Pain Tolerance and Expectations

People have high regard for individuals whose pain tolerance exceed beyond expectations. The Guinness Book of World Records has a long list of personalities who have defied different forms of pain that come from bee and scorpion stings, snake bites, as well as pain from car crashes, fire accidents, and the like.

Pain tolerance is defined as the duration or intensity of pain that a person is willing to endure at any given time. Based on observation, tolerance for pain varies from person to person, and may even fluctuate depending on the severity of the pain. A number of factors such as sex, age, race and ethnicity, motivation to endure pain, past experiences with pain, coping skills, and energy level --- all influence a person's pain tolerance.

The point at which a person feels pain is called pain threshold. People don't experience the same intensity of pain from the same stimuli, and no uniform relationship exists between tissue damage and pain. Pain intensity, duration, and other characteristics can vary among patients who've undergone the same procedure.

Most people have the misconception that past experiences with pain increases pain tolerance. On the contrary, repeated experience with pain can make a person be aware of how severe a pain can become and how difficult it is to get a relief. Therefore, it is possible that someone who has repeated experiences with pain may have a higher level of anxiety and less pain tolerance.

Society has always expected men to be tough in the face of danger. Indeed, a man's higher tolerance for pain is not just about machismo and male chauvinism, but has a physiological basis. Research shows that difference in sex/gender influence pain perception, where women usually display lower pain tolerance than men. However, it is unknown whether the mechanisms underlying these differences are hormonal, genetic or psychosocial in origin. According to some researchers, men can be more motivated to express a tolerance for pain due to masculine stereotyping, while feminine stereotyping encourages pain expression and lower pain tolerance. In a number of studies, racial and ethnic differences in pain sensitivity and pain response found out that African-Americans and Hispanics tend to have lower thresholds of pain tolerance. In similar experiments, pain-study participants from Nepal and India had higher pain tolerance than their Western counterparts.

These findings suggest that something in the brain’s pain-processing and pain-killing systems may vary by race and ethnicity. “There’s much we still don’t understand about why these health disparities based upon race and ethnicity exist, so more research is needed. We hope our work will increase awareness of this issue among patients and providers alike,” said lead author Carmen R. Green, M.D., an Anesthesiologist and Pain Management Specialist at the University of Michigan Health System. Green chairs the APS Special Interest Group on racial and ethnic disparities in pain.

Different studies have different claims on age as a factor affecting pain tolerance. One study suggested that pain tolerance decreases with age. In another study, children of all ages tend to perceive more pain than adults which meant that as people grow older, pain tolerance increases. It appears that, with increasing age, tolerance to cutaneous pain increases and tolerance to deep pain decreases.

An experiment on motivation to endure pain with monetary incentive was conducted by Roger B. Fillingim, Ph.D., of the Department of Operative Dentistry at the University of Florida and the Gainesville VA Medical Center in Gainesville, Fla.

According to Fillingim, the monetary incentive did not influence pain responses, but the relationship between cardiovascular measures and pain responses was influenced by the incentive manipulation. Specifically, low incentive subjects with higher blood pressure at the start of the study period tended to tolerate pain better. However, this association was not found in the high incentive subjects. For the high incentive subjects, a leap in blood pressure, which is a sign of being engaged in a task, was associated with having higher pain tolerance.

“Additional research is needed to replicate these findings and to further elucidate the relationships among motivation, gender roles, and pain responses,” he concluded.

Understanding the detrimental effects of unrelieved pain, such as depressed immune function, decreased subcutaneous oxygenation leading to infection, and respiratory dysfunction have resulted to pain management to minimize, if not totally avoid, enduring as much pain as possible. Such pain management emphasizes establishing a comfort/function goal with people suffering from pain, making it easier to perform important activities, such as coughing and deep breathing postoperatively.

A patient may become distressed if expectation of pain tolerance is not met. Reassuring the patient can help ease the distress. Patients should be encouraged to use pain relief medications and treatments to reduce their pain to the level that makes it easy for them to function.