of the hand is only when tactile perception is vivid and the emotional reaction toward the magnified image is moderate. The results also suggested that negative body consciousness is important for the modulation of pain using VDBS.

Comparison of pain threshold and duration of pain perception in men and women of different ages

Introduction Pain is a sensory and emotional experience that occurs with the presence of tissue injury, actual or potential. Pain is subjective, and its expression is primarily determined by the perceived intensity of the painful sensation, called the pain threshold. Objective To evaluate whether there are differences in pain threshold (LD) and time to pain perception (TPED) between the gender in different age groups and to analyze the correlation between age and pain threshold in each gender. Methods and procedures Participants were 60 volunteers divided into 6 groups (n = 10 each) according to gender and age (18–33, 34–49, and 50–64 years). The evaluation of perception and pain tolerance was performed by immersing the container with one hand in water at a temperature of 0 °C–2 °C; the latency to withdrawal of the hand from ice water was measured in seconds and was considered a measure of LD. The TPED was reported by each participant as the start time of the painful stimulus. Results We found differences between the LD for G1 (men aged between 18 and 33 years) and G2 (women aged 18 to 33 years) with greater LD for G1 (p = 0.0122) and greater LD for women (p = 0.0094); for other comparisons of LD and TPED, there were no differences (p > 0.05 for all comparisons). Low correlation was found between age progression with increased LD and the TPED only in men (p = 0.01 and r = 0.45 and p = 0.05 and r = 0.34, respectively). Conclusion We conclude that women have a higher pain threshold than men especially when these groups are aged between 18 and 33 years, and in men increasing age correlates with increased TPED and LD.

Gender expression, sexual orientation and pain sensitivity in women.

Despite a growing body of literature investigating sex differences with regard to pain, surprisingly little research has been conducted on the influence of various aspects of self-identity, including gender expression and sexual orientation, on pain sensitivity within each sex, particularly among women. In men, dispositional femininity is linked to greater clinical pain and trait masculinity is associated with higher pain thresholds. To examine whether gender expression and sexual orientation are associated with within-sex differences in ischemic pain sensitivity in healthy young women. A convenience sample of 172 females (mean age 21.4 years; range 18 to 30 years of age; 56.0% white, 89% heterosexual) performed an ischemic pain task in counterbalanced order. Desired levels of dispositional femininity for a preferred romantic partner and self-described levels of personal dispositional femininity were measured. Compared with heterosexual women, lesbian and bisexual women reported lower pain intensity ratings early in the discomfort task. Irrespective of sexual orientation, attraction to more feminine romantic partners and dispositional masculinity were correlated with lower pain intensity, and with higher pain thresholds and tolerance levels. These preliminary findings suggest that within-sex differences in sexual orientation and other aspects of identity, irrespective of biological sex, may be important to consider when examining experimental pain performance and clinical pain experiences. Larger investigations of the psychophysiological relationships among sexual orientation, gender expression and pain sensitivity are warranted. These findings may have implications for differences in clinical pain sensitivity of lesbian and bisexual women compared with heterosexual women.

Endocrine manifestations and management of Prader-Willi syndrome

Prader-Willi syndrome (PWS) is a complex genetic disorder, caused by lack of expression of genes on the paternally inherited chromosome 15q11.2-q13. In infancy it is characterized by hypotonia with poor suck resulting in failure to thrive. As the child ages, other manifestations such as developmental delay, cognitive disability, and behavior problems become evident. Hypothalamic dysfunction has been implicated in many manifestations of this syndrome including hyperphagia, temperature instability, high pain threshold, sleep disordered breathing, and multiple endocrine abnormalities. These include growth hormone deficiency, central adrenal insufficiency, hypogonadism, hypothyroidism, and complications of obesity such as type 2 diabetes mellitus. This review summarizes the recent literature investigating optimal screening and treatment of endocrine abnormalities associated with PWS, and provides an update on nutrition and food-related behavioral intervention. The standard of care regarding growth hormone therapy and surveillance for potential side effects, the potential for central adrenal insufficiency, evaluation for and treatment of hypogonadism in males and females, and the prevalence and screening recommendations for hypothyroidism and diabetes are covered in detail. PWS is a genetic syndrome in which early diagnosis and careful attention to detail regarding all the potential endocrine and behavioral manifestations can lead to a significant improvement in health and developmental outcomes. Thus, the important role of the provider caring for the child with PWS cannot be overstated.

Exploration of the effects of gender and mild esophagitis on esophageal pain thresholds in the normal and sensitized state of asymptomatic young volunteers

Clinical data suggest gender differences in gastrointestinal pain, but very little experimental data exist. Esophageal painful thresholds to mechanical, thermal, electric, and chemical stimuli can be measured with the esophageal multimodal pain model. The aim was to measure the effect of gender and mild esophagitis on esophageal pain perception. Thirty-five healthy asymptomatic volunteers [19 men, median age 29 (22-56years)] underwent upper GI endoscopy, 24h pH/impedance measurement, and multimodal esophageal pain stimulation before and after sensitization with acid. Stimulus intensities at painful thresholds were recorded. Men had higher pain thresholds (PT) to mechanical stimulation (mean volume: men 20.9±10mL vs women 15.2±6.8mL, P=0.02) and more men tolerated the maximum acid challenge (58% vs 20%, P=0.03). There were no differences between genders for PT to (1) thermal stimulation [mean stimulation time (men, women): heat; 20±5s vs 21±6s or cold; 33.3±20.1s vs 20.7±21.4s, P>0.2], (2) electrical current (mean current: men 17.6±9.2mA vs women 12.9± 3.7 mA, P=0.11), or (3) acid volume [median volume: men 200 (20;200) mL vs women 133 (40;200) mL, P=0.2]. Fifteen asymptomatic subjects had mild esophagitis (10 men, all Los Angeles A). There were no differences in esophageal PT between subjects with normal endoscopy or mild esophagitis (all P>0.3). The effects of gender and mild esophagitis on esophageal multimodal pain perception have been measured in asymptomatic volunteers. The study suggests that gender, not mild esophagitis, tends to influence mechanical and chemical esophageal pain.