ArticlePain perception in athletes compared to normally active controls: A systematic review with meta-analysisTesarz, Jonasa,*; Schuster, Alexander K.b; Hartmann, Mechthilda; Gerhardt, Andreasa; Eich, WolfgangaAuthor Information Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. aDepartment of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Germany bMannheimer Institute of Public Health, Medical Faculty Mannheim, University of Heidelberg, Germany *Corresponding author. Address: Department of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. Tel.: +49 6221 56 37862; fax: +49 6221 56 8450. E-mail address:[email protected] Article history: Received 6 September 2011; Received in revised form 5 March 2012; Accepted 5 March 2012. Pain: June 2012 - Volume 153 - Issue 6 - p 1253-1262 doi: 10.1016/j.pain.2012.03.005 Buy Metrics Abstract Summary Differences in pain perception between athletes and nonathletes were meta-analyzed. Available data suggest that regular physical activity is associated with specific alterations in pain perception. This study systematically reviewed differences in pain perception between athletes and normally active controls. We screened MEDLINE, Sport-Discus, EMBASE, Web of Science, PsycINFO, PSYNDEX, and the citations of original studies and systematic reviews. All studies on experimentally induced pain that compared pain perception between athletes and normally active controls were eligible. The main outcome measures were pain tolerance and pain threshold. Effects are described as standardized mean differences and were pooled using random-effects models. Fifteen studies including 899 subjects met the inclusion criteria. Twelve of these studies assessed pain tolerance, and 9 studies examined pain threshold. A meta-analysis of these studies revealed that athletes possessed higher pain tolerance compared to normally active controls (effect size calculated as Hedges’ g = 0.87, 95% confidence interval [CI95] 0.53–1.21; P < 0.00001), whereas available data on pain threshold were less uniform (Hedges’ g = 0.69, CI95 0.16–1.21; P = 0.01). After exclusion of studies with high risk of bias, differences between groups in pain threshold were not significant any longer. Our data suggest that regular physical activity is associated with specific alterations in pain perception. Psychological and biological factors that may be responsible for these alterations are discussed. © 2012 Lippincott Williams & Wilkins, Inc.