Ultra-marathon runners may have lower levels of pain-related anxiety and reduced pain-related escape and avoidance behaviors compared with the general population, which may partially underlie their supranormal pain tolerance, according to a study published in the Journal of Pain.

The study included 20 ultra-marathon runners and 20 age- and gender-matched control individuals. Participants underwent the cold pressor test using water cooled to 0.1 to 0.5°C and completed the Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20 questionnaire, the Pain Vigilance and Awareness Questionnaire, and the Pain Resilience Scale.

The ultra-marathon runners were found to keep their hands in the cold water for longer periods of time during the cold pressor test compared with controls (P =.007), with 16 runners keeping their hand in the water for the full 3-minute duration of the test compared with 8 control individuals.

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The runners had lower scores on all Pain Anxiety Symptoms Scale-20 subscales compared with controls (escape and avoidance behaviors, P <.001; fearful thinking, P =.03; cognitive anxiety, P =.015; physiological anxiety, P =.019). However, there were no significant differences between groups for the other questionnaires. Notably, pain catastrophizing, pain hypervigilance, and pain-specific resistance were comparable in the 2 groups.

Using mediation analysis, reduced pain-related escape and avoidance behaviors were found to account for 40% of the difference in immersion time between the runners and control participants (P =.020).

“Much remains to be learned regarding athletes’ pain perception and the study of pain-related psychological and physiological processes in athletes appears to be a promising area of research within pain science,” the researchers wrote.

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Roebuck GS, Urquhart DM, Knox L, et al. Psychological factors associated with ultra-marathon runners’ supra-normal pain tolerance: a pilot study. [published online June 29, 2018]. J Pain. doi:10.1016/j.jpain.2018.06.003