Pain catastrophizing in athletes correlates with pain and cardiovascular changes during a painful cold pressor test

Abstract

Context: Athletes are often exposed to pain due to injury and competition. There is preliminary evidence that cardiovascular measures could be an objective measure of pain, but the cardiovascular response can be influenced by psychological factors such as catastrophizing. Objectives: The purpose of our study was to use a painful cold pressor test to measure the relationship between catastrophizing, pain, and cardiovascular variables in athletes. Design: Pre-post test. Setting: We completed all measures in a laboratory setting. Participants: Thirty-six male rugby athletes participated in the study. Main outcome measures: We measured catastrophizing with the Pain Catastrophizing Scale and pain with a Numeric Pain Rating Scale. Cardiovascular measures included heart rate, systolic, and diastolic blood pressure, and heart rate variability. Results: During the cold pressor test, participants experienced a significant increase in pain (0 to 4.1±2.2), systolic blood pressure (126.7±16.5mm Hg to 149.7±23.4mm Hg), diastolic blood pressure (76.9±8.3mm Hg to 91.9±11.5mm Hg) and heart rate variability (from 0.0164ms±0.0121 to 0.0400ms±0.0323) (all p<.001). In addition, there was a significant decrease in heart rate after the cold pressor test (p=0.04). There was a significant correlation between athlete's pain catastrophizing to both pain intensity and change in heart rate during the cold pressor test (p=.017 and p=.003 respectively). A significant linear regression indicated pain and catastrophizing explained 29% of the variance of the change in heart rate (p=.003). Conclusion: Athletes who have catastrophizing thoughts are more likely to experience higher levels of pain and a greater cardiovascular response during a painful stimulus. The change in cardiovascular variables may be a good alternative for an objective measure of pain in athletes in the future.

A scoping review of heart rate variability in sport and exercise psychology

“…HRV has been assessed in line with pain measurements to understand its relationship with subjective ratings of pain during pain tasks. Across the majority of studies, athletes who report greater experiences of pain or who had higher pain catastrophizing often have stronger cardiovascular reactions during cold pressor tasks such as increased HRV (SDNN) (Matylda et al, 2020) and decreased vmHRV (HFms 2 ) (Britton et al, 2019). Whereas athletes who tend to experience pain more often, in this study experienced contact athletes had higher vmHRV (RMSSD) when experiencing pain (Thornton et al, 2019).…”

“…Within sport psychology, some topics relating to HRV already received extensive attention, such as HRV-biofeedback (Jimenez Morgan & Molina Mora, 2017;Pagaduan et al, 2020;Pagaduan et al, 2021) and recovery/overtraining (e.g., Dobson et al, 2020;Hauer et al, 2020;Tibana et al, 2019). However, there were also some less researched applications of HRV, such as pain (Matylda et al, 2020;Thornton et al, 2019) and motivation (Korobeynikov, 2011). This was also present within exercise psychology such as motivation (Crawford et al, 2020;Kuroda et al, 2015) and self-efficacy (Matsuo et al, 2015).…”

Perceived Pain in Athletes: A Comparison between Endurance Runners and Powerlifters through a Cold Experimental Stimulation and Two Sessions of Various Physical Activation

“…The twominute time limit was imposed by a precautionary decision aimed at ensuring the utmost safety of the study's participants while also providing a period of time deemed useful for stimulating the response, as indicated by Peckerman et al [75], who suggest that 90-120 s of stimulation should be sufficient to obtain a true peak response. In any case, the extension of the CPT to three minutes, carried out in other previous studies [76][77][78], could possibly have affected the process of inhibitory control and modulation of perceived pain in a different way within the endurance runners. Furthermore, the comparative evaluation of the intensity of pain perceived by the two groups of athletes and controls for several time points, and not just a single detection at the end of the 120 s CPT test, could indicate from which time point on groups differ after training.…”

Both Gender and Agonistic Experience Affect Perceived Pain during the Cold Pressor Test

“…The 1.5 min limit was dictated by a precautionary decision, with the intention of guaranteeing extreme safety to the participants in the study and at the same time having a time interval that is considered useful to activate, as indicated by other scholars who suggested that 90 to 120 s of stimulation should be sufficient to achieve a true peak response [ 68 ]. In any case, the extension of the CPT to 3 min, carried out in other previous studies [ 69 , 70 , 71 ], could possibly have affected the process of inhibitory control and modulation of perceived pain in a different way within male and female athletes.…”