Variation in Pain Threshold and Tolerance in High-Risk Schoolchildren Mahbuba Sumiya

Variation in pain threshold and tolerance in high-risk schoolchildren

By: Mahbuba Rahat | Art By: Kevin Song

Abstract

The present study examined variation in the physiologic stress response in 3rd and 4th grade schoolchildren. Students were drawn from the Oak Park School District, a largely low income and minority district outside of Detroit, Michigan, with low state test scores. A total of 22 students (9 female, 8-10 years old) completed the cold pressor task (CPT), a widely used and validated marker of physiologic stress. The CPT was adapted for children, and involves immersing the right hand up to the wrist in cold water (at 10±1°C). The main outcome measure was pain threshold, measured in the time (in s) elapsed from when the child’s hand is immersed in the water to the time that they reported first experiencing pain, and pain tolerance, measured as the time (in s) elapsed from when the child’s hand is immersed in the water to the time it was voluntarily removed (maximum 180 s). Across the sample, there was substantial variation in pain threshold (range = 1-180 s, M = 58.2 s, SD = 70.3 s) and pain tolerance (range = 1-180 s, M = 88.9 s, SD = 79.1 s). Nine students kept their hand in the cold water for the maximum amount of time (180 s). Pain threshold was highly correlated with pain tolerance, p < 0.001. Female and male students did not differ in pain threshold or tolerance (ps > 0.4). Relative to younger students, older students demonstrated a higher pain threshold, p = 0.006. Age was not associated with pain threshold, p = 0.16. These results suggest substantial variation in pain threshold and tolerance among a sample of highrisk schoolchildren. Variation in stress response, as measured via pain threshold and tolerance, may be useful for identifying children at highest risk of stress and associated negative outcomes (e.g., anxiety, school underperformance, cardiovascular disease).

Introduction Relative to their more affluent counterparts, lower income, minority schoolchildren are at higher risk of stress and associated negative outcomes (e.g., educational underperformance, truancy, anxiety) [1, 4]. Stress can negatively impact the body’s physiological responses to stress, which can trigger a variety of behavioral, cognitive, and emotional problems, including anxiety, depression, and cardiovascular disease [5]. The present study examines variation in psychophysiological response to stress in 3rd and 4th grade schoolchildren. Students were drawn from the Oak Park School District, a largely lower income, minority district, with low state standardized test scores (e.g., see https://www. mischooldata.org/).

Methods

A total of 22 students (9 female, 8-10 yrs) completed the cold pressor task (CPT), a widely used and validated experimental model of physiologic stress (see Figure 1). The CPT has been used to measure the response of the autonomic nervous system, which controls unconscious functions (e.g., heart rate, respiratory rate) that modulates the “fight or flight” response to stressors [7]. The CPT was adapted for children using ethical recommendations and involves immersing the right hand up to the wrist in cold water (10±1°C) [2, 3]. The main outcome measures will be pain threshold, measured in the time (in s) elapsed from when the child’s hand is immersed in the water to the time that they reported first experiencing pain, and pain tolerance, measured as the time (in s) elapsed from when the child’s hand is immersed in the water to the time it was voluntarily removed, up to a maximum of 180 s.

Figure 1. Cold pressor task. Image from Von Baeyer, Piira, Chambers, Trapanotto, & Zeltzer (2005) [6]. Children are instructed to submerge their hand up to the wrist in cold water (A). Pain threshold and tolerance was measured by child self-reports(B). Pain threshold is the moment (in s after submersion) in which the child feels pain, and pain tolerance is the moment (in s) in which the child removes his/her hand from the water.

Results

Across the sample, there was substantial variation in pain threshold (see Figure 2) and tolerance (see Figure 3); pain threshold ranged from 1-180 s (M = 58.2 s, SD = 70.3 s), and pain tolerance ranged from 1-180 s (M = 88.9 s, SD = 79.1 s). Nine students kept their hand in the cold water for the maximum amount of time (180 s). Pain threshold was highly correlated with pain tolerance, r(22) = 0.7, p < 0.001. Female and male students did not differ in their pain threshold or tolerance (ps > 0.4). Relative to younger students, older students demonstrated a higher pain threshold, r(22) = 0.56, p = 0.006 (see Figure 4). Age was not associated with pain threshold, p = 0.16.

Figure 2. Pain Threshold. Histogram of pain threshold across the sample (N = 22 students). Pain threshold is the moment (in s after submersion) in which the child reports feeling pain.

Figure 3. Pain Tolerance. Histogram of pain threshold across the sample (N = 22 students). Pain threshold is the moment (in s after submersion) in which the child reports feeling pain.

Conclusions

Results of this study show substantial variation in pain threshold and tolerance among 3rd and 4th grade schoolchildren drawn from a high-risk school district near Detroit, Michigan. Overall, we found that pain threshold and tolerance were highly correlated, and that pain threshold (but not tolerance) improved with age. Given that pain threshold and tolerance in the CPT are linked to autonomic function and the way that children’s bodies respond to stress, the CPT may be useful for identifying children at highest risk of stress and associated negative outcomes (e.g., anxiety, school underperformance, cardiovascular disease). At-risk children can be targeted for behavioral interventions that can enhance autonomic functioning (e.g., mindfulness-based techniques) [8].

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