The Impact of Familiarization on Pressure and Heat Pain Scores Original Research
Main Article Content
Keywords
Pain Familiarization, Pain, Testing, Pain Variability
Abstract
Introduction: Quantitative sensory testing (QST) provides an effective means to better understand the pain process; however, inherent variability exists depending on how QST methods are implemented. The current study sought to investigate the impact of pain testing familiarization on pain pressure testing (PPT) and heat pain testing during QST in young, healthy participants.
Methods: 25 participants (13(m)/12(f); 22.5 ± 2.5 yrs) underwent 4 separate testing sessions of pressure pain threshold (PPT) and pressure pain supra-threshold (PPTs) and heat pain threshold (HT) and 50/100 Visual Analogue Scale (H50), which included pain familiarization.
Results: No significant effects were seen across session for PPT (F(3,184) = 1.205, p = 0.309) or PPTs (F(3,184) = 0.227, p = 0.8774) and trial type for PPT (F(1,184) = 0.12, p = 0.722) or PPTs (F(1,184) = 0.743, p = 0.390). A significant main effect for the independent variable of trial was found for the dependent variable of H50 (F(1,184) = 109.42, p = < 0.000) with the experimental trial values lower than familiarization values. This was not seen within the HT (F(1,184) = 3.374, p = 0.068) values.
Conclusions: When testing for moderate levels of heat pain, familiarization should be considered. Additional research is still needed to support or deny the need for familiarization to be included in pain testing research to increase the accuracy of future research studies.
References
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21. Thibodeau MA, Welch PG, Katz J, Asmundson GJG. Pain-related anxiety influences pain perception differently in men and women: A quantitative sensory test across thermal pain modalities. PAIN®. 2013;154(3):419-426. doi:10.1016/j.pain.2012.12.001
22. Levine FM, Lee De Simone L. The effects of experimenter gender on pain report in male and female subjects. PAIN. 1991;44(1):69. doi:10.1016/0304-3959(91)90149-R
23. Segelcke D, Talbot SR, Palme R, et al. Experimenter familiarization is a crucial prerequisite for assessing behavioral outcomes and reduces stress in mice not only under chronic pain conditions. Sci Rep. 2023;13(1):2289. doi:10.1038/s41598-023-29052-7
24. Eckert NR, Vierck CJ, Simon CB, Cruz-Almeida Y, Fillingim RB, Riley JL. Testing Assumptions in Human Pain Models: Psychophysical Differences Between First and Second Pain. J Pain. 2017;18(3):266-273. doi:10.1016/j.jpain.2016.10.019
25. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45-56. doi:10.1016/0304-3959(83)90126-4
26. Chesterton LS, Sim J, Wright CC, Foster NE. Interrater Reliability of Algometry in Measuring Pressure Pain Thresholds in Healthy Humans, Using Multiple Raters. Clin J Pain. 2007;23(9):760. doi:10.1097/AJP.0b013e318154b6ae
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29. Elkin L, Kay M, Higgins J, Wobbrock J. An Aligned Rank Transform Procedure for Multifactor Contrast Tests. Published online 2021. https://doi.org/10.1145/3472749.3474784
30. Kay M, Elkin L, Higgins J, Wobbrock J. ARTool: Aligned Rank Transform for Nonparametric Factorial ANOVAs. Published online 2021. https://github.com/mjskay/ARTool
31. Ben-Shachar MS, Ludecke D, Makowski D. {e}ffectsize: Estimation of Effect Size Indices and Standardized Parameters. Published online 2020. https://doi.org/10.21105/joss.02815
32. Kuznetsova A, Brockhoff P, Christensen RHB. {lmerTest} Package: Tests in Linear Mixed Effects Models. Published online 2017.
33. R Core Team. R: A Language and Environment for Statistical Computing. Published online 2024. https://www.R-project.org/
34. Wickam H, Bryan J. readxl: Reach Excel Files. Published online 2023. https://CRAN.R-project.org/package=readxl
35. Wickam H. Reshaping Data with the {reshape} Package. Published online 2007. http://www.jstatsoft.org/v21/i12/
36. Hope R. Rmisc: Ryan Miscellaneous. Published online 2022. https://CRAN.R-project.org/package=Rmisc
37. Wickam H, Mara Averick, Jennifer Bryan, et al. Welcome to the {tidyverse}. Published online 2019.
38. Naugle KM, Ohlman T, Wind B, Miller L. Test-Retest Instability of Temporal Summation and Conditioned Pain Modulation Measures in Older Adults. Pain Med Malden Mass. 2020;21(11):2863-2876. doi:10.1093/pm/pnaa288
39. Martel MO, Wasan AD, Edwards RR. Sex Differences in the Stability of Conditioned Pain Modulation (CPM) among Patients with Chronic Pain. Pain Med. 2013;14(11):1757-1768. doi:10.1111/pme.12220
40. Bellosta-López P, Doménech-García V, Palsson TS, Herrero P, Christensen SWM. Long-term consistency of clinical sensory testing measures for pain assessment. Korean J Pain. 2023;36(2):173-183. doi:10.3344/kjp.23011
41. Vincenot M, Beaulieu LD, Gendron L, Marchand S, Léonard G. Reliability and minimal detectable change of dynamic temporal summation and conditioned pain modulation using a single experimental paradigm. PLOS ONE. 2024;19(7):e0307556. doi:10.1371/journal.pone.0307556
42. Marcuzzi A, Wrigley PJ, Dean CM, Adams R, Hush JM. The long-term reliability of static and dynamic quantitative sensory testing in healthy individuals. PAIN. 2017;158(7):1217. doi:10.1097/j.pain.0000000000000901
43. Brady SM, Georgopoulos V, Veldhuijzen van Zanten JJCS, et al. The interrater and test–retest reliability of 3 modalities of quantitative sensory testing in healthy adults and people with chronic low back pain or rheumatoid arthritis. PAIN Rep. 2023;8(6):e1102. doi:10.1097/PR9.0000000000001102
44. Cornwall A, Donderi DC. The effect of experimentally induced anxiety on the experience of pressure pain. PAIN. 1988;35(1):105. doi:10.1016/0304-3959(88)90282-5
45. Crettaz B, Marziniak M, Willeke P, et al. Stress-Induced Allodynia – Evidence of Increased Pain Sensitivity in Healthy Humans and Patients with Chronic Pain after Experimentally Induced Psychosocial Stress. PLOS ONE. 2013;8(8):e69460. doi:10.1371/journal.pone.0069460
46. Gera O, Ginzburg K, Gur N, Defrin R. Effects of acute stress exposure on pain sensitivity: the role of individual stress responsiveness and orientation to pain and stress. PAIN. 2025;166(10):e388. doi:10.1097/j.pain.0000000000003622
47. Tang J, Gibson SJ. A Psychophysical Evaluation of the Relationship Between Trait Anxiety, Pain Perception, and Induced State Anxiety. J Pain. 2005;6(9):612-619. doi:10.1016/j.jpain.2005.03.009
48. Rhudy JL, Meagher MW. Fear and anxiety: divergent effects on human pain thresholds. PAIN. 2000;84(1):65. doi:10.1016/S0304-3959(99)00183-9
49. Greffrath W, Baumgärtner U, Treede RD. Peripheral and central components of habituation of heat pain perception and evoked potentials in humans. PAIN. 2007;132(3):301-311. doi:10.1016/j.pain.2007.04.026
50. Cosentino G, Antoniazzi E, Bonomi L, et al. Age-, gender- and body site-specific reference values of thermal Quantitative Sensory Testing in the Italian population using the Q-sense device. Neurol Sci. 2023;44(12):4481-4489. doi:10.1007/s10072-023-06929-z
51. Rolke R, Baron R, Maier C, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values. PAIN. 2006;123(3):231. doi:10.1016/j.pain.2006.01.041
52. Rolke R, Magerl W, Campbell KA, et al. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain. 2006;10(1):77-77. doi:10.1016/j.ejpain.2005.02.003
53. Powell-Roach KL, Yao Y, Rutherford JN, et al. Thermal and mechanical quantitative sensory testing values among healthy African American adults. J Pain Res. 2019;12:2511-2527. doi:10.2147/JPR.S211855
54. Eckert NR, Vierck CJ, Simon CB, et al. Methodological Considerations for the Temporal Summation of Second Pain. J Pain. 2017;18(12):1488-1495. doi:10.1016/j.jpain.2017.07.009
55. Tracy L m., Georgiou-Karistianis N, Gibson S j., Giummarra M j. Location, location, location: Variation in sensitivity to pain across the body. Eur J Pain. 2016;20(10):1721-1729. doi:10.1002/ejp.895
2. Rikard SM. Chronic Pain Among Adults — United States, 2019–2021. MMWR Morb Mortal Wkly Rep. 2023;72. doi:10.15585/mmwr.mm7215a1
3. Zis P, Daskalaki A, Bountouni I, Sykioti P, Varrassi G, Paladini A. Depression and chronic pain in the elderly: links and management challenges. Clin Interv Aging. 2017;12:709-720. doi:10.2147/CIA.S113576
4. Khalid S, Sambamoorthi U, Umer A, Lilly CL, Gross DK, Innes KE. Increased Odds of Incident Alzheimer’s Disease and Related Dementias in Presence of Common Non-Cancer Chronic Pain Conditions in Appalachian Older Adults. J Aging Health. 2022;34(2):158-172. doi:10.1177/08982643211036219
5. Fishbain DA, Lewis JE, Gao J. The Pain Suicidality Association: A Narrative Review. Pain Med. 2014;15(11):1835-1849. doi:10.1111/pme.12463
6. Ditre JW, Zale EL, LaRowe LR. A Reciprocal Model of Pain and Substance Use: Transdiagnostic Considerations, Clinical Implications, and Future Directions. Annu Rev Clin Psychol. 2019;15(Volume 15, 2019):503-528. doi:10.1146/annurev-clinpsy-050718-095440
7. Forstenpointner J, Otto J, Baron R. Individualized neuropathic pain therapy based on phenotyping: are we there yet? Pain. 2018;159(3):569-575. doi:10.1097/j.pain.0000000000001088
8. Naugle KM, Fillingim RB, Riley JL. A Meta-Analytic Review of the Hypoalgesic Effects of Exercise. J Pain. 2012;13(12):1139-1150. doi:10.1016/j.jpain.2012.09.006
9. Magora F, Cohen S, Shochina M, Dayan E. Virtual reality immersion method of distraction to control experimental ischemic pain. IMAJ-RAMAT GAN-. 2006;8(4):261.
10. Cheatham SW, Stull KR. Roller massage: Comparison of three different surface type pattern foam rollers on passive knee range of motion and pain perception. J Bodyw Mov Ther. 2019;23(3):555-560. doi:10.1016/j.jbmt.2019.05.002
11. Bellosta-López P, Doménech-García V, Palsson TS, Herrero P, Christensen SWM. Long-term consistency of clinical sensory testing measures for pain assessment. Korean J Pain. 2023;36(2):173-183. doi:10.3344/kjp.23011
12. Li R, Holley AL, Palermo TM, Ohls O, Edwards RR, Rabbitts JA. Feasibility and reliability of a quantitative sensory testing protocol in youth with acute musculoskeletal pain postsurgery or postinjury. PAIN. 2023;164(7):1627. doi:10.1097/j.pain.0000000000002865
13. Geber C, Klein T, Azad S, et al. Test–retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): A multi-centre study. PAIN. 2011;152(3):548. doi:10.1016/j.pain.2010.11.013
14. Nothnagel H, Puta C, Lehmann T, et al. How stable are quantitative sensory testing measurements over time? Report on 10-week reliability and agreement of results in healthy volunteers. J Pain Res. 2017;10:2067-2078. doi:10.2147/JPR.S137391
15. De Vita MJ, Buckheit K, Gilmour CE, Moskal D, Maisto SA. Development of a Novel Brief Quantitative Sensory Testing Protocol That Integrates Static and Dynamic Pain Assessments: Test-Retest Performance in Healthy Adults. Pain Med. 2022;23(2):347-351. doi:10.1093/pm/pnab290
16. Uddin Z, MacDermid JC. Quantitative Sensory Testing in Chronic Musculoskeletal Pain. Pain Med. 2016;17(9):1694-1703. doi:10.1093/pm/pnv105
17. Wylde V, Palmer S, Learmonth ID, Dieppe P. Test–retest reliability of Quantitative Sensory Testing in knee osteoarthritis and healthy participants. Osteoarthritis Cartilage. 2011;19(6):655-658. doi:10.1016/j.joca.2011.02.009
18. Vallerand AH, Polomano RC. The relationship of gender to pain. Pain Manag Nurs. 2000;1(3, Supplement 1):8-15. doi:10.1053/jpmn.2000.9759
19. Pickering G, Jourdan D, Eschalier A, Dubray C. Impact of Age, Gender and Cognitive Functioning on Pain Perception. Gerontology. 2002;48(2):112-118. doi:10.1159/000048937
20. Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. BJA Br J Anaesth. 2013;111(1):52-58. doi:10.1093/bja/aet127
21. Thibodeau MA, Welch PG, Katz J, Asmundson GJG. Pain-related anxiety influences pain perception differently in men and women: A quantitative sensory test across thermal pain modalities. PAIN®. 2013;154(3):419-426. doi:10.1016/j.pain.2012.12.001
22. Levine FM, Lee De Simone L. The effects of experimenter gender on pain report in male and female subjects. PAIN. 1991;44(1):69. doi:10.1016/0304-3959(91)90149-R
23. Segelcke D, Talbot SR, Palme R, et al. Experimenter familiarization is a crucial prerequisite for assessing behavioral outcomes and reduces stress in mice not only under chronic pain conditions. Sci Rep. 2023;13(1):2289. doi:10.1038/s41598-023-29052-7
24. Eckert NR, Vierck CJ, Simon CB, Cruz-Almeida Y, Fillingim RB, Riley JL. Testing Assumptions in Human Pain Models: Psychophysical Differences Between First and Second Pain. J Pain. 2017;18(3):266-273. doi:10.1016/j.jpain.2016.10.019
25. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45-56. doi:10.1016/0304-3959(83)90126-4
26. Chesterton LS, Sim J, Wright CC, Foster NE. Interrater Reliability of Algometry in Measuring Pressure Pain Thresholds in Healthy Humans, Using Multiple Raters. Clin J Pain. 2007;23(9):760. doi:10.1097/AJP.0b013e318154b6ae
27. John Fox, Sanford Weisberg. An {R} Companion to Applied Regression. Published online 2019. https://socialsciences.mcmaster.ca/jfox/Books/Companion/
28. Singman H, Bolker B, Westfall J, Aust F, Ben-Shachar M. afex: Analysis of Factorial Experiments. Published online 2024. https://CRAN.R-project.org/package=afex
29. Elkin L, Kay M, Higgins J, Wobbrock J. An Aligned Rank Transform Procedure for Multifactor Contrast Tests. Published online 2021. https://doi.org/10.1145/3472749.3474784
30. Kay M, Elkin L, Higgins J, Wobbrock J. ARTool: Aligned Rank Transform for Nonparametric Factorial ANOVAs. Published online 2021. https://github.com/mjskay/ARTool
31. Ben-Shachar MS, Ludecke D, Makowski D. {e}ffectsize: Estimation of Effect Size Indices and Standardized Parameters. Published online 2020. https://doi.org/10.21105/joss.02815
32. Kuznetsova A, Brockhoff P, Christensen RHB. {lmerTest} Package: Tests in Linear Mixed Effects Models. Published online 2017.
33. R Core Team. R: A Language and Environment for Statistical Computing. Published online 2024. https://www.R-project.org/
34. Wickam H, Bryan J. readxl: Reach Excel Files. Published online 2023. https://CRAN.R-project.org/package=readxl
35. Wickam H. Reshaping Data with the {reshape} Package. Published online 2007. http://www.jstatsoft.org/v21/i12/
36. Hope R. Rmisc: Ryan Miscellaneous. Published online 2022. https://CRAN.R-project.org/package=Rmisc
37. Wickam H, Mara Averick, Jennifer Bryan, et al. Welcome to the {tidyverse}. Published online 2019.
38. Naugle KM, Ohlman T, Wind B, Miller L. Test-Retest Instability of Temporal Summation and Conditioned Pain Modulation Measures in Older Adults. Pain Med Malden Mass. 2020;21(11):2863-2876. doi:10.1093/pm/pnaa288
39. Martel MO, Wasan AD, Edwards RR. Sex Differences in the Stability of Conditioned Pain Modulation (CPM) among Patients with Chronic Pain. Pain Med. 2013;14(11):1757-1768. doi:10.1111/pme.12220
40. Bellosta-López P, Doménech-García V, Palsson TS, Herrero P, Christensen SWM. Long-term consistency of clinical sensory testing measures for pain assessment. Korean J Pain. 2023;36(2):173-183. doi:10.3344/kjp.23011
41. Vincenot M, Beaulieu LD, Gendron L, Marchand S, Léonard G. Reliability and minimal detectable change of dynamic temporal summation and conditioned pain modulation using a single experimental paradigm. PLOS ONE. 2024;19(7):e0307556. doi:10.1371/journal.pone.0307556
42. Marcuzzi A, Wrigley PJ, Dean CM, Adams R, Hush JM. The long-term reliability of static and dynamic quantitative sensory testing in healthy individuals. PAIN. 2017;158(7):1217. doi:10.1097/j.pain.0000000000000901
43. Brady SM, Georgopoulos V, Veldhuijzen van Zanten JJCS, et al. The interrater and test–retest reliability of 3 modalities of quantitative sensory testing in healthy adults and people with chronic low back pain or rheumatoid arthritis. PAIN Rep. 2023;8(6):e1102. doi:10.1097/PR9.0000000000001102
44. Cornwall A, Donderi DC. The effect of experimentally induced anxiety on the experience of pressure pain. PAIN. 1988;35(1):105. doi:10.1016/0304-3959(88)90282-5
45. Crettaz B, Marziniak M, Willeke P, et al. Stress-Induced Allodynia – Evidence of Increased Pain Sensitivity in Healthy Humans and Patients with Chronic Pain after Experimentally Induced Psychosocial Stress. PLOS ONE. 2013;8(8):e69460. doi:10.1371/journal.pone.0069460
46. Gera O, Ginzburg K, Gur N, Defrin R. Effects of acute stress exposure on pain sensitivity: the role of individual stress responsiveness and orientation to pain and stress. PAIN. 2025;166(10):e388. doi:10.1097/j.pain.0000000000003622
47. Tang J, Gibson SJ. A Psychophysical Evaluation of the Relationship Between Trait Anxiety, Pain Perception, and Induced State Anxiety. J Pain. 2005;6(9):612-619. doi:10.1016/j.jpain.2005.03.009
48. Rhudy JL, Meagher MW. Fear and anxiety: divergent effects on human pain thresholds. PAIN. 2000;84(1):65. doi:10.1016/S0304-3959(99)00183-9
49. Greffrath W, Baumgärtner U, Treede RD. Peripheral and central components of habituation of heat pain perception and evoked potentials in humans. PAIN. 2007;132(3):301-311. doi:10.1016/j.pain.2007.04.026
50. Cosentino G, Antoniazzi E, Bonomi L, et al. Age-, gender- and body site-specific reference values of thermal Quantitative Sensory Testing in the Italian population using the Q-sense device. Neurol Sci. 2023;44(12):4481-4489. doi:10.1007/s10072-023-06929-z
51. Rolke R, Baron R, Maier C, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values. PAIN. 2006;123(3):231. doi:10.1016/j.pain.2006.01.041
52. Rolke R, Magerl W, Campbell KA, et al. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain. 2006;10(1):77-77. doi:10.1016/j.ejpain.2005.02.003
53. Powell-Roach KL, Yao Y, Rutherford JN, et al. Thermal and mechanical quantitative sensory testing values among healthy African American adults. J Pain Res. 2019;12:2511-2527. doi:10.2147/JPR.S211855
54. Eckert NR, Vierck CJ, Simon CB, et al. Methodological Considerations for the Temporal Summation of Second Pain. J Pain. 2017;18(12):1488-1495. doi:10.1016/j.jpain.2017.07.009
55. Tracy L m., Georgiou-Karistianis N, Gibson S j., Giummarra M j. Location, location, location: Variation in sensitivity to pain across the body. Eur J Pain. 2016;20(10):1721-1729. doi:10.1002/ejp.895
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Feb 7, 2026
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The Impact of Familiarization on Pressure and Heat Pain Scores: Original Research. (2026). Research in Health and Medicine, 6(1). https://doi.org/10.53520/rhm2026.104186
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