Psychological Factors Associated With Ultramarathon Runners' Supranormal Pain Tolerance: A Pilot Study

Athletes seem to have higher pain tolerance than the normally active population. It is unknown whether psychological factors contribute to their supranormal pain tolerance. The aim of this pilot study was to examine pain-related psychological processes in ultramarathon runners ('ultrarunners') and to explore whether psychological factors mediate the elevated pain tolerance displayed by ultrarunners. Forty participants took part in the study: 20 ultrarunners and 20 age- and gender-matched controls. Participants underwent the cold pressor test using water cooled to 0.1 to 0.5°C and completed the Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, and Pain Resilience Scale. Immersion time on the cold pressor test was significantly longer for the ultrarunners (P = .007) and they also had lower scores on all Pain Anxiety Symptoms Scale-20 subscales (P ≤ .030). The 2 groups did not differ significantly on the other questionnaires. Mediation analysis revealed that reduced pain-related escape and avoidance behaviors accounted for 40% of the difference in immersion time between the groups (P = .020). Our results suggest that ultrarunners have lower levels of pain-related anxiety than the general population and that their supranormal pain tolerance is partially mediated by reduced pain-related escape and avoidance behaviors. PERSPECTIVE: This study investigated whether psychological factors contribute to the supranormal pain tolerance displayed by ultrarunners. It found that ultrarunners have lower levels of pain-related anxiety than nonrunning controls and that reduced pain-related escape and avoidance behaviors partially mediate their elevated pain tolerance.