Age-related changes in pain sensitivity in healthy humans: A systematic review with meta-analysis

Literature suggests that pain perception diminishes in old age. The most recent review used search strategies conducted over a decade ago and concluded that study findings were equivocal. The aim of this systematic review, with meta-analysis, was to determine age-related changes in pain sensitivity in healthy pain-free adults, children and adolescents. A search of PubMed, Science Direct, and PsycINFO identified studies that compared pain sensitivity response to noxious stimuli at different time points in the lifespan of healthy individuals. Selected studies were assessed for methodological quality and data pooled and meta-analysed. Publication bias was tested using Funnel plots. Twelve studies were included in the review (study sample sizes 30-244 participants). Seven of nine studies found statistically significant differences in pain sensitivity response between old (meanSD 62.2 +/- 3.4 to 79 +/- 4years) and younger adults (22 +/- 1.5 to 39.1 +/- 8.8years), but the direction of change was inconsistent. Meta-analysis found that pressure pain threshold was lower in old adults compared with younger adults (p=0.018, I-2=60.970%). There were no differences in contact heat pain thresholds between old and younger adults (p=0.0001, I-2=90.23%). Three studies found that younger children (6-8.12years) were more sensitive to noxious stimuli than older children (9-14years). Methodological quality of studies was high, with a low risk of publication bias. There was substantial statistical and methodological heterogeneity. There is tentative evidence that pressure pain threshold was lower in old adults compared with younger adults, with no differences in heat pain thresholds. Further studies are needed. SignificanceThere is tentative evidence that old adults may be more sensitive to mechanically-evoked pain but not heat-evoked pain than young adults. There is a need for further studies on age-related changes in pain perception.