Comparison of pain perception in response to cold Immersion between genders among healthy young

adults : an investigation using pressure pain threshold as a quantitative measure

Procedure

Test stimulus

A computerized algometer (AlgoMed; Medoc Ramat Yishai, Israel) will be used to measure the PPT.
Suprathreshold PPT will be measured at the dorsum of the dominant hand. A pressure of 30 kPa/s will
be applied to the test site by placing a 1 cm2 probe perpendicular to the skin until the participant reports
a change from the pressure to pain intensity. The participants will be instructed to press the algometer
trigger button in the patient control until the pressure sensation changes to pain intensity. Once the
patient-controlled unit is activated, the trial will be automatically terminated, and the amount of
pressure (kPa) will be recorded. If participants do not report pain at the maximum pressure level, which
will be set at 1000 kPa for safety reasons, the assessor will terminate the procedure, and a score of 1000
kPa will be assigned for that trial. PPT will be measured thrice (with a 30-s time interval between
trials), and the mean of three measurements will be used for the analysis. Two familiarization trials will
be carried out on the dominant mid-forearm of the participant before the formal trials.

Conditioning stimulus

CPM will be established using a cold pressor test on the contralateral hand. The participant will be
instructed to immerse their hand up to the wrist crease in a circulated cold water bath, maintained at
the temperature at ~6±1°C, until the participants felt the maximum tolerable pain or for a maximum
period of 2 minutes. The participants will report their pain intensity on NRS during immersion (every
15s, once they started feeling their cold as pain) and immediately after removing the hand from the
cold bath. Total immersion time will be recorded.

Test stimulus

Three PPT trails will be measured at 30, 60, and 90 seconds after immersing the hand.

A percentage score will be established for each time point of CPM measurement with a positive
score indicating an increase in PPTs after the conditioning stimulus and thus presence of CPM
effect.