Temperature and the cold pressor test.

UNLABELLED As a method of experimental pain induction, the cold pressor test is thought to mimic the effects of chronic conditions effectively. A survey of previous studies using the cold pressor, however, revealed a lack of standardization and control of water temperature, questioning comparability and reliability. This study reports the influence of temperature on pain tolerance and intensity by using a commercially available circulating water bath. Twenty-six participants (12 men, 14 women) underwent 4 cold pressor trials with temperature order counterbalanced across 1 degrees C, 3 degrees C, 5 degrees C, and 7 degrees C, temperatures representative of the range used in previous literature. After each cold immersion participants rated pain intensity on a visual analogue scale and the McGill Pain Questionnaire. Tolerance times were recorded for each trial. Significant main effects of temperature were found for tolerance time, with higher temperatures resulting in longer times, and pain intensity, with lower temperatures resulting in higher intensities. Gender differences were found, with men tolerating the stimulus for significantly longer than women. It was concluded that small differences in water temperature have a significant effect on pain intensity and tolerance time. The use of cold pressor equipment that ensures a precise constant temperature of circulating water is necessary to ensure comparable and reliable results. PERSPECTIVE The cold pressor method of experimental pain induction has been widely used in the evaluation of psychological and physiological pain treatments. This article highlights the need for clear methodologic guidelines for the technique and demonstrates that very minor changes in experimental protocol can produce significant differences.

[1]  M. Venturino,et al.  Suggestion and distraction in the control of pain: test of two hypotheses. , 1984, Journal of abnormal psychology.

[2]  J. W. Thompson,et al.  Analgesic effects of different frequencies of transcutaneous electrical nerve stimulation on cold-induced pain in normal subjects , 1989, Pain.

[3]  Ronald Melzack,et al.  The McGill pain questionnaire: from description to measurement. , 2005, Anesthesiology.

[4]  F. Mosteller,et al.  An experimental pain method sensitive to morphine in man: the submaximum effort tourniquet technique. , 1966, The Journal of pharmacology and experimental therapeutics.

[5]  Suggestion and distraction in the control of pain , 1983 .

[6]  E. Worthington,et al.  Imagery and Verbal Counseling Methods in Stress Inoculation Training for Pain Control. , 1981 .

[7]  L. Arendt-Nielsen,et al.  The analgesic effect of codeine as compared to imipramine in different human experimental pain models , 2001, Pain.

[8]  N. Walsh,et al.  Normative Model for Cold Pressor Test , 1989, American journal of physical medicine & rehabilitation.

[9]  E. Keogh,et al.  Avoidance versus focused attention and the perception of pain: differential effects for men and women , 2000, Pain.

[10]  K. Gil,et al.  Experimental induction of pain: Utility in the study of clinical pain , 1995 .

[11]  Josef K. Wang.  Advances in Pain Research and Therapy , 1980 .

[12]  Anil Batra,et al.  Both pain and EEG response to cold pressor stimulation occurs faster in fibromyalgia patients than in control subjects , 2000, Psychiatry Research.

[13]  R. Fillingim,et al.  Sex differences in the perception of noxious experimental stimuli: a meta-analysis , 1998, Pain.

[14]  M. Verbaten,et al.  Affective pictures processing, attention, and pain tolerance , 2001, Pain.

[15]  P. Compton.  Pain tolerance in opioid addicts on and off naltrexone pharmacotherapy: a pilot study. , 1998, Journal of pain and symptom management.

[16]  M. Bushnell,et al.  A psychophysical comparison of sensory and affective responses to four modalities of experimental pain. , 1992, Somatosensory & motor research.

[17]  C. Eccleston.  The attentional control of pain: methodological and theoretical concerns , 1995, Pain.

[18]  R. Liebert,et al.  The physical and psychological experience of pain: the effects of labeling and cold pressor temperature on three pain measures in college women , 1998, Pain.

[19]  Malcolm H. Johnson,et al.  The effects of distraction on exercise and cold pressor tolerance for chronic low back pain sufferers , 1997, Pain.

[20]  R. Fillingim,et al.  Sex-related hormonal influences on pain and analgesic responses , 2000, Neuroscience & Biobehavioral Reviews.

[21]  Joseph Schwarzwald,et al.  The influence of warning signal timing and cognitive preparation on the aversiveness of cold-pressor pain , 1996, Pain.

[22]  M. Feldner,et al.  Perceived control over anxiety-related events as a predictor of pain behaviors in a cold pressor task. , 2001, Journal of behavior therapy and experimental psychiatry.

[23]  E. Hilgard.  Pain as a puzzle for psychology and physiology. , 1969, The American psychologist.

[24]  Gary H. Duncan,et al.  Sex differences in the perception of noxious heat stimuli , 1991, Pain.

[25]  M. Rosenbaum.  Individual differences in self-control behaviors and tolerance of painful stimulation. , 1980, Journal of abnormal psychology.

[26]  K J Berkley.  Sex differences in pain , 1997, Behavioral and Brain Sciences.

[27]  K. Mccaul,et al.  Attention, distraction, and cold-pressor pain. , 1982, Journal of Personality and Social Psychology.

[28]  R. Maki,et al.  Does distraction reduce pain-produced distress among college students? , 1992, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[29]  Roger B. Fillingim,et al.  Gender differences in the responses to noxious stimuli , 1995 .

[30]  R. Melzack.  The McGill Pain Questionnaire: Major properties and scoring methods , 1975, PAIN.

[31]  E. Keogh,et al.  Gender, coping and the perception of pain , 2002, Pain.

[32]  H. Hekmat,et al.  Pain Attenuating Effects of Preferred Versus Non-preferred Music Interventions , 1993 .

[33]  F. M. Levine,et al.  The effects of experimenter gender on pain report in male and female subjects , 1991, Pain.

[34]  C. Cleeland,et al.  The effects of distraction on responses to cold pressor pain , 1990, Pain.

[35]  C. Woolf.  Transcutaneous electrical nerve stimulation and the reaction to experimental pain in human subjects , 1979, Pain.

[36]  A. Unruh.  Gender variations in clinical pain experience , 1996, Pain.

[37]  J. Riley,et al.  Sex, Gender, and Blood Pressure: Contributions to Experimental Pain Report , 2001, Psychosomatic medicine.

[38]  R. Freeman,et al.  Hypnosis and Distraction Differ in Their Effects on Cold Pressor Pain , 2000, The American journal of clinical hypnosis.

[39]  J. Golding,et al.  Effects of acupuncture and transcutaneous electrical nerve stimulation on cold-induced pain in normal subjects. , 1984, Journal of psychosomatic research.