Pain threshold and pain tolerance in young people with self-injurious behavior: A systematic review and meta-analysis

Pain sensitivity has been proposed as a contributing factor to self-injurious behavior (SIB). Meta-analytic results show that individuals with SIB have lower pain sensitivity than healthy controls (HC). However, these findings are primarily based on adult populations. SIB typically begins in the early teen years and is most prevalent among youth. The aim of the present meta-analysis was to quantify the association of SIB and pain thresholds and pain tolerance in young people aged 10 to 24 years.

We performed a systematic search of the literature (MEDLINE, Web of Science Core Collection and PsycINFO) up until 10 December 2024. Titles, abstracts, and full texts were independently screened by multiple reviewers. Random-effects meta-analysis was performed on two pain-related outcomes: pain threshold and pain tolerance. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Quality assessment was performed using the Newcastle-Ottawa scale.

Of 5200 screened studies, 221 full-text articles were retrieved whereof 8 studies fulfilled the criteria (n=592). Participants ranged from 10 to 22 years. Meta-analysis demonstrated statistically significantly higher pain threshold (Hedges' g = 0.79, 95 % CI [0.13, 1.46]) in individuals with SIB compared to HC and no statistically significant difference in pain tolerance (Hedges' g = 0.39, 95 % CI [-0.02; 0.79], p = 0.056).

Young people with SIB demonstrate higher pain thresholds compared to healthy controls, suggesting that lower sensitivity to painful stimulation may be a risk factor for SIB across developmental stages. Future studies should examine whether this association is independent of psychiatric comorbidity and other confounding factors.