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Updated: Aug 29, 2025

Determining heat and mechanical pain threshold in inflamed skin of human subjects
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Expectations affect pain sensitivity changes during massage.

Abigail T Wilson1,2, Mark D Bishop3,4, Jason M Beneciuk3,5

  • 1School of Kinesiology and Physical Therapy, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA.

The Journal of Manual & Manipulative Therapy
|September 7, 2022
PubMed
Summary
This summary is machine-generated.

Positive expectations enhance pain relief during massage, while negative expectations can worsen pain perception. Understanding these psychological factors is crucial for effective pain management strategies involving manual therapy.

Keywords:
Expectationsconditioned pain modulationmassagepressure pain threshold

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Area of Science:

  • Neuroscience
  • Psychology
  • Pain Management

Background:

  • Pain-inducing massage shares neurophysiological mechanisms with conditioned pain modulation, similar to cold pressor tasks.
  • Both manual therapy and conditioned pain modulation are significantly influenced by participant expectations (positive or negative).

Purpose of the Study:

  • To investigate the impact of positive and negative expectations on pain perception during both pain-free and pain-inducing massage.
  • To explore how psychological expectations modulate neurophysiological responses to massage.

Main Methods:

  • 56 healthy participants were randomized into positive or negative expectation groups.
  • Participants received either pain-free or pain-inducing massage, with pressure pain threshold (PPT) measured throughout.
  • A repeated measures ANCOVA analyzed interaction effects between massage type, expectation set, and PPT.

Main Results:

  • A significant three-way interaction (massage x expectation x PPT) and a time x expectation interaction were found for pain-inducing massage.
  • Participants with positive expectations showed significantly higher PPT at minutes 3 and 4 of pain-inducing massage compared to those with negative expectations.

Conclusions:

  • Psychological expectations play a critical role in modulating pain sensitivity changes experienced during massage.
  • Clinicians should consider the influence of patient expectations when administering pain-inducing massage to optimize outcomes.