Pain tolerance in children and adolescents: Sex differences and psychosocial influences on pain threshold and endurance


  • Funding sources

    This study was supported by a grant from the German Research Foundation (Deutsche Forschungsgemeinschaft) to Arnold Lohaus (Az. Lo 337/15-3). No conflicts of interest exist.

  • Conflicts of interest

    None declared.


Anne-Katharina Schmitz




Laboratory studies with children and adolescents revealed inconsistent findings regarding sex differences in pain tolerance, although lower pain tolerance is commonly reported for adult women. Besides biological mechanisms, several socio-cognitive variables are discussed which may influence pain tolerance in regard to sex differences. The purpose of the present study was to investigate the pain tolerance of children and adolescents using the cold pressor task (CPT) and to analyse influences of pain-coping and pain-related self-efficacy.


About 1021 children and adolescents aged 9–17 participated in the study. Pain tolerance was defined as the length of time a participant's hand remains under water during the CPT. Two phases of pain tolerance were differentiated: the time until pain is reported (pain threshold) and the time from the threshold until the pain increases to a level resulting in the hand being withdrawn (pain endurance). Pain-coping and pain-related self-efficacy were assessed by self-report questionnaires.


We revealed an obvious effect of sex on pain threshold, which increased with age, a small effect on pain tolerance and no significant effect on endurance. Independent of sex, pain endurance was influenced by pain-related self-efficacy and positive self-instruction.


Our results support the assumption that female and male adolescents develop in different directions regarding their pain tolerance when reaching puberty. This seems mainly attributable to a decrease of pain threshold in girls. In contrast, boys and girls are able to endure pain to an equal extent influenced, however, by self-efficacy and coping variables.