Pain intensity and pain duration experienced by male and female athletes playing contact and noncontact sports were measured using the Pain Apperception Test, or PAT (Petrovich, 1957). The PAT consists of 25 line drawings grouped into three series: (a) situations of felt sensation of pain (n = 9); (b) anticipation of pain as opposed to felt sensation of pain (4 counterpart pairs); and (c) origin of pain, either self-inflicted or other-inflicted (4 counterpart pairs). Using a 7-point Likert-like scale, the athletes evaluated each PAT drawing as to the intensity and duration of pain. The drawings feature distinct facial and body characteristics that facilitated the athletes’ projection into the various pain situations portrayed. MANOVA indicated that there were statistically significant differences (.05 level) in pain apperception between (a) male and female athletes, (b) contact and noncontact athletes, and (c) athletes in various sports. Stepwise multiple discriminate function analysis (SMDFA) was used to test the dispersion of group centroids in the discriminate space and to identify the variables that contributed the most variance to the between-group differences. SMDFA’s classification procedures assign athletes to groups based on their pain apperception scores.
Pain Apperception Among Athletes Playing Contact and Noncontact Sports
Pain is often associated with the athletic experience (Addison, Kremer, & Bell, 1998; Cook & Koltyn, 2000). Contact-sport athletes are particularly prone to injuries that can cause acute and chronic pain (Anshel & Russell, 1994). Being able to “play hurt” is often cited as important for success in such sports as lacrosse, football, ice hockey, and wrestling. Authors Iso-Ahola and Hatfield (1986) contend that pain tolerance is the most critical differentiator between successful and unsuccessful athletes in endurance sports.
Despite the attention given to pain by coaches, trainers, and medical personnel, sport psychologists have not systematically studied pain perception/apperception and its far-reaching dimensions (Addison et al., 1998).
Evaluation of reactivity to pain has been approached from the neurological, physiological, cultural, and psychoanalytic points of view. According to Petrovich (1991), overreactions, underreactions, marked fluctuations in thresholds, and marked reactions in the absence of indentifiable stimulus are common. Pain researchers typically focus on sensory endings, nerve tracts, and stimulus intensities (see Cook & Koltyn, 2000). However, the present investigators believe that the study of pain reactions requires a dynamic reconceptualization to advance the evaluation of athletes’ conscious and unconscious attitudes, feelings, and motivations. A projective technique seems most appropriate for studying the psychological aspects of pain.
Apperception, in its original sense dating back to Leibniz (1646-1716), refers to a final, clear perception evidencing recognition, identification, or comprehension of what has been perceived (Reber, 1995). Wundt (1832-1920) used the term similarly to refer to the mental process of selecting and structuring internal experience: of, in other words, focusing attention within the field of consciousness (Reber, 1995). Over the years, however, according to U. Neisser (personal communication, April 16, 2001), apperception has not been used very often, coming to be replaced by the word perception. J. Cutting (personal communication, April 18, 2001) is in agreement with Neisser that apperception and perception are now synonymous. Therefore, our review of literature will focus on pain perception as opposed to pain apperception; pain apperception sport studies were not found.
]Physiological and Psychological Aspects of Pain[
Past and contemporary authors of sport psychology texts have given very little attention to the psychological aspects of pain. For example, Willis and Campbell (1992) indicate that pain is associated with dropout among exercise participants. Van Raalte and Brewer (1996) state that some athletes are using drugs to moderate pain caused by athletic injuries. They devote several pages to the management of pain. Anderson and Williams (1988) have developed a model of stress and athletic injury, but the role of pain is not clearly defined. Although authors such as Andersen (2000) and Weinberg and Gould (1999) do discuss injuries as well as emotions and implications related to injury treatment and recovery, they do not discuss muscle pain or exercise-induced analgesia (i.e., the mechanisms that underlie either muscle pain experienced during exercise or exercise-induced analgesia). Furthermore, they do not cover in much detail (if they cover at all) how the perception of pain or injury influences athletic performance (e.g., the influence on athletes of seeing a gymnast severely injured in a fall from the balance beam). Perhaps the lack of attention authors have given to the psychological aspects of pain results from the dearth of research literature on this important topic.
Conceptualization of Pain
In an attempt to conceptualize pain in sport environments, Addison, Kremer, and Bell (1998) developed an integrative model that stressed action, sensation, cognitive appraisal, and outcome. Drawing on gate control theory (Melzack & Wall, 1965) and the parallel processing model (Leventhal, 1993), the model that Addison and colleagues developed (1993) includes physiological sensation, primary and secondary appraisal, possible outcomes, and cognitive coping strategy. Addison and colleagues also recognized the important role of extrinsic factors (e.g., culture) and intrinsic factors (e.g., personality) in athletes’ pain perception. Focus groups were used to validate the model, and in general they supported its basic premises. The model represents an early attempt to systematize the complex processes involved when athletes experience and respond to pain. As the authors point out, it is anticipated that this model will undergo further elaboration, validation, and confirmation in years to come. Addison and colleagues (1998) also developed a six-factor sport pain taxonomy that includes fatigue/discomfort, positive training pain, negative training pain, negative warning pain, negative acute pain, and numbness.
Athletes’ Tolerance of Pain
During the past decade, there have been numerous investigations of pain in athletic environments. Prokop (2000), for example, summarized well when he stated that pain is a serious warning symptom that places a decisive limit on sports capability in general and on the high performance of the athlete in particular. Addison and colleagues (1998) developed an integrative model linking the physiological sensation of pain to a two-stage process of cognitive appraisal and a series of behavioral responses, mediated by extrinsic and intrinsic factors together with cognitive coping strategies.
Using a controversial pain assessment procedure, Ryan and Kovacic (1966) found that contact-sport athletes tolerated acute pain significantly longer than did noncontact-sport athletes. Both groups tolerated more acute pain than nonathletes. Of particular interest were the assessment procedures used to measure pain. Passing up earlier pain-measurement methods (e.g., cold, heat, noise, electric shock), Ryan and colleagues induced pain by securing a plastic gridiron cleat to an athlete’s leg midway between ankle and knee, using a sphygmomanometer cuff. Inflating the cuff at a slow, constant rate pressed the cleat against the tibia. Inflation continued until the participant indicated that the pain could no longer be endured.
Kress (1999) studied former Olympic cyclists’ cognitive strategies for coping with pain during performance. Using inductive content analysis, he uncovered several higher order themes associated with pain management: pain, preparation, mental skills, mind and body, optimism, control, and “house in order.” Physically and mentally prepared cyclists experienced less pain than their counterparts lacking such preparation. Kress concluded that degree of pain is purely a perception.
Sternberg and colleagues (1998) evaluated experimental pain sensitivity in 36 male and 33 female collegiate athletes two days before a competition, immediately following that competition, and again two days after the competition. When compared to 20 matched nonathlete controls, the male and female athletes provided data showing that competition dramatically reduced the perception of noxious stimuli. The researchers concluded that competition induces both hyperanalgesic and analgesic states that are dependent on the body region tested and the pain assessment methodology.
Effect of Aerobic and Strength Training
The effect of aerobic and strength training on pain tolerance, pain appraisal, and mood of unfit males, as a function of upper and lower limb pain location, was studied by Anshel and Russell (1994). Unfit males (n = 48) were randomly assigned to one of four groups: aerobic training, strength training, combined aerobic and strength training, and the no training control group. The training regimens consisted of exercising at least 3 times per week for 12 weeks. Pain tolerance, pain appraisal, and mood were assessed before the treatment and after 6 weeks and 12 weeks. MANOVA indicated that the presence of aerobic training increased upper limb pain tolerance and improved vigor, while decreasing fatigue, tension, and depression. Strength training showed no influence on pain tolerance or positive mood state, although it increased depression. Lower limb pain tolerance was unaffected by the treatments.
Scott and Gijsbers (1981) studied pressure pain tolerance of elite (high aerobically conditioned) and nonelite (low aerobically conditioned) swimmers. They found that elite swimmers could tolerate more pain than both club swimmers and noncompetitive swimmers. Club swimmers, in turn, could endure more pain than noncompetitors.
Janal and colleagues (1994) studied stoicism among runners. They compared two independent samples of male regular runners (n = 52) and normally active controls (n = 42) in terms of cold-pressor, cutaneous heat, and tourniquet ischemic pain tests. Results demonstrated that the runners’ threshold for noxious cold was significantly higher than that of controls. The heart rate and blood pressure responses to cold were similar in the two groups. However, signal-detection-theory measures demonstrated that runners discriminated among noxious thermal stimuli significantly better than controls. The researchers concluded that the data did not generally support the hypothesis of stoicism in habitual runners.
Cognitive Appraisal, Cognitive Strategies
The use of cognitive strategies to increase pain tolerance has also been investigated. Spink (1988) found that a dissociative cognitive strategy resulted in marked pain reduction and improved swim time, in contrast to associative cognitive strategy or no-strategy condition. Gauron and Bowers (1986) found that cognitive strategies significantly reduced chronic pain of injured collegiate noncontact sport athletes.
Using pain pressure, Brewer, Van Raalte, and Linder (1990b) found support for the hypothesis that pain inhibits motor performance as a function of task complexity. They reasoned that pain induces a state of overarousal which, in turn, negatively affects performance of difficult tasks. The researchers linked their findings with the inverted-U relationship between arousal and performance.
The present study was designed to test the following hypotheses:
1. There will be significant difference in pain apperception of athletes who participate in contact sports and those who participate in noncontact sports.
2. There will be significant difference in pain apperception of men athletes and women athletes.
3. There will be significant difference in pain apperception of athletes who participate in different sports.
4. There will be significant difference in pain apperception of highly skilled, average skilled, and low-skilled athletes.
The volunteer participants (N = 108) were college-age men athletes (n = 83) and women athletes (n = 25) participating in the sports of football (n = 21), rugby (n = 16), men’s track and field (n = 28), women’s track and field (n = 13) , men’s lacrosse (n = 20), women’s softball (n = 1), and women’s soccer (n = 13 ). Mean age was 22.2 years for the men (SD = 3.87) and 18.5 years for the women (SD = 1.33).
This investigation was approved by the Life University IRB. Following the signing of informed consent forms, participants were asked to take the Pain Apperception Test (Petrovich, 1957, 1958a). The PAT consists of 25 TAT-like line drawings grouped into three series: (a) situations of felt pain sensations (n = 9), (b) anticipation of pain versus felt sensation of pain (4 counterpart pairs), and (c) origin of pain, either self-inflicted or other-inflicted (4 counterpart pairs). In all 25 pictures, a male in his middle 30s is shown experiencing or about to experience pain. Examples of these pictures include a man falling from a broken ladder and a man seated in a dentist’s chair about to have a tooth drilled. The pictures were selected based on a survey of undergraduate college students who were instructed to list 10 situations that they associated with pain. The drawings feature distinct facial and body characteristics that facilitated the participants’ projection into the various pain situations portrayed.
Measures of pain intensity and pain duration were obtained for each of the 25 pictures. For the intensity measure, participants were asked to indicate, on a 7-point Likert-like scale, how the man in the picture feels, from 1 (no pain) to 7 (can’t stand pain). For the duration measure, participants were asked, “How long will it hurt him?”; responses again comprised a 7-point scale, from 1 (not at all) to 7 (months). Normative data are reported for three groups: 50 male and 50 female hospital personnel, 100 male hospitalized veterans, and 100 male chronic schizophrenics. Split-half reliabilities for intensity scores range from .56 to .84, with median .70; and for duration scores range from .65 to .89, with median .84 (Spielberger, 1983). Reliabilities are not reported for total scores.
Instructions to participants were as follows:
This is a test of imagination. You will see a number of pictures, one at a time. Each picture has two questions, and each question has seven possible answers to consider. Imagine the feelings of the man in the picture and circle the best possible answer for each question (Petrovich, 1991, p. 21).
According to Petrovich (1957, 1958a), the PAT is a valid and reliable instrument suitable for the assessment and evaluation of psychological variables involved in the experience of pain. The PAT was originally constructed on the basis of logic and empirical findings from extensive research studies done in 1956-1957. Two major premises underlie the PAT. First, each person is predisposed to perceive pain in others in a characteristic and relatively constant manner, stemming from his or her personal, idiosyncratic experiences with, and reactions to, pain. Second, this characteristic perceptual response can be elicited using pictures of persons in pain which require a subject to judge intensity and duration of pain experienced by the persons depicted (Petrovich, 1991).
Results of studies using the PAT indicate intra-individual consistency in pain apperception, neuroticism, and manifest anxiety (Petrovich, 1958a, 1958b, 1958c, 1960a, 1960b). The ability of the PAT to differentiate between normals and disturbed persons was supported by Silverstein and Owens (1961). They found that retarded participants’ painfulness concepts differed quite significantly from those of normal persons, and suggested that strikingly low pain apperception threshold could reflect an emotionally immature pain reaction.
The coaches of the athletes (N = 6) were asked to rate each player as (a) highly skilled, (b) of average skill, or (c) low-skilled. These evaluations were used to determine if athletes of different skill levels differed as to pain apperception. Skill comparisons were made on the basis of the athletic conference in which the athletes participated.
The intraclass correlation (ICC) approach was used to determine the reliability of the PAT (Pain Apperception Test). ICC evaluates the level of agreement between raters in measurements, where the measurements are parametric or at least interval. It may be conceptualized as the ratio of between-groups variance to total variance. According to Portney and Watkins (1993), this method is better than ordinary correlation, as more than two raters can be included. Shrout and Fleiss (1979) also lent support for the use of intraclass correlation when they indicated that it is preferred when sample size is small (comprising fewer than 15). Eleven athletes were tested and retested with a 4-week interval between test administrations. Felt sensation intensity scores ranged from .78 to .86; felt sensation duration scores ranged from .75 to .85.
The purpose of this investigation was to determine if there were differences in pain apperception among (a) contact-sport and noncontact-sport athletes, (b) male and female athletes, (c) athletes who play different sports, and (d) athletes of low, medium, and high skill levels. To answer these questions, data were analyzed by means of descriptive and inferential statistical procedures. The primary research question was “What combination of dependent variables distinguishes these groups and which variables contribute the most to the between-group variances?” Therefore, MANOVA and stepwise multiple discriminate function analyses (SMDFA) were used to determine if there were significant differences (.05 level) in pain apperception between male and female athletes, contact and noncontact sport athletes, athletes who participate in different sports, and athletes of different skill levels. SMDFA’s classification procedures were used to assign athletes to groups based on their pain apperception scores. Cohen and Cohen (1983) lent credence to the use of SMDFA when they stated that it is a form of canonical analysis used when the dependent variable is categorical and is especially useful when the dependent variable has more than two categories.
Contact X Gender Pain Apperception
A 2 X 2 MANOVA (Gender X Contact) revealed a significant multivariate effect for gender, Wilks’s lambda = 0.73, F(10, 93) = 3:38, p < 0.001, eta squared = 0.267. Female athletes (n = 25) possessed lower pain apperception than male athletes (n = 83). Therefore, the hypothesis of significant difference in pain apperception between male athletes and female athletes was accepted. SMDFA revealed a significant multivariate effect for gender, Wilks’s lambda = 0.74, F(14, 91) = 2.26, p < 0.01. The variables self-inflicted-pain intensity, F(1, 106) = 14.82, p < 0.001, and self-inflicted-pain duration, F(1, 106) = 9.70, p < 0.001, contributed the most to between-groups differences in pain apperception. Females had lower pain apperception than males on these variables.
Based on their pain apperception scores, SMDFA’s classification procedures assigned 71.3% of the original grouped cases correctly to their respective groups; 71.0%of the males (n = 59) and 72.0% of the females (n = 24) were assigned correctly to their respective groups. Cross-validation procedures indicated that 69.4% of the grouped cases had been correctly classified.
Table 1 shows descriptive statistics for the collegiate athletes, in terms of contact/noncontact and contact/noncontact by gender. Note that the contact-sport athletes’ mean scores for pain apperception variables in all instances are lower than the scores of the noncontact-sport players. In addition, male contact-sport athletes have lower pain apperception scores than male noncontact-sport players. These generalizations are also true for 8 of 10 variables for female contact versus noncontact players. In general, the mean pain apperception scores for contact-sport athletes of either gender are lower than for noncontact-sport athletes.
Table 2 shows univariate F test values of pain apperception for male and female athletes. Statistically significant (.01 level) between-group differences were found for self-inflicted pain intensity, self-inflicted pain duration, and other-inflicted pain duration variables. Female athletes’ pain apperception scores were lower than those of male athletes.
Contact/Noncontact Pain Apperception
MANOVA revealed significant multivariate effect for pain apperception between contact-sport and noncontact-sport athletes, Wilks’s lambda = 0.80, F(10, 97) = 2.32, p < 0.017, eta squared = 0.23. Therefore, the hypothesis of significant difference in pain apperception was accepted. Contact-sport athletes (N = 49) had lower pain apperception than did noncontact-sport athletes (N = 59). SMDFA also revealed a significant between-group difference in pain apperception betweencontact-sport and noncontact-sport athletes, Wilks’s lambda = 0.89, F(1, 106) = 12.97, p < 0.001.
Using the first canonical discriminant function (self-inflicted-pain duration), the dispersion of the group centroids was tested using Wilks’s lambda, which may be interpreted as chi-square. This analysis revealed that the centroids were positioned in the discriminant space a significant distance from each other, Wilks’s lambda = 0.89, chi-square (1) = 12.18, p < 0.001.
SMDFA revealed that self-inflicted-pain duration accounted for the largest amount of between-group variance for contact-sport and noncontact-sport athletes, F(1, 106) = 12.97, p < 0.001, eta squared = 0.109. Other variables that distinguished contact-sport from noncontact-sport athletes were self-inflicted-pain intensity, F(1, 106) = 11.12, p < 0.001, eta squared = 0.095; other-Inflicted-pain intensity, F(1, 106) = 8.26, p < 0.01, eta squared = 0.072; and other-inflicted-pain duration, F(1, 106) = 9.96, p < 0.01, eta squared = 0.086.
SMDFA’s classification procedures assigned 62.0% of the original grouped cases correctly to their respective groups. Cross-validation procedures also indicated that 62.0% of the grouped cases were correctly classified, with 71% of the contact-sport athletes assigned correctly to a group and 67.8% of the noncontact-sport athlete assigned correctly to a group.
MANOVA also produced univariate F values of pain apperception for contact-sport athletes (n = 49) and noncontact sport athletes (n = 59) . Of the 10 dependent variables, 6 reached statistical significance at or beyond the .05 level. In terms of felt sensation pain duration, contact-sport athletes were significantly lower in pain apperception than noncontact-sport athletes, F(1, 106) = 4.56, p < .05, eta squared = 0.41. A significant difference between contact-sport athletes and noncontact-sport athletes was also found for anticipated duration of pain, F(1, 106) = 4.31, p < .05, eta squared = 0.039. Once again, contact-sport performers were lower in their apperception of pain duration than were noncontact-sport athletes. Self-inflicted-pain intensity apperceived by contact-sport athletes was significantly lower than that for noncontact-sport performers, F(1, 106) = 11.12, p < 0.001, eta squared = 0.095. A statistically significant difference in apperception of self-inflicted-pain duration was also found for contact-sport versus noncontact-sport players, F(1, 106) = 12.97, p < 0.001, eta squared = 0.109. Once again, contact-sport players were lower in apperception of self-inflicted-pain duration than were noncontact-sport athletes. Other-inflicted-pain intensity scores for contact-sport athletes were significantly lower than for noncontact-sport performers, F (1, 106) = 8.26, p < 0.01, eta squared = 0.072. Contact-sport athletes were also significantly lower in other-inflicted-pain duration than noncontact-sport athletes, F(1, 106) = 9.96, p < 0.01, eta squared = 0.086.
Gender/Sport Pain Apperception
A 2 X 5 MANOVA (Gender X Sport) revealed a significant multivariate effect for sport, Wilks’s lambda = .361, F (40, 354) = 2.74, p < 0.001, eta squared = 0.225. However, a significant difference was not found for gender, Wilks’s lambda = 0.91, F(10, 93) = 0.97, p > 0.47, eta squared = 0.095. Therefore, the hypothesis of significant differences in pain apperception among athletes in different sports was accepted. The hypothesis of significant differences in pain apperception among male and female athletes in different sports was rejected.
Univariate F-test comparisons of the 10 Pain Apperception Test variables for male athletes (n = 83) and female athletes (n = 25) produced three significant differences. Statistically significant differences (.01 level) were found for self-inflicted-pain intensity, F(1, 102) = 17.75, p < 0.001, eta squared = 0.148; for self-inflicted-pain duration, F(1, 102) = 8.74, p < 0.01, eta squared = 0.079; and for other-inflicted-pain duration, F(1, 102) = 5.68, p < 0.05, eta squared = 0.019. For these variables, female athletes had lower pain apperception scores than male athletes. Using these three variables, MANOVA produced an overall statistically significant difference between male and female athletes, Wilks’s lambda = 0.73, F(10, 93) = 3.38, p < 0.001, eta squared = 0.267.
SMDFA indicated that self-inflicted-pain intensity contributed the most to between-group differences, F(1, 103) = 8.53, p < 0.001]. Felt-sensation pain duration was the second variable in the stepwise procedures, F(2, 103) = 7.69, p < 0.001, that contributed the most to the between-group differences. No other variables reached statistical significance at or beyond the .05 level.
The SMDFA classification procedures indicated that 71.3% of the original grouped cases were correctly classified by their respective sports. Cross-validation procedures indicated that 69.4% of the cases were classified correctly. The correctly classified percentages by sport (with specified sport in parentheses) were as follows: 62.5% (rugby), 12.5% (track and field), 70% (lacrosse), 75.0% (soccer), and 23.8% (football). Of the original grouped cases, 42.6% of athletes were classified correctly. However, cross-validation procedures indicated that 38.9% of the grouped cases were correctly classified.
Table 3 shows descriptive statistics for pain apperception variables for male and female athletes in the sports of track and field, football, lacrosse, rugby, and soccer. Of the 10 comparisons, 7 variables were found to be statistically significant at or beyond the .05 level. Highly significant differences in pain apperception were found for the following:
1. felt sensation intensity, F(4, 102) = 2.79, p < .005, eta squared = 0.099
2. felt sensation duration, F(4, 102) = 3.36, p < 0.01, eta squared = 0.117
3. anticipated pain duration, F(4, 102) = 5.80, p < 0.001, eta squared = 0.185
4. felt sensation anticipated duration, F(4, 102) = 2.70, p < 0.05, eta squared 0.096
5. self-inflicted-pain intensity, F(4,102) = 8.21, p < 0.001, eta squared = 0.244
6. self-inflicted-pain duration, F(4, 102) = 3.43, p < .01, eta squared = 0.118
7. other-inflicted-pain duration, F (4, 102) = 2.56, p < 0.05, eta squared = 0.091
Where statistically significant, univariate, between-sport differences in pain apperception appeared, Bonferroni’s post hoc procedures were used to locate those differences. For felt sensation intensity, it was found that track and field athletes experienced higher apperception of pain than lacrosse and soccer players did. There were no significant differences in pain apperception between track and field athletes and rugby or football athletes. Bonferroni’s post hoc procedures also indicated that there were statistically significant differences in felt sensation duration among athletes who participated in track and field, rugby, and lacrosse, with rugby and lacrosse players scoring significantly lower for pain apperception than did track and field athletes. Significant differences in felt sensation duration were not found between track and field athletes and participants in thesoccer or football.
Statistically significant differences were not found among highly skilled athletes (n = 44), athletes of average skill (n = 42), and low-skilled athletes (n = 22) in terms of pain apperception, Wilks’s lambda = 0.779, F(20, 192) = 1.28, p > 0.200). Univariate F-test comparisons indicated that statistically significant differences in pain apperception were found for felt-sensation-pain duration, F(2, 105) = 3.44, p < .05, and anticipated duration, F(2, 105) = 3.72, p < .05.
In reviewing the literature, studies of pain apperception in athletes using projective techniques were not found. To date, pain research involving athletes has focused primarily on the use of such assessment procedures as anecdotal and clinical reports, cold-water pressor procedures, and paper-and-pencil tests (e.g., Pain Catastrophizing Scale, McGill Pain Questionnaire). In an early investigation, pain was assessed in athletes by strapping a football cleat to the tibia using a sphygmomanometer (blood pressure) cuff. The cuff was inflated until the athlete could no longer endure the pain.
One of the main purposes of the present study was to determine if there were differences in pain apperception between male and female athletes. MANOVA revealed that female athletes had significantly lower pain apperception than male athletes did. In terms both of self-inflicted-pain intensity and self-inflicted-pain duration, female athletes scored significantly lower than their male counterparts; females also scored significantly lower than males for duration of other-inflicted-pain, although not for intensity of other-inflicted pain.
Comparative data using projective techniques were not found, but Hall and Davies (1991) did report that the data about interaction of gender with experience of pain are contradictory and inconclusive. Using the cold-water pressor test, Hall and Davies’s research on gender differences in athletes’ and others’ perception of pain intensity and affect indicated that nonathletes report significantly higher pain intensity than male and female athletes. Hall and Davies concluded that the literature supports the premise that pain threshold does not vary between males and females, whereas pain tolerance is greater in males (Otto & Dougher, 1985; Petrie, 1960).
In an attempt to explain gender differences, Rosillo and Fogel (1973) suggest that men are culturally conditioned to associate pain tolerance with masculinity. In contrast, women are often culturally and socially conditioned to avoid pain. Although sport-related research on pain is scarce, within the context of athletic performance a different set of social learning factors may be operating (Iso-Ahola & Hatfield, 1986; Jarmenko, 1978). For example, Ryan and Kovacic (1966) reported that female athletes displayed higher tolerance for aversive stimuli (i.e., sphygmomanometer cuff pressure) than did female nonathletes and male nonathletes. However, in a more recent investigation using the cold-water pressor test, Sullivan and colleagues (2000) examined differences in pain perception bewteen varsity athletes and sedentary controls. They found that the athletes reported less pain than the sedentary individuals, with men reporting less pain than women. Regression analyses revealed that catastrophizing accounted for differences between men and women as to pain perception.
In terms of the present study, there are two plausible explanations for the difference in pain apperception bewteen male and female athletes. First, the lower pain apperception among female athletes may result from their relative inexperience with pain, compared to male athletes; it is possible that the women did not know how to respond to the line drawings showing a man in his middle 30s in painful situations. The second explanation is that females actually do have lower pain apperception than males.
Another important objective of this research was to determine if there were pain apperception differences between contact-sport and noncontact-sport athletes. MANOVA revealed a significant multivariate effect for pain apperception among contact-sport as opposed to noncontact-sport athletes, Wilks’s lambda = 0.80, F(10, 97) = 2.32, p < 0.017. Contact-sport athletes had lower pain apperception than noncontact-sport players. Although using a different assessment procedure, Ryan and Kovocic (1966) reported that contact-sport athletes tolerated acute pain significantly longer than nonathletes did. It is likely that the contact sport experience helps athletes manage pain and is thus an influential variable in differences in pain apperception among athletes.
The measurement of pain apperception in athletes in different sports was another important objective of this study. Rugby players and female soccer players scored lowest on four of the pain apperception variables. Among the five groups of athletes, rugby players scored lowest on anticipated pain intensity, anticipated pain duration, felt sensation anticipated intensity, and felt sensation anticipation duration. The female soccer players scored lowest among the five teams on self-inflicted-pain intensity, self-inflicted-pain duration, other-Inflicted-pain intensity, and other-inflicted-pain duration. Since rugby is a contact, or collision, sport in which no protective equipment is used, it is no surprise that rugby players in this study obtained low pain apperception scores (firsthand observation of a rugby game can be convincing, concerning the validity of this statement). However, it is intuitively surprising that female soccer athletes scored lower than male rugby athletes and male football players on 4 of the 10 pain apperception variables, since soccer is often thought of as a semicontact sport.
Our finding, furthermore, is not in agreement with Sullivan and colleagues (2000), who found that male athletes and sedentary males scored lower in pain than did female athletes and sedentary females. Studying pressure pain tolerance of elite (high aerobically conditioned) and nonelite (low aerobically conditioned) swimmers, Scott and Gijsbers (1981) furthermore, reported that elite swimmers tolerated more pain than either club swimmers or noncompetitive swimmers did. Janel and colleagues’ results (1994) are also in conflict with the present findings. The earlier work compared two independent samples, male regular runners and normally active controls, through cold-pressor, cutaneous heat, and tourniquet ischemic pain tests. The runners’ threshold for noxious cold was significantly higher than that of the controls. Differences in pain sensitivity have been due to the instruments used in the various studies.
Finally, it is apparent from the above analyses that the Pain Apperception Test is not a very useful instrument to measure pain apperception in athletes. It is unable, for example, to discriminate among athletes who were obviously very different in their ability to withstand pain (e.g., rugby players vs. soccer players). Test revisions are needed to make the PAT appropriate for athletes. Perhaps sport-specific pain apperception instruments would better allow athletes to relate to portrayed painful situations. Incorporating sport-specific injury within the 25 cards and using line drawings (and/or photographs) of men and women might enhance the validity, reliability, and objectivity of the test.
William F. Straub, Scott B. Martin, David Z. Williams, and Alyson L. Ramsey
Appreciation is extended to the players who participated in this study. Appreciation is extended to graduate student Tim Meyers, University of North Texas for his assistance with data collection. Appreciation is expressed to Coaches Rick McGuire and Brian Maggard, University of Missouri; Coach Dave Carty, Fairleigh Dickinson University; Coach John Hedlund, North Texas State University and Coach Mike Spino, Life University. Appreciation is extended to Professors Ulric Neisser and James Cutting, Cornell University, Department of Psychology, for their comments regarding the difference between apperception and perception.
Addison, T., Kremer, J., & Bell, R. (1998). Understanding the psychology of pain in sport. Irish Journal of Psychology, 19(4). 486-503.
Andersen, M. B. (Ed.)(2000). Doing sport psychology. Champaign, IL: Human Kinetics.
Andersen, M. B., & Williams, J. M. (1988). A model of stress and athletic injury: Prediction and prevention. Journal of Sport and Exercise Psychology, 10, 294 – 306.
Anshel, M. H., & Russell, K. G. (1994). Effect of aerobic and strength training on pain tolerance, pain appraisal and mood of unfit males as a function of pain location. Journal of Sports Sciences, 12, 535-547.
Bartholomew, J. B., Brewer, B., Linder, D. E., Cornelius, A., & Bart, S. M. (1998). A psychometric evaluation of the Sports Inventory for Pain. The Sport Psychologist, 12, 29-39.
Brewer, B. W., Karoly, P., Linder, D. E., & Landers, D. M. (1990a). Validation of a procedure to induce pain of varied intensities. Research Quarterly for Exercise and Sport, 61, 268-271.
Brewer, B. W., Van Raalte, J. L., & Linder, D. E. (1990b). Effects of pain on motor performance. Journal of Sport and Exercise Psychology, 12, 353-365.
Cohen, J., & Cohen, P. (1983). Applied multiple regression and correlational analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
Cook, D. B., & Koltyn, K. F. (2000). Pain and exercise. International Journal of Sport Psychology, 31, 256-277.
Gauron, E. F., & Bowers, W. A. (1986). Pain control techniques in college-age athletes. Psychological Reports, 59, 1163-1169.
Hall, E. G., & Davies, S. (1991). Gender differences in perceived intensity and affect of pain between athletes and nonathletes. Perceptual and Motor Skills, 73, 779 – 786.
Heyneman, N. E., Fremouw, W. F., Gano, D., & Kirkland, F. (1990). Individual differences and the effectiveness of different coping strategies for pain. Cognitive Therapy and Research, 14, 63-77.
Iso-Ahola, S. E., & Hatfield, B. (1986). Psychology of sports: A social psychological approach. Dubuque, IA: Brown.
Janal, M. N., Glusman, M., Kuhl, J. P., & Clark, W. C. (1994). Are runners stoical? An examination of pain sensitivity in habitual runners and normal active controls. Pain, 58(1), 109-116.
Jarmenko, M. E. (1978). Cognitive strategies in pain tolerance. Journal of Behavior Therapy and Experimental Psychiatry, 9, 239.
Kress, J. L. (1999). A naturalistic investigation of former Olympic cyclists’ cognitive strategies for coping with exertion pain during performance. Dissertation Abstracts International (B), 59(9), 4763.
Leventhal, H. (1993). The pain system: A multilevel model for the study of motivation and emotion. Motivation and Emotion, 17, 139-146.
Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 50, 971-979.
Otto, M. W., & Dougher, M. J. (1985). Sex differences and personality factors in response to pain. Perceptual and Motor Skills, 61, 383-390.
Petrie, A. (1960). Some psychological aspects of pain and the relief of suffering. Annals of the New York Academy of Sciences, 86, 13.
Petrovich, D. V. (1957). The pain apperception test: A preliminary report. Journal of Psychology, 44, 118-122.
Petrovich, D. V. (1958b). A survey of painfulness concepts. Journal of Clinical Psychology, 14, 288-291.
Petrovich, D. V. (1958c). The Pain Apperception Test: An application to sex differences. Journal of Clinical Psychology, 15, 412-414.
Petrovich, D. V. (1958a). The Pain Apperception Test: Psychological correlates of pain perception. Journal of Clinical Psychology, 14, 367-374.
Petrovich, D. V. (1960a). Pain apperception in chronic schizophrenics. Journal of Projective Techniques, 25, 352-355.
Petrovich, D. V. (1960b). The apperceptive study of psychological aspects of pain. Perceptual and Motor Skills, 11, 57.
Petrovich, D. V. (1991). Pain Apperception Test manual. San Diego, CA: Western Psychological Services.
Portney, L. G., & Watkins, M. P. (1993). Foundations of clinical research: Applications and practice. Norwalk, CT: Appleton & Lange.
Prokop, L. (2000). The significance of pain in sport. Kinesiology, 32(1), 77-84.
Reber, A. S. (Ed.). (1995). The Penguin dictionary of psychology. New York: Penguin.
Rosillo, R. H., & Fogel, M. L. (1973). Pain, affect, and progress in physical rehabilitation. Journal of Psychosomatic Research 17, 21-28.
Ryan, E. D., & Kovacic, C. R. (1966). Pain tolerance and athletic participation. Perceptual and Motor Skills, 22, 383-390.
Scott, V., & Gijsbers, K. (1981). Pain perception in competitive swimmers. British Medical Journal, 283, 91-93.
Shrout, P. E., & Fleiss, J. L. (1979). Intraclass correlation: Uses in assessing rater reliability. Psychological Bulletin, 86, 420-428.
Silverstein, A. B., & Owens, E. P. (1961). Pain apperception in the mentally retarded. Journal of Projective Techniques, 25, 352-355.
Spielberger, C. D. (1978). [Review of the Pain Apperception Test.] In O. K. Buros (ed.), The eighth mental measurements yearbook (pp. 638-640). Lincoln, NE: Buros Institute of Mental Measurements.
Spink, K. S. (1988). Facilitating endurance performance: The effect of cognitive strategies and analgesic suggestions. The Sport Psychologist, 2, 97-104.
Sternberg, W. G., Bailin, D., Grant, M., & Gracely, R. H. (1998). Competition alters the perception of noxious stimuli in male and female athletes. Pain, 76(1-2), 231-238.
Sullivan, M. J. L., Tripp, D. A., Rogers, W. M., & Stanish, W. (2000). Catastrophizing and pain perception in sport participants. Journal of Applied Sport Psychology, 12(2), 151-167.
Van Raalte, J. L., & Brewer, B. W. (Eds.)(1996). Exploring sport and exercise psychology. Washington, DC: American Psychological Association.
Weinberg, R. S., & Gould, D. (1995). Foundations of sport and exercise psychology. Champaign, IL: Human Kinetics.
Willis, J. D., & Campbell, L. R. (1992). Exercise psychology. Champaign, IL: Human Kinetics.