title: Predictors of Cold and Pressure Pain Tolerance in Healthy South African Adults.
abstract: BACKGROUND
  Studies on relationships between sex, ethnicity, and pain have largely emanated from the United States and Europe. We compared cold (CPT) and pressure pain tolerance (PPT) in male and female South Africans of African and European ancestry and assessed whether psychosocial factors (including pain beliefs) predicted differences in pain tolerance.
  
  
  METHODS
  We recruited 106 (62 female) students of African ancestry and 106 (55 female) of European ancestry and subjected them to a cold-pressor test and pressure algometry. Socioeconomic status (SES), pain catastrophizing, depression, anxiety, and pain beliefs were assessed as predictors of pain tolerance.
  
  
  RESULTS
  CPT was lower in students of African compared with European ancestry (for both sexes), and PPT was lower in female than male students (for both ethnicities). Females were very accepting of men expressing pain and males less so. Males of African ancestry were least accepting but still tolerant. Multivariate analysis identified African ancestry, and particularly being a female of African ancestry, as strong predictors of lower CPT. Anxiety was a weak predict or of CPT. Sex was the only strong predictor of PPT on multivariate analysis (PPT females < males), and catastrophizing was a weak predictor. Female sex and African ancestry were strong predictors of acceptance of expression of pain in males. SES was a weak predictor of the Appropriate Pain Behavior Questionnaire-Malescore.
  
  
  CONCLUSIONS
  Despite different cultural and social backgrounds from US and European cohorts, we saw similar patterns of sex and ethnic differences in CPT and PPT in an African cohort. Traditional psychosocial predictors of pain sensitivity predicted variation in the outcome variables but were not strong predictors.
authors.affiliation: Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Leeana Aarthi
authors.initials: LA
authors.lastname: Bagwath Persad
authors.affiliation: Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Peter Rowland
authors.initials: PR
authors.lastname: Kamerman
authors.affiliation: Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Antonia Louise
authors.initials: AL
authors.lastname: Wadley
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D044383:Black People; D058443:Catastrophization / Q000523:psychology*; D003080:Cold Temperature; D005260:Female; D006801:Humans; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D058748:Pain Perception / Q000502:physiology; D017288:Pain Threshold / Q000502:physiology; D011312:Pressure; D014481:United States; D055815:Young Adult; D001741:Black or African American
keywords: African; Cold; Experimental; Pain; Pressure; Tolerance