A person’s pain threshold is essentially the amount of pain they are able to tolerate. And there are some surprising variables that determine our personal pain thresholds.

There is a very good reason why understanding pain tolerance and pain thresholds is important for many pain sufferers, and that is the surprising fact that our ability to tolerate pain is closely linked to the likelihood we will suffer with chronic pain during our lifetime.

One hundred and fifty years of twin research has categorically proven that most human traits are heritable. Yet genetic factors are only half the story. Environmental causes are of equal or greater importance, but not the home or family environment. The interesting finding from twin studies is that family environment has a negligible effect on gene expression. This essentially affirms that our genes combine with our individual lifestyles to determine where our bodies end up. And pain is no exception to this.

The cold pressor test is a simple and validated test in which the test subject immerses one hand or foot into ice water for 1–3 min while blood pressure and heart rate are monitored. This method has been used for a broad range of research applications with often surprising results. It turns out you can accurately predict the likelihood of an individual developing high blood pressure later in life based on their tolerance to having their hand in cold water, for example. 

The cold pressor test enabled researchers to gain great insights into factors that influence pain tolerance. By comparing pain tolerance within groups of individuals and those with other groups, it is possible to untangle the factors that influence pain tolerance. 

On average genetic factors appear to account for a little over half of our pain tolerance. While the household we grow up in and our immediate family culture have a negligible effect. Fascinatingly, there is a very strong correlation in pain tolerance between close friends. So you are more likely to share a pain tolerance with your friends than your siblings. But only if you are male. Female friend groups don’t demonstrate any statistical similarities in terms of pain tolerance. And nobody knows why. 

A 2018 study looked closely at psychological and cultural factors that determine pain tolerance. The authors identified female gender, Asian race, catastrophizing, and fear of pain as risk factors for decreased tolerance to pain. But as interesting as all this is, there is far more important research finding for the average pain sufferer to digest.

A 2016 study found that tolerance to the cold pressor test predicted the likelihood of chronic pain after surgery in women receiving surgery. Thus a pre-existing sensitivity to pain appears to be a significant factor in determining the likelihood we will have pain in the future.

This study also strongly suggests that our ability to tolerate pain is closely tied to our resilience to physical trauma (in this case, surgery). When taken in the context of other research findings, it indicates that the likelihood of us experiencing pain is determined by a combination of our genes and our prior life experiences. 

If you want to manage chronic pain successfully, you have to deliberately inflict pain on people in order to activate their body’s healing responses. The pain of remedial care is an unavoidable fact of life. If you want to break up tracts of scar tissue, mobilize chronically stiff joints, or strengthen wasted muscles, pain is an inevitable consequence. 

Years of inflicting pain on the public has given clinicians an excellent opportunity to observe how different individuals handle pain. And there is a massive variance in how much people are able or willing to tolerate. One interesting pattern that seems to surprise a lot of people is that, in keeping with the research, cultural background is one of the easiest ways to predict a person’s willingness to handle the pain of treatment. There is a strong tendency towards people from certain cultures to be willing to handle a lot more pain than others, which may well be a neon signpost pointing towards some profound truths about our individual relationships with pain. 

Even our belief systems play a part in determining how we handle different types of pain. It is a well-known fact that Japanese mothers navigate the pain of labour in a vastly different way from Western mothers. For example, it is virtually unheard of for a Japanese mother to request pain relief drugs during labour. Researchers believe that differences like these are driven by differing attitudes and beliefs about the entire birthing process. 

But there is more to pain resilience than cultural conditioning. Other types of conditioning play a key role in determining our pain thresholds.