Goreis Andreas, Fanninger Selina, Lozar Annika, Mayer Anna, Pfatrisch Nina, Voracek Martin, Plener Paul L, Kothgassner Oswald D
Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.
Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria.
Front Physiol. 2025 Jul 16;16:1628111. doi: 10.3389/fphys.2025.1628111. eCollection 2025.
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.
冷加压试验（CPT）是一种评估疼痛感知和应激反应的既定方法；有证据表明，女性比男性更能感觉到CPT带来的疼痛。然而，方法上的差异——尤其是水温方面的差异——使跨研究比较变得复杂，并阻碍了稳健的研究设计。为了解决这些问题，我们研究了三种水温（1°C、3°C和6°C）对健康成年人疼痛结果和生理应激指标（心率[HR]和心率变异性[HRV]）的影响，同时探讨性别差异。在一项有148名参与者（68%为女性）的随机、单盲、受试者内试验中，使用具有连续循环功能的温度控制冷却装置进行CPT。参与者将其优势手浸入水中长达3分钟，试验即终止。记录疼痛阈值、耐受性和强度以及HR和HRV。结果显示，不同温度下的疼痛阈值、耐受性和强度存在显著差异，较低温度会引起疼痛感知增加（中等效应量）。在1°C和3°C条件下，男性表现出更高的疼痛耐受性，50%的男性达到3分钟的截止时间，而女性在6°C时为39%，在3°C时为23%，在1°C时为19%。在疼痛强度方面未观察到显著的性别差异，并且HR和HRV在不同温度或不同性别之间没有变化。然而，疼痛仅与男性的HR和HRV相关。我们的研究结果强调了精心设计CPT方案的必要性。控制水温并实施适当的停止规则——可能超过3分钟——对于提高可比性、可重复性以及全面理解健康人群的疼痛机制至关重要。
