The influence of sex and level of physical activity on maximum tolerance to mechanical pain

Cordeiro, Marina Aleixo; Santos, Matheus Bieberbach Rodrigues dos; Zotz, Talita Gianello Gnoato; Macedo, Ana Carolina Brandt de

doi:10.1016/j.bjane.2021.09.019

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Brazilian Journal of Anesthesiology

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Original Investigation • Braz. J. Anesthesiol. 72 (5) • Sep-Oct 2022 • https://doi.org/10.1016/j.bjane.2021.09.019 copy

The influence of sex and level of physical activity on maximum tolerance to mechanical pain

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

A difference in maximum tolerance to mechanical pain (MTMP) between the sexes is widely studied but there is still no consensus on whether the level of physical activity (PA) influences pain.

Objectives

To compare the MTMP between men and women with different levels of PA.

Methods

Sixty five individuals were divided in female (n = 35) and male group (n = 30). The main outcome measures were PA level and MTMP by pressure algometry. Pressure was applied three times on both sides at the following points: cervical (5^th and 7^th) and lumbar (3^th and 5^th) vertebrae; trapezius, rhomboid, gluteus, gastrocnemius, pectoralis major, tibialis anterior, and deltoid muscles, elbow, hand, knee, and ankle.

Results

It was observed that the PA level has little influence on the MTMP at all the assessed points and that men have greater MTMP than women.

Conclusion

Sex, not the PA level, influences the MTMP.

Keywords
Pain; Pain measurement; Exercise

Decubitus	Point/region	Description
Prone	5th cervical vertebra - C5	3 cm to the right (R) and left (L) of the C5.32
	7th cervical vertebra	3 cm to the R and L of the C7³⁴34 Garcia E, Godoy-Izquierdo D, Godoy JF, et al. Gender differences in pressure pain threshold in a repeated measures assessment. Psychol Health Med. 2007;12:567-79.
	Trapezius (medium fibers)	Mean distance of C7 and coracoid process⁹9 Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30:115-26.,³⁵35 Antonaci FA, Sand T, Lucas GA. Pressure algometry in healthy subjects: inter-examiner variability. Scand J Rehab Med. 1998;30:3-8.,³⁶36 Jones DH, Kilgour RD, Comtois AS. Test-retest reliability of pressure pain threshold measurements of the upper limb and torso in young healthy women. J Pain. 2007;8:650-6.
	Rhomboid	Mean region of the R and L of the rhomboid³²32 Daughton DM, Fix AJ, Kass I, et al. Maximum oxygen consumption and the ADAPT quality-oflife scale. Arch Phys Med Rehabil. 1982;63:62022.
	3rd lumbar vertebra - L3	5 cm to the R and L of the L3⁹9 Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30:115-26.,³²32 Daughton DM, Fix AJ, Kass I, et al. Maximum oxygen consumption and the ADAPT quality-oflife scale. Arch Phys Med Rehabil. 1982;63:62022.
	5th lumbar vertebra - L5	5 cm to the R and L of the L5⁹9 Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30:115-26.,³²32 Daughton DM, Fix AJ, Kass I, et al. Maximum oxygen consumption and the ADAPT quality-oflife scale. Arch Phys Med Rehabil. 1982;63:62022.
	Gluteus	3 cm below the R and L iliac crest⁹9 Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30:115-26.,³⁷37 Farasyn AD, Meeusen R, Nijs J. Validity of cross-friction algometry procedure in referred muscle pain syndromes. Clin J Pain. 2008;24:456-62.
	Gastrocnemius	Mean portion of the R and L gastrocnemius³²32 Daughton DM, Fix AJ, Kass I, et al. Maximum oxygen consumption and the ADAPT quality-oflife scale. Arch Phys Med Rehabil. 1982;63:62022.
Supine	Pectoralis major	2 cm below mean the distance of the R and L clavicle⁹9 Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30:115-26.
	Elbow	3 cm anterior to the R and L lateral epicondyle of the humerus³⁸38 Kroner-Herwig B, Gassmann J, Tromsdorf M, et al. The effects of sex and gender role on responses to pressure pain. Psychosoc Med. 2012;9:14635874.
	Hand	Middle of the R and L first dorsal interosseous muscle (anatomical snuffbox)³⁹39 Alabas OA, Tashani OA, Tabasam G, et al. Gender role affects experimental pain responses: A systematic review with metaanalysis. Eur J Pain. 2012;16:1211-23.
	Knee	5 cm medial to the center of the R and L patella³⁰30 Corrêa JB, Costa LO, Oliveira NT, et al. Effects of the carrier frequency of interferential current on pain modulation in patients with chronic nonspecific low back pain: a protocol of a randomised controlled trial. BMC Musculoskelet Disord. 2013;14:195.
	Tibialis anterior (TA)	5 cm to the mean distance of the R and L tibia⁴⁰40 Stefania LC, Torresa IL, Souzaa IC, et al. BDNF as an effect modifier for gender effects on pain thresholds in healthy subjects. Neurosci Lett. 2012;514:62-6.
	Ankle	2 cm below the R and L lateral malleolus⁴¹41 Hilberg T, Czepa D, Freialdenhoven D, et al. Joint pain in people with haemophilia depends on joint status. Pain. 2011;152:2029-35.
Lateral	Deltoid (medium fibers)	Central region of the R and L deltoid muscle⁹9 Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30:115-26.,³⁵35 Antonaci FA, Sand T, Lucas GA. Pressure algometry in healthy subjects: inter-examiner variability. Scand J Rehab Med. 1998;30:3-8.

	Females (n = 35)	Males (n = 30)	p
Age (mean ± SD)	21.3 ± 2.5	22.6 ± 3.7	0.16
Smokers (n.%)	1 (2.8%)	3 (10%)	0.11
Alcoholic	11 (31.4%)	10 (33.3%)	0.17
Dominant Side
Right	33 (94.2%)	27 (90%)	0.52
Left	2 (5.7%)	3 (10%)
HAP			0.07
Inactive	16 (45.7%)	4 (13.3%)
Moderately Active	9 (25.7%)	17 (56.66%)
Active	10 (28.5%)	9 (30%)

		Females (n = 35)		Males (n = 30)
	HAP	R	L	R	L
C5	Inactive	4.4 ± 1.4	4.5 ± 1.3	4.9 ± 0.5	4.7 ± 0.3
	Mod Active	4.9 ± 1.5	4.5 ± 1.6	6.6 ± 1.8^b b p< 0.05 same side between groups (Kruskall Wallis).	6.0 ± 1.7^b b p< 0.05 same side between groups (Kruskall Wallis).
	Active	4.5 ± 2.0	4.6 ± 2.0	8.3 ± 3.7^b b p< 0.05 same side between groups (Kruskall Wallis).	6.4 ± 2.4^a a p< 0.05 (within groups, t test).
C7	Inactive	5.9 ± 1.6	6.1 ± 3.2	6.6 ± 0.9	5.7 ± 0.5
	Mod Active	7.3 ± 2.6	6.9 ± 2.9	8.6 ± 2.6	7.3 ± 2.3^a a p< 0.05 (within groups, t test).
	Active	7.6 ± 3.7	6.5 ± 2.9^a a p< 0.05 (within groups, t test).	10.4 ± 4.3	7.6 ± 2.9^a a p< 0.05 (within groups, t test).
Trapezius	Inactive	5.2 ± 2.1	4.7 ± 1.7	5.4 ± 1.2	4.4 ± 0.1
	Mod Active	6.0 ± 2.1	6.0 ± 2.9	7.2 ± 2.5	6.9 ± 1.9
	Active	6.3 ± 2.4	5.4 ± 2.3	9.7 ± 4.7	8.4 ± 2.6^b b p< 0.05 same side between groups (Kruskall Wallis).
Romboid	Inactive	7.4 ± 2.3	7.3 ± 2.7	8.5 ± 1.9	7.6 ± 2.1
	Mod Active	7.7 ± 2.9	8.1 ± 2.3	11.0 ± 3.0^b b p< 0.05 same side between groups (Kruskall Wallis).	10.0 ± 3.0
	Active	7.8 ± 3.9	7.6 ± 2.5	12.0 ± 4.9	10.8 ± 5.0
Deltoid	Inactive	7.9 ± 3.0	9.3 ± 4.9^a a p< 0.05 (within groups, t test).	7.8 ± 1.6	7.6 ± 1.7
	Mod Active	8.8 ± 3.5	9.3 ± 3.5	12.6 ± 4.6^b b p< 0.05 same side between groups (Kruskall Wallis).	12.5 ± 3.7^b b p< 0.05 same side between groups (Kruskall Wallis).
	Active	8.5 ± 3.4	8.3 ± 3.2	13.4 ± 5.0^b b p< 0.05 same side between groups (Kruskall Wallis).	14.0 ± 5.0^b b p< 0.05 same side between groups (Kruskall Wallis).
L3	Inactive	6.6 ± 2.2	6.5 ± 2.5	6.5 ± 2.1	7.1 ± 0.9
	Mod Active	6.9 ± 1.6	7.0 ± 1.8	8.3 ± 2.3	9.4 ± 2.7^a a p< 0.05 (within groups, t test). ,^b b p< 0.05 same side between groups (Kruskall Wallis).
	Active	7.6 ± 2.6	7.4 ± 2.4	9.0 ± 3.8	8.7 ± 4.0
L5	Inactive	7.2 ± 2.1	7.3 ± 3.3	7.4 ± 0.9	7.4 ± 0.7
	Mod Active	7.1 ± 2.0	7.5 ± 1.5	9.5 ± 2.9^b b p< 0.05 same side between groups (Kruskall Wallis).	9.9 ± 2.9
	Active	8.0 ± 2.6	8.0 ± 2.1	9.8 ± 3.9	9.2 ± 3.1
Gluteus	Inactive	5.9 ± 1.9	5.7 ± 2.6	6.5 ± 1.6	6.8 ± 1.9
	Mod Active	6.1 ± 1.7	6.5 ± 1.7	8.0 ± 1.9^b b p< 0.05 same side between groups (Kruskall Wallis).	8.1 ± 2.4
	Active	6.5 ± 2.4	6.7 ± 2.6	8.8 ± 2.4	7.3 ± 1.8^a a p< 0.05 (within groups, t test).
Gastrocnemius	Inactive	6.6 ± 2.5	6.7 ± 2.3	7.2 ± 0.9	7.1 ± 1.3
	Mod Active	7.0 ± 2.5	7.1 ± 2.3	9.0 ± 1.9^b b p< 0.05 same side between groups (Kruskall Wallis).	8.6 ± 1.4^b b p< 0.05 same side between groups (Kruskall Wallis).
	Active	7.5 ± 2.8	6.9 ± 2.2	10.5 ± 3.4	9.9 ± 3.4
Pectoral Major	Inactive	4.5 ± 2.2	4.6 ± 2.6	4.4 ± 1.0	4.8 ± 0.4
	Mod Active	5.8 ± 2.8	6.1 ± 2.4	7.0 ± 2.2	6.9 ± 1.9
	Active	4.1 ± 1.1	4.5 ± 1.5	7.0 ± 3.6^b b p< 0.05 same side between groups (Kruskall Wallis).	9.9 ± 3.4
Elbow	Inactive	5.7 ± 2.2	5.4 ± 1.7	5.6 ± 0.5	5.2 ± 0.4
	Mod Active	6.3 ± 2.6	6.5 ± 2.0	8.8 ± 2.9^b b p< 0.05 same side between groups (Kruskall Wallis).	8.3 ± 2.1^b b p< 0.05 same side between groups (Kruskall Wallis).
	Active	5.8 ± .1.5	5.9 ± 1.7	7.6 ± 3.4	7.5 ± 3.2
Hand	Inactive	5.6 ± 2.1	6.1 ± 2.0	4.8 ± 0.9	5.4 ± 0.7^a a p< 0.05 (within groups, t test).
	Mod Active	6.7 ± 2.6	7.6 ± 2.2	8.4 ± 2.0^b b p< 0.05 same side between groups (Kruskall Wallis).	9.0 ± 2.2
	Active	5.6 ± 1.7	6.5 ± 2.1^a a p< 0.05 (within groups, t test).	6.8 ± 3.1	7.7 ± 2.9^a a p< 0.05 (within groups, t test).
Knee	Inactive	6.9 ± 2.4	6.4 ± 3.1^a a p< 0.05 (within groups, t test).	6.2 ± 1.1	6.3 ± 1.7
	Mod Active	7.1 ± 1.5	6.9 ± 2.3	9.0 ± 2.2^b b p< 0.05 same side between groups (Kruskall Wallis).	8.3 ± 1.6
	Active	8.1 ± 3.3	7.2 ± 2.0	7.5 ± 2.0	7.6 ± 2.5
Tibial Anterior	Inactive	7.8 ± 2.5	7.4 ± 2.6	8.9 ± 1.4	9.4 ± 0.4^b b p< 0.05 same side between groups (Kruskall Wallis).
	Mod Active	8.5 ± 2.9	9.0 ± 3.4	11.3 ± 2.2^b b p< 0.05 same side between groups (Kruskall Wallis).	10.0 ± 1.8^a a p< 0.05 (within groups, t test).
	Active	8.9 ± 3.2	8.4 ± 2.9	11.7 ± 3.4	10.6 ± 3.3^a a p< 0.05 (within groups, t test).
Ankle	Inactive	6.2 ± 2.0	6.3 ± 2.0	6.4 ± 1.2	6.4 ± 0.6
	Mod Active	6.7 ± 2.6	7.1 ± 2.6	8.2 ± 2.0	7.9 ± 2.0
	Active	6.4 ± 2.2	6.2 ± 2.3	6.5 ± 1.3	7.1 ± 1.7

	Females		Males
	R	L	R	L
C5	4.53 ± 1.63	4.53 ± 1.61	6.58 ± 2.82^b b p< 0.05 (between groups).	5.62 ± 2.26^a a p< 0.05 comparing right and left side within group. ,^b b p< 0.05 (between groups).
C7	6.74 ± 2.75	6.47 ± 3.02	8.35 ± 3.45^b b p< 0.05 (between groups).	6.88 ± 2.65^a a p< 0.05 comparing right and left side within group.
Trapezius	5.85 ± 2.24	5.26 ± 2.26^a a p< 0.05 comparing right and left side within group.	7.45 ± 3.67	6.76 ± 2.64^b b p< 0.05 (between groups).
Romboid	7.55 ± 2.99	7.58 ± 2.57	10.36 ± 4.17^b b p< 0.05 (between groups).	9.20 ± 4.17^a a p< 0.05 comparing right and left side within group.
Deltoid	8.26 ± 3.23	9.92 ± 4.18	12.38 ± 5.36^b b p< 0.05 (between groups).	11.51 ± 4.54^b b p< 0.05 (between groups).
L3	7.00 ± 2.22	6.85 ± 2.33	8.10 ± 2.97	8.57 ± 3.34^b b p< 0.05 (between groups).
L5	7.42 ± 2.24	7.51 ± 2.60	9.15 ± 3.32^b b p< 0.05 (between groups).	9.11 ± 3.20^b b p< 0.05 (between groups).
Gluteus	6.14 ± 2.00	6.19 ± 2.42	7.92 ± 2.31^b b p< 0.05 (between groups).	7.49 ± 2.91^b b p< 0.05 (between groups).
Gastrocnemius	6.97 ± 2.59	6.88 ± 2.25	9.07 ± 2.70^b b p< 0.05 (between groups).	8.41 ± 2.44^a a p< 0.05 comparing right and left side within group. ,^b b p< 0.05 (between groups).
Pectoral Major	4.73 ± 2.23	4.99 ± 2.40	6.45 ± 2.97^b b p< 0.05 (between groups).	6.39 ± 2.56^b b p< 0.05 (between groups).
Elbow	5.93 ± 2.17	5.86 ± 1.84	7.69 ± 3.35^b b p< 0.05 (between groups).	7.37 ± 2.84^b b p< 0.05 (between groups).
Hand	5.93 ± 2.18^b b p< 0.05 (between groups).	6.68 ± 2.19	7.00 ± 2.79^b b p< 0.05 (between groups).	7.82 ± 2.81^a a p< 0.05 comparing right and left side within group.
Knee	7.34 ± 2.54^b b p< 0.05 (between groups).	6.74 ± 2.62	7.90 ± 2.49	7.39 ± 2.11
Tibial Anterior	8.27 ± 2.84	8.06 ± 2.96	10.78 ± 2.86^b b p< 0.05 (between groups).	9.77 ± 2.52^a a p< 0.05 comparing right and left side within group. ,^b b p< 0.05 (between groups).
Ankle	6.42 ± 2.24	6.52 ± 2.24	7.26 ± 2.11	7.20 ± 2.15

Active HAP Classification/sex
						95 % Confidence Interval for mean
	R2	R Adjusted	F	p	beta	Lower bound	Upper bound
C5R	0.309	0.269	7.615	0.013*	0.55	0.894	6.704
DelR	0.272	0.229	6.359	0.022*	0.52	0.806	9.062
DelL	0.343	0.304	8.864	0.008*	0.58	1.667	9.778
PMR	0.252	0.208	5.723	0.029*	0.50	0.339	5.411
PML	0.216	0.171	4.681	0.045*	0.46	0.059	4.725
Moderately Active HAP Classification/sex
C5R	0.198	0.165	5.931	0.023*	0.45	0.269	3.257
C5L	0.159	0.124	4.531	0.442*	0.39	0.045	2.913
RbR	0.226	0.194	7.008	0.014*	0.47	0.728	5.882
DelR	0.156	0.121	4.435	0.046*	0.39	0.075	7.426
L5R	0.158	0.123	4.498	0.044*	0.39	0.063	4.625
GLR	0.202	0.166	5.991	0.022*	0.44	0.294	3.462
KR	0.172	0.137	4.972	0.035*	0.41	0.142	3.677
TAR	0.247	0.216	7.868	0.010*	0.49	0.757	4.977
L3L	0.176	0.141	5.117	0.033*	0.41	0.203	4.435
ELL	0.164	0.129	4.695	0.042*	0.40	0.088	3.165

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] * Corresponding author. E-mail:ana.macedo@ufpr.br (A.C. de Macedo).