The DOI matches its Crossref record; 52 of the 52 references it cites were found in a registry or an index.
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Radloff, L. S. (1977) · Applied Psychological Measurement · doi:10.1177/014662167700100306 · Cited by 53,267
Development and validation of brief measures of positive and negative affect: The PANAS scales.
Watson, D., Clark, L. A., & Tellegen, A. (1988) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.54.6.1063 · Cited by 32,433
On Methods in the Analysis of Profile Data
Greenhouse, S. W., & Geisser, S. (1959) · Psychometrika · doi:10.1007/bf02289823 · Cited by 4,946
Grading the severity of chronic pain
Von Korff, M., Ormel, J., Keefe, F. J., & Dworkin, S. F. (1992) · Pain · doi:10.1016/0304-3959(92)90154-4 · Cited by 3,022
The unequal burden of pain: confronting racial and ethnic disparities in pain
Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., Kaloukalani, D. A., Lasch, K. E., Myers, C., Tait, R. C., et al. (2003) · Pain Medicine · doi:10.1046/j.1526-4637.2003.03034.x · Cited by 1,248
Self-citationSignificance Test for Sphericity of a Normal $n$-Variate Distribution
Mauchly, J. W. (1940) · The Annals of Mathematical Statistics · doi:10.1214/aoms/1177731915 · Cited by 1,158
Influence of aging on peripheral nerve function and regeneration
Verdú, E., Ceballos, D., Vilches, J., & Navarro, X. (2000) · Journal of the Peripheral Nervous System · doi:10.1046/j.1529-8027.2000.00026.x · Cited by 857
Thomas, E., Peat, G., Harris, L. K., Wilkie, R., & Croft, P. R. (2004) · Pain · doi:10.1016/j.pain.2004.04.017 · Cited by 507
Gibson, S. J., & Farrell, M. J. (2004) · Clinical Journal of Pain · doi:10.1097/00002508-200407000-00004 · Cited by 481
The epidemiology of pain in elderly people
Helme, R. D., & Gibson, S. J. (2001) · Clinics in Geriatric Medicine · doi:10.1016/s0749-0690(05)70078-1 · Cited by 451
Flagged first, then by citations
Cited by
Sorted by citations
Items 101–142 of 142
Racial Differences in Head Pain and Other Pain-Related Outcomes After Mild Traumatic Brain Injury
Naugle, K. M., Nguyen, T., Smith, J. A., Saxe, J. M., & White, F. A. (2022) · Journal of Neurotrauma · doi:10.1089/neu.2022.0415 · Cited by 5
“Other studies in healthy adults have shown no race differences 30–32 or greater pressure pain sensitivity 33 in AAs compared with non-Hispanic Whites (NHWs).”
Does Age Impact on Expectations and Concerns of Patients Attending a Chronic Pain Clinic?
McLoughlin, M., Imran, A., Hannigan, A., & Harmon, D. C. (2017) · Pain Practice · doi:10.1111/papr.12576 · Cited by 5
Digit ratio (2D:4D) and postoperative pain perception
Kasielska‐Trojan, A., Stabryła, P., & Antoszewski, B. (2017) · Early Human Development · doi:10.1016/j.earlhumdev.2017.05.003 · Cited by 5
Sudhakaran, J., & Kim, J. K. (2025) · Journal of Thermal Biology · doi:10.1016/j.jtherbio.2025.104108 · Cited by 4
Opportunities and challenges of pain-related myocardial ischemia-reperfusion injury
Jiang, W., Yin, Y., Gu, X., Zhang, Z., & Ma, H. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.900664 · Cited by 4
“In contrast, studies have shown that pain sensitivity decreases with age (Harkins et al., 1986; Riley et al., 2014; Tinnirello et al., 2021).”
Molecular and Cellular Mechanisms of Neuropathic Pain in Aging
Huang, H., Wu, J., Chang, Y., Wang, H., Tian, Y., Chen, Z., Feng, J., & Wang, H. (2023) · ACS Chemical Neuroscience · doi:10.1021/acschemneuro.3c00010 · Cited by 5
Ganoderma tsuage promotes pain sensitivity in aging mice
Yang, K.-N., Lin, C.-Y., Li, W., Tang, C., Pradhan, J., Chao, M., & Tseng, C. (2024) · Scientific Reports · doi:10.1038/s41598-024-61499-0 · Cited by 4
Jones, K., Armstrong, M., Luna, J., Thakkar, R. K., Fabia, R. B., Groner, J. I., Noffsinger, D. L., Ni, A., Griffin, B. R., & Xiang, H. (2024) · Journal of Medical Extended Reality · doi:10.1089/jmxr.2024.0004 · Cited by 4
“16,17 However, many studies use experimental pain conditions, 18 – 20 which are different from pain caused by medical conditions such as burn injury.”
Dai, S., Ren, Y., Chen, L., Wu, M., Wang, R., & Zhou, Q. (2024) · BMC Anesthesiology · doi:10.1186/s12871-024-02720-5 · Cited by 4
“The study by Sy et al. [13] showed that age ≥ 50 is a protective factor affecting CRBD, speculating that the reason may be that as age increases, pain sensitivity decreases [30], which leads to an increase in the tolerance threshold for CRBD.”
BackgroundInfluence of genetic variants on remifentanil sensitivity in Chinese women
Niu, H., Zhao, S., Wang, Y., Huang, S., Zhou, R., Wu, Z., Song, W., & Chen, X. (2022) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/jcpt.13780 · Cited by 4
“Clinical characteristics such as age or BMI may distort the results.(26) Therefore, linear regression analysis was used to test the independent effect (Table 4).”
MethodGriffioen, M. A., Johantgen, M., Rueden, K. V., Greenspan, J. D., Dorsey, S. G., & Renn, C. L. (2015) · Pain Management Nursing · doi:10.1016/j.pmn.2015.06.010 · Cited by 4
“Although black or African Americans (Rahim-Williams & Fillingim, 2012; Riley et al., 2014) show enhanced sensitivity to experimentally induced pain (Fillingim, 2005; Gibson & Farrell, 2004), no race differences have been found in regard to baseline pain scores (Bernstein et al.”
BackgroundPurnawan, I., Setiyarini, S., Probosuseno, P., & Widyastuti, Y. (2021) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2021.7462 · Cited by 4
“The demographic characteristics of respondents, such as ethnic origin [24], age [25], and gender [26], [27], have an influence on stress, anxiety, and pain.”
BackgroundRana, P., Robinson, M. E., Alappattu, M. J., Riley, J. L., Lott, D. J., & Bishop, M. D. (2025) · Frontiers in Pain Research · doi:10.3389/fpain.2025.1677563 · Cited by 3
Self-citationLahaye, C., Miolanne, M., Farigon, N., Pereira, B., Dubray, C., Beudin, P., Greil, A., & Boirie, Y. (2023) · European Journal of Pain · doi:10.1002/ejp.2085 · Cited by 3
“Conversely, some experimental studies show an increase in pain thresholds with age, particularly in the lower limbs (Riley et al., 2014).”
BackgroundSex and Age Differences in Ketamine Efficacy and Safety in Chronic Pain Alleviation
Pickering, G. P., Voute, M., Sorel, M., Pereira, B., & Riant, T. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14124269 · Cited by 3
“The analgesic effects of ketamine may be modulated by age due to both age-related physiological alterations and pharmacokinetic and pharmacodynamic changes [27,28].”
Evans, M., Sulley, A. M., Crowley, D. C., Langston, J., & Guthrie, N. (2020) · Nutrients · doi:10.3390/nu12061831 · Cited by 3
“existing literature and varies depending on the stimuli [34].”
BackgroundLam, C. N., Larach, D. B., Chou, C.-P., & Black, D. S. (2024) · Pain Medicine · doi:10.1093/pm/pnad119 · Cited by 2
Merriwether, E. N., Vanegas, S. M., Curado, S., Zhou, B., Mun, C. J., Younger, O. S., Elbel, B. D., Parikh, M., & Jay, M. R. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.104625 · Cited by 2
de la Vega, R., Fisher, E., & Palermo, T. M. (2018) · Springer eBooks · doi:10.1007/978-3-319-78340-6_22 · Cited by 2
Sex and Gender Differences in Pain Across the Life Course
Keogh, E. (2018) · Springer eBooks · doi:10.1007/978-3-319-95369-4_18 · Cited by 2
Culturally Conscientious Pain Measurement in Older African Americans
Booker, S. Q., Herr, K., & Tripp‐Reimer, T. (2016) · Western Journal of Nursing Research · doi:10.1177/0193945916648952 · Cited by 2
“, 2015), leaving some to conclude that African Americans may become more sensitive to pain as they age, increasing their risk of chronic pain and more intense pain (Bulls et al., 2015; Riley et al., 2014).”
BackgroundJohnson, A. J., & Cruz‐Almeida, Y. (2021) · Pain · doi:10.1097/j.pain.0000000000002441 · Cited by 1
Self-citationGao, P., Liu, G., Huang, Z., Wu, Y., Zhao, J., Fan, S., Liang, J., & Luo, Z. (2026) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2026.01.006 · Cited by 1
Normative data for the balance error scoring system for patients with chronic neck pain
Leungbootnak, A., Puntumetakul, R., Chatprem, T., Hunsawong, T., Wanpen, S., & Boucaut, R. (2026) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2026.101585 · Cited by 1
“94 In contrast, middle-aged adults experience the highest pain levels, likely due to accumulated mechanical stress, 95,96 early degenerative changes, 97 and psychosocial factors.”
Jain, A., Sadik, E., Cardenas‐Rojas, A., Mahesh, K., Ooi, P., Grami, V., & Christo, P. J. (2026) · Clinical Pharmacology Advances and Applications · doi:10.2147/cpaa.s506172 · Cited by 2
“5,36 This combination of reduced detection of mild stimuli, while also experiencing heightened vulnerability to persistent pain, highlights the importance of individualized assessment in this population.”
Horgas, A. L., & Elliott, A. F. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-816094-7.00012-x · Cited by 2
Insulin syringe for anesthesia in ptosis surgery: a randomized, fellow eye-controlled clinical study
Joo, C. W., Song, W. S., Lee, M. J., & Choi, Y. J. (2023) · International Ophthalmology · doi:10.1007/s10792-023-02671-9 · Cited by 1
“Another possible explanation is that elderly patients are less sensitive to pain stimuli; therefore, the pain caused by the two needles may not be distinguishable [30, 31].”
BackgroundNatural hair color and questionnaire‐reported pain among women in the United States
Li, W., Gao, X., Tworoger, S. S., Qureshi, A. A., & Han, J. (2015) · Pigment Cell & Melanoma Research · doi:10.1111/pcmr.12445 · Cited by 1
“For example, in one study, older individuals reported more head and chest pain, but less genital pain (Shega et al., 2014), but another study did not find age-related patterns to pain reporting among older adults (Riley et al., 2014).”
BackgroundDor durante o tratamento odontológico em pacientes com doença de Parkinson
Cabral, E. D., da Silva, L. V. C., Centro Universitário Tabosa de Almeida, C., & Lins, C. (2020) · Revista Portuguesa de Estomatologia Medicina Dentária e Cirurgia Maxilofacial · doi:10.24873/j.rpemd.2020.11.715 · Cited by 1
Nguyen, C. H., Kortlever, J. T. P., Gonzalez, A. I., Crijns, T. J., Ring, D., Vagner, G. A., & Reichel, L. M. (2021) · PubMed Central · doi:10.22038/abjs.2021.51098.2533 · Cited by 1
“742 Previous orthopaedic condition 40 (40) 21 (33) 19 (54) 0.”
InfluentialMechanismen der endogenen Schmerzhemmung
Laube, W. (2022) · Springer eBooks · doi:10.1007/978-3-662-63846-0_6 · Cited by 1
Race and sex differences in pain sensitivity and beliefs
Persad, B., & Persad, L. A. B. (2015) · University of the Witwatersrand, Johannesburg Institutional Repository on DSpace (University of the Witwatersrand, Johannesburg)
Temporal and Spatial Manifestations of Exercise-induced Hypoalgesia and Conditioned Pain Modulation
Vægter, H. B. (2014) · VBN Forskningsportal (Aalborg Universitet) · doi:10.5278/vbn.phd.med.00034
Min, D. E.-J. (2017) · OpenBU (Boston University)
Insulin syringe for anaesthetic injection in ptosis surgery: A randomised controlled clinical studyPreprint
Song, W. S., Lee, M. J., & Choi, Y. J. (2021) · Research Square · doi:10.21203/rs.3.rs-225791/v1
Hornung, R. S., Kinchington, P. R., Umorin, M., & Kramer, P. R. (2023) · Molecular Pain · doi:10.1177/17448069231202598
“Aging is also associated with alterations in pain perception as observed as an increase in pain threshold.(11,12) This alteration in pain perception is unclear but may be due to alterations in brain regions involved in pain perception,(13,14) alterations in functional connectivity,(15) or alterations in nociceptor sen…”
BackgroundBorna, S., Ho, O. A., Gomez-Cabello, C. A., Haider, S. A., Genovese, A., Prabha, S., Haider, C. R., Felton, C. L., McLeod, C. J., Bruce, C. J., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm14010037
“…shows that race contributes to variations in pain sensitivity, and aging leads to significant neurochemical and neuroanatomical changes that affect pain sensitivity, notably reducing responses to thermal and electric shock stimuli and correlating with fewer opioid receptors in the brain [14,15].”
Courtin, A. S., Krænge, C. E., Mitchell, A. G., Ehmsen, J. F., Brask‐Thomsen, P. K., Gylfadottir, S. S., & Fardo, F. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.09.22.677851 · Cited by 1
“Older adults often exhibit elevated thermal detection and pain thresholds, suggesting that they are less sensitive to temperature changes [19,22,39,45].”
Phillips, A. E., Faghih, M., Ramsey, M., Han, S. S., Hart, P., Afghani, E., Bick, B. L., Easler, J. J., Yadav, D., Wilcox, C. M., et al. (2026) · Journal of Pain Research · doi:10.2147/jpr.s562097
“…In mechanical pressure-pain models using pressure algometers, previous studies have shown that healthy AA participants 9 and AA participants with knee OA exhibit either lower thresholds 30,33 or no difference, 31,34,35 compared to non-AA healthy participants and non-AA participants with knee OA.”
Meints, S. M., Edwards, R. R., Tan, C. O., Dairi, I., Whittington, A. J., Thomas, J. D., DiGregorio, H., Brown, C., Campbell, C. M., Nolan, E., et al. (2026) · PAIN Reports · doi:10.1097/pr9.0000000000001428
“For example, older adults are less sensitive to warmth and heat pain, 54 have a decline in pain inhibition (ie, conditioned pain modulation), 11,52 and show a general increase in pain thresholds.”
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
