Neuroscience Letters 467 (2009) 237–240
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Hand dominancy—A feature affecting sensitivity to pain
Dorit Pud∗, Yael Golan, Rivka Pesta
Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel
a r t i c l ei n f o
Received 13 July 2009
Received in revised form 5 October 2009
Accepted 15 October 2009
Sensitivity to pain
a b s t r a c t
Hand dominancy (i.e. handedness) is a factor that should be considered for further characterizing indi-
vidual variations in sensitivity to pain. The aim of the present study was to examine the contribution of
volunteers (52 males and 57 females), of whom 65 were right-handed and 44 left-handed. Subjects were
exposed to the cold pressor test (1◦C) for both hands while measuring the cold pain threshold, intensity,
and tolerance. No significant differences were found in pain threshold or intensity between the right
versus the left hands among either the right-handed or the left-handed subjects. However, among the
right-handed subjects only, cold pain tolerance was significantly longer in the right hand than in the
left hand (32.9±5.1s vs. 27.0±4.2s, respectively; p=0.018). Significant differences were found between
males and females in pain threshold, but not in pain intensity or tolerance, either when their right or
left hand was tested (p=0.027 and p=0.009, respectively). Analyzing pain perception by handedness and
gender revealed that the right-handed males were less sensitive to pain in their right versus their left
hand, as determined by lower pain intensity (p=0.031) and longer tolerance (p=0.047). No significant
differences were found among the left-handed males or among the females. The results provide further
evidence that handedness is one vital feature that should be considered more often when designing a
psychophysical study. This may lead towards improving the translation of laboratory research findings
to the clinical setting.
© 2009 Elsevier Ireland Ltd. All rights reserved.
Pain is a complex and subjective experience, and numerous
studies have been conducted over the years to identify fac-
tors that may affect and predict individual sensitivity to pain.
Laboratory pain models mimicking clinical pain have been devel-
oped using psychophysical methods in an attempt to quantify
and better understand the perception of pain and the basic
mechanisms underlying it. Those studies, conducted mainly with
healthy volunteers, show a wide range of stimulus–response
relations between the administered noxious stimulus and indi-
vidual sensitivity to pain [17,5,8]. Indeed, several factors have
been found to correlate with different pain parameters, includ-
ing gender , age , ethnicity , and psychological factors
Hand dominancy (i.e. handedness) is an additional feature that
should be considered for further characterizing individual vari-
ations in sensitivity to pain [11,15,27]. As early as the 1960s,
there was evidence that the left hand is more sensitive to pain
than the right hand in both dextral and sinistral subjects, as
reflected by lower pain thresholds and less withstanding pain
. Nevertheless, findings from consequent studies revealed that
this handedness difference in pain perception is not consistently
∗Corresponding author. Tel.: +972 4 8288003; fax: +972 4 8288017.
E-mail address: firstname.lastname@example.org (D. Pud).
observed. While there were some studies clearly demonstrating
such a difference [9,4,22,21], others failed to do so [20,19,30,12].
In any case, however, once a handedness difference is identified,
it usually involves greater sensitivity to pain in the non-dominant
Given the controversy surrounding this issue, further investiga-
tion is warranted. If indeed handedness differences do exist, and
the non-dominant hand is more sensitive to pain than the domi-
nant one, then this feature should be taken into consideration as
an additional factor that may affect individual sensitivity to pain.
Therefore, the aim of the present study was to examine the contri-
bution of handedness and gender to sensitivity to tonic cold pain
in healthy male and female volunteers. Our working hypotheses
were that: (1) right-handed subjects would show higher sensitiv-
ity to cold pain on their left hand and (2) females would be more
sensitive to pain than males.
Participants were 109 healthy paid volunteers, including 57
females and 52 males, ranging in age from 20 to 32 years (mean
age±SD, 24.6±2.5). The volunteers were students who were
enrolled in the study after meeting the following inclusion criteria:
(1) clear dominancy of either right- or left-handedness; (2) free
from chronic pain of any type; (3) no medication use (except for
oral contraceptives); and (4) ability to understand the purpose
and instructions of the study. The study was approved by the
university’s Ethics Committee, and a written informed consent
0304-3940/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved.
D. Pud et al. / Neuroscience Letters 467 (2009) 237–240
was obtained from all participants prior to the beginning of the
At the beginning of the study, all the potential subjects were
asked to answer 12 questions regarding the hand (right or left) he
or she uses for various daily activities (e.g., writing, brushing teeth,
ject is right-handed, left-handed or ambivalent. The present study
lent subjects were excluded from the study before being exposed
to the pain tests). Then, each subject was asked to immerse each of
his/her hands separately in a random order (i.e. right hand conse-
quence to left hand, or vice versa) into the cold pressor test (CPT)
apparatus (Heto CBN 8-30 Lab equipment, Allerod, Denmark) at a
water temperature of 1◦C±0.5. Each hand was held in a still posi-
maintain that position in the cold water for as long as they could.
A stopwatch was set at a cut-off time of 180s for safety reasons.
Subjects were instructed to indicate the exact point in time when
the cold sensation began to elicit pain. The time until the pain
was first perceived was defined as the cold pain threshold (s). Pain
intensity was measured by immediately asking subjects after hand
withdrawal to mark their maximal pain intensity on a 0–100 visual
analogue scale (VAS), where 0 represents ‘no pain’ and 100 repre-
sents the ‘worst pain one can imagine’. The latency of intolerability
(spontaneous hand removal) was defined as pain tolerance (s). Tol-
erance for the subjects who did not withdraw their hand for the
entire 180s was recorded as 180s.
Statistical analyses included paired t-tests for comparisons of
cold pain perception between the hands for each gender and of
repeated measures (two-way RM ANOVA) was conducted for each
of the pain measures (threshold, intensity, and tolerance). The fac-
tors included were dominant handedness (RD vs. LD) and gender
for either hand that was being tested by all the subjects (right vs.
pairwise multiple comparisons. All values are given as mean±SEM
and significance was calculated at the p<0.05 level.
pain scores (threshold, intensity, and tolerance) revealed signifi-
cant difference between hands in cold pain tolerance. Specifically,
the dominant hand could tolerate the noxious cold stimulation
for longer duration (33.7±4.2s) than the non-dominant hand
Additionally, further analyses by handedness were conducted.
No significant differences were found in the cold pain thresholds
between the right versus the left hands among either the right-
handed or the left-handed subjects (see Fig. 1A).
Likewise, no significant differences were found in cold pain
intensity between the right versus the left hands among either the
right-handed or the left-handed subjects (see Fig. 1B).
in the right hand (32.9±5.1s) than in the left hand (27.0±4.2s)
(two-way RM ANOVA, p=0.018). Among the left-handed subjects,
no significant differences in tolerance time were found between
the right versus the left hands (p=0.528) (see Fig. 1C).
When analyzing the three pain scores (threshold, intensity and
tolerance) according to gender for each hand separately (right vs.
left) without taking into account the dominant handedness (RD
vs. LD), the males showed significantly higher cold pain thresh-
old in comparison to females either when their right (9.3±1.1 vs.
6.4±0.6, p=0.027) or left (8.8±0.9 vs. 5.9±0.5, p=0.009) hand
was being tested. However, no significant differences were found
between males and females in regard to pain intensity or tolerance
for either hand.
according to dominant handedness (RD/LD): (A) threshold (in s); (B) intensity (VAS,
0–100); (C) tolerance (in s). Black diamond=RD, right-handed; white square=LD,
left-handed. Values are mean±SEM. *p<0.005, the difference between right and
(RD vs. LD) and gender for either hand that was being tested (right
vs. left). As can be seen from Table 1, the right-handed males were
in the lower VAS (p=0.031) and longer tolerance time (p=0.047).
or among the females.
The main finding was that the right-handed males showed a higher
sensitivity to cold pain in their left hand than in their right hand.
In line with our findings, several previous studies have demon-
strated that right-handed individuals exhibit higher sensitivity to
experimental cold pain in their left versus their right hand, as mea-
sured by a lower pain threshold and shorter tolerance [18,4,28].
In addition, several studies have reported pressure pain threshold
However, these findings become less consistent when testing
by other experimental pain modalities, such as heat [30,16,6,1,27],
tent findings leave open the question of the role of handedness in
the individual sensitivity to pain. Given that most previous studies
have demonstrated handedness differences in response to these
modalities (known to be mediated by deep nociceptors), it was
suggested by Taylor et al.  and subsequently by Sarlani et al.
D. Pud et al. / Neuroscience Letters 467 (2009) 237–240
Differences in cold pain perception by handedness (RD and LD) and gender for either hand being tested (right vs. left).
Gender HandednessHand tested Mean±SEM
9.6 ± 1.6
8.5 ± 1.4
9.0 ± 1.5
9.1 ± 1.3
6.5 ± 0.8
6.0 ± 0.6
6.3 ± 1.1
5.8 ± 0.8
78.0 ± 0.3
81.7 ± 0.3
76.1 ± 0.3
76.9 ± 0.3
79.5 ± 0.3
77.8 ± 0.3
77.5 ± 0.5
79.4 ± 0.5
40.4 ± 8.3
29.4 ± 5.1
38.0 ± 9.7
43.1 ± 10.8
27.3 ± 6.4
25.3 ± 6.3
24.6 ± 8.5
24.7 ± 8.6
Male RD (n=28)
Female RD (n=37)
 that the laterality differences are associated with deep rather
than cutaneous (i.e. electrical, heat, or sharp mechanical stimuli)
Our working hypothesis in the present study was that right-
handed subjects would show higher sensitivity to cold pain in
their left hand than in their right hand, given right brain domi-
nance for negative emotion and tactual sensitivity. Moreover, it is
believed that the dominancy of right-handedness is more “clear-
cut” than that of left-handedness. The results of this study can
indeed verify this assumption. In line with our results, Friedli et al.
 found lower pain thresholds for percutaneous electrical stimu-
lation on the left versus the right side among 74% of right-handed
subjects. Pauli et al.  assessed pressure pain threshold (PPT)
asymmetry of the left and right digits in right-handed versus left-
handed subjects using a pressure algometer. Their results showed
clear PPT asymmetry in the right-handed participants, whereas no
such finding was observed in the left-handed group. Ozcan et al.
 demonstrated higher sensitivity in the non-dominant hands
of right-handed subjects, but no asymmetry in the left-handed
Several explanations have been proposed to explain the exis-
 attributed the difference to greater involvement of the right
hemisphere in negative affect. As such, greater pain sensitivity in
the left hand may reflect laterality differences in the aversive emo-
tional rather than the sensory/discriminative component of pain.
Ozcan et al.  suggested that the dominant hand is faster and
the dominant side can withstand more pain. This superiority has
been attributed to cerebral laterality. Pauli et al.  claimed that
since the laterality of manual function is less pronounced in left-
handed than in right-handed individuals, it is not surprising that
left-handers also show less laterality of pain sensitivity than right-
to handedness. In our study, women were found to be more sensi-
tive to pain in terms of lower cold pain threshold alone. Cold pain
tolerance and intensity failed to show any significant difference
between the genders. The fact that right-handers showed higher
sensitivity to cold pain in their left hand only among males is novel
and suggests that there is a clear gender-dependent difference in
handedness should be taken into account as an additional fea-
ture for further characterizing individual variations in sensitivity
The diversity among laboratories in psychophysical studies,
as reflected in their different approaches and various kinds of
experimental settings, may lead to biases and limit the ability
to generalize conclusions from one study to another. One way
to minimize these biases is to utilize consistent methodological
approaches as much as is allowable. Handedness is one such vital
be considered more often when designing a psychophysical study.
For example, in recent years, a diffuse noxious inhibitory control
(DNIC)-like effect has been identified as an ‘advanced psychophys-
ical’ measure with high clinical relevancy in the characterization
of one’s capacity to modulate pain. This DNIC-like effect can be
studied experimentally in the laboratory by measuring the pain
intensity for a ‘test’ stimulus before and during the application of
a noxious ‘conditioning’ stimulus. A reduction in the magnitude of
the ‘test-pain’ in response to the ‘conditioning stimulus’ is consid-
ered as the DNIC-like effect (for a review, see Pud et al. ). Thus,
it is pertinent to consider the individual’s handedness in order to
choose which extremity will be exposed to the ‘test pain’ or to the
‘conditioning stimulus’ in order to accurately calculate the DNIC-
like effect. Implementation of these suggestions may lead towards
improving the translation of laboratory research findings to the
Conflict of interest statement
The authors would like to state that there are no conflicts of
interest regarding this work.
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