Water temperature and biological sex influence cold pressor pain in healthy adults: a randomized within-subjects trial
The Cold Pressor Test (CPT) is an established method for evaluating pain perception and stress responses; evidence indicates that females perceive the CPT as more painful than males. However, methodological variations—particularly in water temperature—complicate cross-study comparisons and hinder ro...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Physiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphys.2025.1628111/full |
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| author | Andreas Goreis Andreas Goreis Selina Fanninger Annika Lozar Anna Mayer Nina Pfatrisch Martin Voracek Martin Voracek Paul L. Plener Paul L. Plener Paul L. Plener Oswald D. Kothgassner Oswald D. Kothgassner |
| author_facet | Andreas Goreis Andreas Goreis Selina Fanninger Annika Lozar Anna Mayer Nina Pfatrisch Martin Voracek Martin Voracek Paul L. Plener Paul L. Plener Paul L. Plener Oswald D. Kothgassner Oswald D. Kothgassner |
| author_sort | Andreas Goreis |
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| description | The Cold Pressor Test (CPT) is an established method for evaluating pain perception and stress responses; evidence indicates that females perceive the CPT as more painful than males. However, methodological variations—particularly in water temperature—complicate cross-study comparisons and hinder robust study designs. To address these issues, we examined the effects of three water temperatures (1°C, 3°C, and 6°C) on pain outcomes and physiological stress markers (heart rate [HR] and heart rate variability [HRV]) in healthy adults while exploring sex differences. In a randomized, single-blind, within-subjects trial with 148 participants (68% female), the CPT was administered using a temperature-controlled cooling device with continuous circulation. Participants immersed their dominant hand for up to 3 min, when the trial was terminated. Pain threshold, tolerance, and intensity were recorded alongside HR and HRV. Results revealed significant variations in pain threshold, tolerance, and intensity across temperatures, with lower temperatures eliciting increased pain perception (medium effect sizes). Males demonstrated higher pain tolerance in 1°C and 3°C conditions, with 50% reaching the 3-min cutoff, compared to 39% at 6°C, 23% at 3°C, and 19% at 1°C for females. No significant sex differences were observed for pain intensity, and HR and HRV did not vary across temperatures or between sexes. However, pain was associated with HR and HRV only in males. Our findings underscore the need for meticulous CPT protocol design. Controlling water temperature and implementing appropriate stopping rules—potentially extending beyond 3 min—are critical for improving comparability, replicability, and understanding of pain mechanisms in healthy populations overall. |
| format | Article |
| id | doaj-art-0be2834f779b40a5a3fab0975139b8a0 |
| institution | Kabale University |
| issn | 1664-042X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Physiology |
| spelling | doaj-art-0be2834f779b40a5a3fab0975139b8a02025-08-20T03:44:28ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2025-07-011610.3389/fphys.2025.16281111628111Water temperature and biological sex influence cold pressor pain in healthy adults: a randomized within-subjects trialAndreas Goreis0Andreas Goreis1Selina Fanninger2Annika Lozar3Anna Mayer4Nina Pfatrisch5Martin Voracek6Martin Voracek7Paul L. Plener8Paul L. Plener9Paul L. Plener10Oswald D. Kothgassner11Oswald D. Kothgassner12Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, AustriaComprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, AustriaDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, AustriaDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, AustriaDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, AustriaDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, AustriaDepartment of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, AustriaUniversity Research Platform “The Stress of Life (SOLE) – Processes and Mechanisms underlying Everyday Life Stress”, University of Vienna, Vienna, AustriaDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, AustriaComprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, AustriaDepartment of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, GermanyDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, AustriaComprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, AustriaThe Cold Pressor Test (CPT) is an established method for evaluating pain perception and stress responses; evidence indicates that females perceive the CPT as more painful than males. However, methodological variations—particularly in water temperature—complicate cross-study comparisons and hinder robust study designs. To address these issues, we examined the effects of three water temperatures (1°C, 3°C, and 6°C) on pain outcomes and physiological stress markers (heart rate [HR] and heart rate variability [HRV]) in healthy adults while exploring sex differences. In a randomized, single-blind, within-subjects trial with 148 participants (68% female), the CPT was administered using a temperature-controlled cooling device with continuous circulation. Participants immersed their dominant hand for up to 3 min, when the trial was terminated. Pain threshold, tolerance, and intensity were recorded alongside HR and HRV. Results revealed significant variations in pain threshold, tolerance, and intensity across temperatures, with lower temperatures eliciting increased pain perception (medium effect sizes). Males demonstrated higher pain tolerance in 1°C and 3°C conditions, with 50% reaching the 3-min cutoff, compared to 39% at 6°C, 23% at 3°C, and 19% at 1°C for females. No significant sex differences were observed for pain intensity, and HR and HRV did not vary across temperatures or between sexes. However, pain was associated with HR and HRV only in males. Our findings underscore the need for meticulous CPT protocol design. Controlling water temperature and implementing appropriate stopping rules—potentially extending beyond 3 min—are critical for improving comparability, replicability, and understanding of pain mechanisms in healthy populations overall.https://www.frontiersin.org/articles/10.3389/fphys.2025.1628111/fullcold pressor test (CPT)water temperaturepainphysiological stress responsewithin-subjects randomized trialsex differences |
| spellingShingle | Andreas Goreis Andreas Goreis Selina Fanninger Annika Lozar Anna Mayer Nina Pfatrisch Martin Voracek Martin Voracek Paul L. Plener Paul L. Plener Paul L. Plener Oswald D. Kothgassner Oswald D. Kothgassner Water temperature and biological sex influence cold pressor pain in healthy adults: a randomized within-subjects trial Frontiers in Physiology cold pressor test (CPT) water temperature pain physiological stress response within-subjects randomized trial sex differences |
| title | Water temperature and biological sex influence cold pressor pain in healthy adults: a randomized within-subjects trial |
| title_full | Water temperature and biological sex influence cold pressor pain in healthy adults: a randomized within-subjects trial |
| title_fullStr | Water temperature and biological sex influence cold pressor pain in healthy adults: a randomized within-subjects trial |
| title_full_unstemmed | Water temperature and biological sex influence cold pressor pain in healthy adults: a randomized within-subjects trial |
| title_short | Water temperature and biological sex influence cold pressor pain in healthy adults: a randomized within-subjects trial |
| title_sort | water temperature and biological sex influence cold pressor pain in healthy adults a randomized within subjects trial |
| topic | cold pressor test (CPT) water temperature pain physiological stress response within-subjects randomized trial sex differences |
| url | https://www.frontiersin.org/articles/10.3389/fphys.2025.1628111/full |
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