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Age and Race Effects on Pain Sensitivity and Modulation Among Middle-Aged and Older Adults
Open accessAbstract
Unlabelled This study tested the effects of aging and race on responses to noxious stimuli using a wide range of stimulus modalities. The participants were 53 non-Hispanic blacks and 138 non-Hispanic white adults, ages 45 to 76 years. The participants completed a single 3-hour sensory testing session where responses to thermal, mechanical, and cold stimuli were assessed. The results suggest that there are selected age differences, with the older group less sensitive to warm and painful heat stimuli than middle-aged participants, particularly at the knee. This site effect supports the hypothesis that the greatest decrement in pain sensitivity associated with aging occurs in the lower extremities. In addition, there were several instances where age and race effects were compounded, resulting in greater race differences in pain sensitivity among the older participants. Overall, the data suggest that previously reported race differences in pain sensitivity emerged in our older samples, and this study contributes new findings in that these differences may increase with age in non-Hispanic blacks for temporal summation and both heat and cold immersion tolerance. We have added to the aging and pain literature by reporting several small to moderate differences in responses to heat stimuli between middle- and older-age adults.Perspective This study found that the greatest decline in pain sensitivity with aging occurs in the lower extremities. In addition, race differences in pain sensitivity observed in younger adults were also found in our older sample.
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“Age-related changes in sensory (i.e., increased central sensitization, pain facilitation, reduced pain inhibition)(Cruz-Almeida, Sibille, Goodin, Petrov, Bartley, Riley, III, King, Glover, Sotolongo, Herbert, Schmidt, Fessler, Staud, Redden, Bradley, and Fillingim 2014;Riley, III, Cruz-Almeida, Glover, King, Goodin, Sibille, Bartley, Herbert, Sotolongo, Fessler, Redden, Staud, Bradley, and Filling”
From Successful aging: Advancing the science of physical independence in older adults (2015) · cites this paper as Riley, III, Cruz-Almeida, Glover, King, Goodin, Sibille, Bartley, Herbert, Sotolongo, Fessler, Redden, Staud, Bradley, and Fillingim 2014
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“Supporting this, studies have found greater temporal summation of pain in response to heat[24;38;61;78] and mechanical pressure[38;78] in ethnic/racial minorities.”
ResultPredictors of Catheter-Related Bladder Discomfort After Surgery: A Literature Review
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Self-citationRace Effects on Conditioned Pain Modulation in Youth
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Self-citationVitamin D Status and Pain Sensitization in Knee Osteoarthritis: A Critical Review of the Literature
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“Moreover, recent studies have suggested that CPM response could be influenced by ethnic background [35, 36] as well as aging [37, 38].”
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“Degreased skin over the retromaleolar path of the right sural nerve was stimulated by a pair of custom-made surface Table 1 Summary of studies on age-related differences in TS. Studies Subject Age range, y Stimulus Site Frequency, Hz Results Harkins et al.10 10 young/10 elderly 21-34/53-75 Heat pain: train of 5 stimul…”
BackgroundResultInfluentialCutaneous pigmentation modulates skin sensitivity via tyrosinase-dependent dopaminergic signalling
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“Moreover, experimental data on age-related changes in pain perception are scare and contradictory.(39) Thus, pain management in the elderly is extremely challenging, especially for those who have undergone hip arthroplasty, functional recovery and pain relief is strongly demanded.”
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“This also eliminated to possibility of only mild CS-related pain in less sensitive males because several studies have shown that CSrepeated pain of .20 is needed for consistent CPM.9,26 Reliability of CPM is dependent on the reliability of the TS used.”
MethodResultInfluentialSelf-citationAntinociceptive Effect of Hydantoin 3-Phenyl-5-(4-ethylphenyl)-imidazolidine-2,4-dione in Mice
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“This process is influenced by the individual characteristics of each person and includes age, ethnicity, gender, past experiences, memories and emotional state, among others [5–8].”
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Older Age as a Prognostic Factor of Attenuated Pain Recovery After Shoulder Arthroscopy
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“We included a middle-aged group based on previous epidemiologic findings of peak pain intensity during middle age [35] and identified differences in endogenous pain sensitivity and modulation found among middle-aged adults [36,37].”
Self-citationPredictors of Cold and Pressure Pain Tolerance in Healthy South African Adults
Persad, L. A. B., Kamerman, P. R., & Wadley, A. L. (2016) · Pain Medicine · doi:10.1093/pm/pnw291 · Cited by 15
Honda, M., Iida, T., Komiyama, O., Masuda, M., Uchida, T., Nishimura, H., Okubo, M., Shimosaka, M., Narita, N., Niwa, H., et al. (2015) · Journal of Oral Science · doi:10.2334/josnusd.57.355 · Cited by 14
Riley, J. L., Cruz‐Almeida, Y., Staud, R. M., & Fillingim, R. B. (2018) · Pain · doi:10.1097/j.pain.0000000000001382 · Cited by 14
“A larger study found the oldest individuals experienced greater heat temporal summation at the forearm compared to amiddle-aged groupwith no differences at the knee.(37) Naugle et al.”
Self-citationEffects of Conditioned Pain Modulation on the Nociceptive Flexion Reflex in Healthy People
Dhondt, E., Oosterwijck, S. V., Coppieters, I., Danneels, L. A., & Oosterwijck, J. V. (2019) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000724 · Cited by 13
Thermal and mechanical quantitative sensory testing values among healthy African American adults
Powell-Roach, K. L., Yao, Y., Rutherford, J. N., Schlaeger, J. M., Patil, C. L., Suarez, M. L., Shuey, D. A., Angulo, V., Carrasco, J. D., Ezenwa, M. O., et al. (2019) · Journal of Pain Research · doi:10.2147/jpr.s211855 · Cited by 13
“5 °C.(5,7,9,14,20,62) In our study, average HPTh and CPTh was reported within 6 °C from the temperature of adaptation.”
BackgroundSelf-citationMinority Aging and Endogenous Pain Facilitatory Processes
Bulls, H. W., Goodin, B. R., McNew, M. E., Gossett, E. W., & Bradley, L. A. (2015) · Pain Medicine · doi:10.1093/pm/pnv014 · Cited by 13
Self-citationMickle, A. M., Domenico, L. H., Tanner, J. J., Terry, E. L., Cardoso, J. S., Glover, T. L., Booker, S. Q., Addison, A., Gonzalez, C. E., Garvan, C. S., et al. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1058476 · Cited by 14
Self-citationPain Assessment in People With Dementia: Remaining Controversies
Rababa, M. (2018) · Global Journal of Health Science · doi:10.5539/gjhs.v10n5p62 · Cited by 12
“Two recent studies (Riley et al., 2014; Stabell, Stubhaug, Flægstad, & Nielsen, 2013) have revealed that pain threshold increases with age.”
BackgroundRassu, F. S., Luedke, J. C., Nanavaty, N., Mathur, V. A., & Meagher, M. W. (2020) · PAIN Reports · doi:10.1097/pr9.0000000000000842 · Cited by 12
“chronic pain) show enhanced temporal summation relative to nonHispanic White (NHW) counterparts.(20,38,70) Pain-free African Americans show enhanced summation relative to NHWs,(13,55) suggesting that the risk for greater pain severity may manifest”
BackgroundRhudy, J. L., Huber, F. A., Kuhn, B. L., Lannon, E. W., Palit, S., Payne, M. F., Hellman, N. M., Sturycz, C. A., Guereca, Y. M., Toledo, T. A., et al. (2020) · PAIN Reports · doi:10.1097/pr9.0000000000000808 · Cited by 11
Kirby, N. V., Tetzlaff, E. J., Kidd, S. A., Brown, E. E., Bezgrebelna, M., Yoon, L., Henderson, S. B., & Kenny, G. P. (2025) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2025.179965 · Cited by 13
Age-Associated Differences in Central Artery Responsiveness to Sympathoexcitatory Stimuli
Bock, J. M., Hughes, W. E., & Casey, D. P. (2019) · American Journal of Hypertension · doi:10.1093/ajh/hpz035 · Cited by 10
Girotti, G., Trevisan, C., Fratta, S., Toffanello, E. D., Inelmen, E. M., Manzato, E., & Sergi, G. (2019) · European Geriatric Medicine · doi:10.1007/s41999-019-00207-y · Cited by 12
Balasch‐Bernat, M., Willems, T. M., Danneels, L. A., Meeus, M., & Goubert, D. (2021) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-021-04623-9 · Cited by 10
“Furthermore, also hypervigilance is correlated to higher amounts of pain [28].”
BackgroundKnox, P. J., Simon, C. B., & Hicks, G. E. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.03.005 · Cited by 9
Facteurs prédictifs de l’inconfort lié à la sonde vésicale
Moataz, A., Chadli, A., Wichou, E., Gallouo, M., Jandou, I., Saber, S., Serhier, Z., Dakir, M., Debbagh, A., & Aboutaieb, R. (2020) · The French Journal of Urology · doi:10.1016/j.purol.2020.09.014 · Cited by 9
Adversity type and timing predict temporal summation of pain in African-American adults
Morris, M. C., Goodin, B. R., Bruehl, S. P., Myers, H. F., Rao, U., Karlson, C., Huber, F. A., Nag, S., Carter, C., Kinney, K. L., et al. (2023) · Journal of Behavioral Medicine · doi:10.1007/s10865-023-00440-8 · Cited by 9
“Age range was restricted because age is known to influence pain sensitivity (Riley et al., 2014) and another key variable evaluated in the larger study – hair cortisol concentration (Staufenbiel et al., 2015).”
Self-citationXing, X., Bai, Y., Sun, K., & Yan, M. (2020) · BMC Anesthesiology · doi:10.1186/s12871-020-0949-6 · Cited by 8
Is Open Reduction Internal Fixation Using Titanium Plates in the Mandible as Successful as We Think?
Capucha, T., Shilo, D., Abdalla‐Aslan, R., Blanc, O., Ginini, J. G., Semel, G., Emodi, O., & Rachmiel, A. (2021) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000008258 · Cited by 8
Pain Management in the Older Adults
Rajput, K., Ng, J., Zwolinski, N., & Chow, R. M. (2024) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2024.03.011 · Cited by 7
Bruehl, S. P., Morris, M. C., & Al’Absi, M. (2022) · PAIN Reports · doi:10.1097/pr9.0000000000000987 · Cited by 7
Pain inhibits pain: Conditioned pain modulation (CPM)
Yi, T. A. N. G., Hu, L., DanDan, T. A. N. G., & Peng, W. (2015) · Chinese Science Bulletin (Chinese Version) · doi:10.1360/n972015-00872 · Cited by 7
Toufexis, C., Macgregor, M., Lewis, A., & Flood, A. P. (2023) · British Journal of Pain · doi:10.1177/20494637221150333 · Cited by 6
Roh, S.-H., Moon, J., & Lee, J. (2023) · Journal of Thermal Biology · doi:10.1016/j.jtherbio.2023.103627 · Cited by 6
Umeda, M., & Escobedo, T. (2018) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-018-00544-x · Cited by 6
Pain threshold between men and women with different fat masses and percentages
Mariani, L., da Silva, C. F., Buzanello, M. R., & Bertolini, G. R. F. (2020) · Brazilian Journal Of Pain · doi:10.5935/2595-0118.20200007 · Cited by 6
Maleki, S. M., Heydarpour, S., Nikray, R., & Heydarpour, F. (2024) · Health Science Reports · doi:10.1002/hsr2.2265 · Cited by 5
You, Y., Zhou, Y.-G., Chen, H., Kancheva, A., Carrillo-Larco, R. M., Yuan, C., & Xu, X.-L. (2024) · PAIN Reports · doi:10.1097/pr9.0000000000001211 · Cited by 5
“This might be due to a decrement in pain sensitivity that occurs with ageing 26 ; hence, adults younger than 65 years may not be able to tolerate pain and therefore would seek medical attention for their health problems.”
Experimental Pain Phenotype Profiles in Community-dwelling Older Adults
Wilson, A. T., Johnson, A. J., Nodarse, C. L., Hoyos, L., Lysne, P. E., Peraza, J. A., Montesino-Goicolea, S., Valdes-Hernandez, P. A., Somerville, J. E. T., Bialosky, J. E., et al. (2022) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001048 · Cited by 5
Self-citation
Metadata
- Authors
- Riley, J. L., Cruz-Almeida, Y., Glover, T. L., King, C. D., Goodin, B. R., Sibille, K. T., Bartley, E. J., Herbert, M. S., Sotolongo, A., Fessler, B. J., Redden, D. T., Staud, R., Bradley, L. A., & Fillingim, R. B.
- Affiliations
- University of Florida Health (US)
- University of Florida (US)
- University of Alabama at Birmingham (US)
- University of Alabama (US)
- Corresponding author
- Riley, Joseph L.
- ORCID
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 15
- Issue
- 3
- Pages
- 272-282
- ISSN
- 1526-5900 (ISSN-L)
- PMC
- PMC4005289
- OpenAlex
- W2057166679
- Cited by
- 142
- References
- 52
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 9 · 2023: 13 · 2022: 8 · 2021: 13 · 2020: 10 · 2019: 11 · 2018: 11 · 2017: 13 · 2016: 9 · 2015: 28 · 2014: 5
- FWCI
- 9.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Pfizer
- National Institutes of Health (5r01ag033906-10, UL1TR000064, UL1TR000165)
- Center for Clinical and Translational Science, University of Alabama at Birmingham (UL1 TR000165)
- National Institute on Aging (L30 AG040467, R-01-AG-033906, L30 AG043172, R01AG039659, P30AG028740, P30AG031054)
- National Institute of Neurological Disorders and Stroke (T32NS045551)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23AR062099)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Life Sciences › Neuroscience › Sensory Systems › Ion Channels and Receptors
- Keywords
- aging, racial differences, pain sensitivity, pain modulation, thermal pain, cold pain, temporal summation, pain tolerance, lower limb pain, knee joint, non-Hispanic Black adults, middle-aged adults, older adults
- MeSH terms
- Aged, Aging, Cold Temperature, Female, Forearm, Hot Temperature, Humans, Hyperalgesia, Knee, Male, Middle Aged, Pain Measurement, Physical Stimulation, Pain Threshold, Black People, White People
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