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Memory of pain induced by physical exercise
Przemysław Bąbel
a
a
Institute of Psychology, Jagiellonian University, Kraków, Poland
Published online: 25 Mar 2015.
To cite this article: Przemysław Bąbel (2015): Memory of pain induced by physical exercise, Memory, DOI:
10.1080/09658211.2015.1023809
To link to this article: http://dx.doi.org/10.1080/09658211.2015.1023809
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Memory of pain induced by physical exercise
Przemysław Bąbel
Institute of Psychology, Jagiellonian University, Kraków, Poland
(Received 23 September 2014; accepted 23 February 2015)
The aim of this study was to assess the memory of pain induced by running a marathon and the factors
that influence it. Sixty-two marathon runners participated in the study, which comprised two phases.
Immediately after a participant had reached the finishing line of the marathon, they were asked to rate
the intensity and the unpleasantness of their pain and the emotions they felt at that time. Either three or
six months later they were asked again to rate the intensity and the unpleasantness of the same pain
experience. Regardless of the length of recall delay, participants underestimated both recalled pain
intensity and unpleasantness. The pain and negative affect reported at the time of the pain experience
accounted for 24% of the total variance in predicting recalled pain intensity and 22% of the total
variance in predicting recalled pain unpleasantness. Positive affect at the time of pain experience was not
a significant predictor of both the recalled pain intensity and pain unpleasantness. It is concluded that
pain induced by physical exercise is not remembered accurately and the pain and negative affect
experienced influence recall. Further research is needed on the influence of positive affect on the
memory of pain.
Keywords: Athletes; Marathon; Negative affect; Pain intensity; Pain unpleasantness.
The accuracy of the memory of pain is an
important problem in clinical practice and research
on pain. Diagnoses and decisions about treatment
are often made on the basis of how a patient
describes pain, both present and past. Moreover,
memory of pain is often implied in the pain
measures used in both pain diagnosis and research.
Assessments of the effectiveness of treatments for
pain are based on patient reports of relief from
pain, assuming that relief represents the difference
between present (post-treatment) and past (pre-
treatment) pain. Previous research has found that
when pain was recalled with a greater intensity in
comparison to the actual pain experience, patients
reported greater pain relief after both active and
placebo treatments (De Pascalis, Chiaradia, &
Carotenuto, 2002; Feine, Lavigne, Thuan Dao,
Morin, & Lund, 1998; Price et al., 1999), but those
who reported complete pain relief during the pain
experience were unable to recollect this pain relief
at the six-month follow-up check (Everts et al.,
1999). There is also evidence that the memory of
past pain influences subsequent pain experience
(Chen, Zeltzer, Craske, & Katz, 2000; Gedney &
Logan, 2006; Noel, Chambers, McGrath, Klein, &
Stewart, 2012a) and may play a role in the
development of chronic pain (Tasmuth, Kataja,
Blomqvist, von Smitten, & Kalso, 1997; Tasmuth,
von Smitten, Hietanen, Kataja, & Kalso, 1995).
Moreover, memories of painful medical proce-
dures may influence the willingness of patients
to undergo future painful medical procedures
(Redelmeier, Katz, & Kahneman, 2003), and
memories of painful experimental procedures
may influence the later decisions of experimental
subjects in relation to pain stimuli (Kahneman,
Fredrickson, Schreiber, & Redelmeier, 1993).
Address correspondence to: Przemysław Bąbel, Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060 Kraków,
Poland. E-mail: przemyslaw.babel@uj.edu.pl
© 2015 Taylor & Francis
Memory, 2015
http://dx.doi.org/10.1080/09658211.2015.1023809
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There is growing evidence that people may not
remember pain accurately, i.e., there are significant
differences between the ratings of the experienced
and recalled pain. Some studies have shown
that recalled chronic (Broderick et al., 2008;De
Wit et al., 1999; Stone, Schwartz, Broderick, &
Shiffman, 2005), acute (Eli, Schwartz-Arad, Baht,
& Ben-Tuvim, 2003; Everts et al., 1999; McNeil
et al., 2011) and experimental (De Pascalis et al.,
2002; Gedney & Logan, 2006; Price et al., 1999)
pain is exaggerated. However, a few studies have
demonstrated that recalled acute (Bruck, Ceci,
Francoeur, & Barr, 1995; Eli, Baht, Kozlovsky, &
Simon, 2000; Norvell, Gaston-Johansson, & Fridh,
1987) and experimental (De Pascalis, Cacace, &
Massicolle, 2008; Fors & Götestam, 1996;Rode,
Salkovskis, & Jack, 2001) pain may be under-
estimated. Additional data show that past chronic
(Bolton, 1999; Lefebvre & Keefe, 2002), acute
(Bąbel, 2014a, 2014b; Terry, Niven, Brodie, Jones,
& Prowse, 2007) and experimental (Jantsch et al.,
2009; Terry, Brodie, & Niven, 2007) pain may be
remembered accurately.
Many factors may influence the memory of pain,
including the experienced pain (Bąbel, 2014a;
Bąbel, Pieniążek, & Zarotyński, 2015; Jantsch et al.,
2009; Noel, Chambers, McGrath, Klein, & Stewart,
2012b), the peak and the end of pain (Redelmeier
& Kahneman, 1996; Redelmeier et al., 2003;Stone,
Broderick, Kaell, DelesPaul, & Porter, 2000), the
length of delay between the pain experience and its
recall (Broderick et al., 2008; Feine et al., 1998;
Gedney, Logan, & Baron, 2003), and current pain
during pain recall (Bryant, 1993; Feine et al., 1998
;
Holroyd, France, Nash, & Hursey, 1993). Psycho-
logical factors that may be related to the memory
of pain include pain expectations (De Pascalis et al.,
2002; Gedney et al., 2003; Price et al., 1999),
negative affect (Gedney & Logan, 2004, 2006),
state anxiety (Bąbel, 2014a, 2014b;Bąbel et al.,
2015; Eli et al., 2000; Gedney et al., 2003; Noel
et al., 2012b) and distress (Everts et al., 1999;
Jamison, Sbrocco, & Parris, 1989). All the above-
mentioned factors are positively related to the
recalled pain. The only exception is positive affect
which is negatively related to the recalled pain
(Bąbel, 2014a, 2014b). However, recent findings
suggest that memory of pain is influenced by the
type of pain, i.e., the meaning and affective value
of the pain experience, where negative affect may
be negatively related to the recalled pain, and
positive affect may be positively related to the
recalled pain (Bąbel et al., 2015).
Physical exercise often results in pain, and
athletes are regula rly exposed to painful training.
Moreover, physical exercise has an effect on pain
perception: analgesia occurs during and following
exercise (see Koltyn, 2000, and O’Connor &
Cook, 1999, for review), and athletes possess
higher pain tolerance than normally active con-
trol subjects (see Tesarz, Schuster, Hartmann,
Gerhardt, & Eich, 2012, for review). This is
particularly true for regular runners whose pain
threshold was found to be significantly higher
than that of normally active controls (Janal,
Glusman, Kuhl, & Clark, 1994). As previous
experience with pain has a desensitising effect
on pain tolerance, the athletes are more willing to
compete while injured and in pain (Raudenbus h
et al., 2012). This may be the result of the coping
strategies related to pain, e.g., it was found that
ignoring pain significantly attenuated the negative
effect of pain intensity on athletes’ inclination to
play through pain (Der oche, Woodman, Stephan,
Brewer, & Le Sc anff, 2011). Moreover, it was
found that ultra-marathon runners differ from
controls without marathon experience not only in
pain tolerance but also in personality traits (e.g.,
runners are less cooperative and reward depend-
ent) which correlates with pain tolerance (Freund
et al., 2013).
Taking together the results of the above-men-
tioned studies, it seems clearly that athletes in
general and marathon runners in particular may
significantly differ from the population of pain
sufferers whose memories of the pain have been
studied so far. However, although memories of the
pain induced by physical exercise may influence
both subsequent pain experiences during sports
activities and future decisions about whether to
participate in sport and which sport activity to
choose, there have not yet been any studies on the
memory of pain induced by physical exercise.
The main aim of the present study was to
assess the memory of pain induced by running a
marathon. Based on the results of the previous
research on the memory of acute pain, it was
hypothesised that both the recalled pain intens-
ity and unpleasa ntness would be underestimated.
The second aim of the study was to investigate
several factors that may influence the memor y of
pain: the length of recall delay, experienced pain
and negative affect. Based on the resul ts of the
previous studies on the effects of the recall delay
on the memory of pain, it was hypothesised that
after six months from pain experience both the
recalled pain intensity and unpleasantness would
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be underestimated more than after three months’
delay. Moreover, based on the results of the
previous research on the factors influencing the
memory of pain, it was hypothesised that experi-
enced pain and negative affect would have an
effect on the recalled pain, i.e., that more negat-
ive affect and more experienced pain would be
related to recall of more pain. Given that running
a marathon is generally a positive experience, the
impact of positive affect on the memory of pain
was also studied, and it was hypothesised that
positive affect would have an effect on the
memory of pain induced by physical experience,
i.e., that more positive affect would be related to
recall of less pain.
METHOD
Participants
A total of 62 marathon runners participated in
the study, 39 of whom were males (63%). The
mean age of the participants was 37.1 ± 14.2
years. All participants were of polish Caucasian
origin. Participants were recruited from the run-
ners of the 11th Cracovia Marathon, organised on
the 22 April 2012 in Kraków, Poland. None of the
participants has sustained any injuries during the
marathon. The runners were informed that they
would participate in a study on pain induced by
running a marathon and that the study would
comprise two phases: the first phase conducted
immediately after running the marathon, and the
second phase conducted either three or six
months after completion of the marathon. How-
ever, the participants were not informed that the
second phase of the study would investigate
memory of pain.
The runners gave their informed written con-
sent to participate in the study. They wer e
assigned randomly to two experimental groups
that differed in terms of the length of delay
between the marathon and the second phase of
the study. The first group consisted of 32 partici-
pants who completed the second phase of the
study about three months after the marathon; the
second group consisted of 30 participants who
completed the second phase of the study about
six months after the marathon (see Table 1).
There were no significant differences with respect
to age and sex between the groups. The study
protocol was approved by the Research Ethics
Committee at the Institute of Psychology of
Jagiellonian University.
Materials
Pain is a multidimensional experience (Melzack
& Casey, 1968). It contains both sensory (pain
intensity) and affective (pain unpleasantness)
dimensions, and the affective dimension is made
up of feelings of unpleasantness and emotions
associated with future implications, termed sec-
ondary affect (Price, 2000). It has been shown
that both dimens ions are separate (Rainville,
Carrier, Hofbauer, Bushnell, & Duncan, 1999;
Rainville, Feine, Bushnell, & Duncan, 1992), and
that separate measures of the sensory intensity
versus the affective dimension of pain should be
utilised (Price, Harkins, & Baker, 1987), espe-
cially in the research on the memory of pain
(Ornstein, Manning, & Pelphrey, 1999 ). More-
over, it has been shown that the affective dimen-
sion of different types of pain is differentially
influenced by psychological factors (Price et al.,
1987). That is why it was decided to measure both
dimensions of pain in the current study.
The participants rated pain intensity by means
of an 11-point Numeric Rating Scale (NRS),
ranging from 0 = “no pain” to 10 = “the most
intense pain imaginable”. Pain unpleasantn ess
was measured by means of a similar 11-point
NRS, ranging from 0 = “not at all unpleasant
pain” to 10 = “the most unpleasant pain imagin-
able”. The NRS has demonstrated good vali dity
and reliab ility, and psychometric analyses suggest
TABLE 1
Group means and standard deviations of all the study variables
Sex Pain intensity Pain unpleasantness Affect
Group N M F Age
Recall
delay (days) Experienced Recalled Experienced Recalled Positive Negative
1 32 19 13 38.56 ± 18.6 104.69 ± 9.7 5.31 ± 2.52 4.19 ± 2.67 4.75 ± 2.69 3.84 ± 2.3 33.91 ± 8.27 14.19 ± 4.35
2 30 20 10 35.52 ± 6.61 186.77 ± 5.12 5.43 ± 2.22 3.2 ± 1.92 5.13 ± 2.34 3.17 ± 2.2 32.48 ± 9.63 15.62 ± 6.14
M, male; F, female; NRS, Numeric Rating Scale; PANAS, the Positive and Negative Affect Schedule.
MEMORY OF PAIN INDUCED BY PHYSICAL EXERCISE 3
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that the NRS is the preferred pain ratin g scale
(Ferreira-Valente, Pais-Ribeiro, & Jensen, 2011;
Gagliese, Weizblit, Ellis, & Chan, 2005; Jensen,
Karoly, & Braver, 1986).
Positive and negative affect were measured by
the two 10-item mood scales that comprise the
Positive and Negative Affect Schedule (PANAS;
Watson, Clark, & Telleg en, 1988). Respondents
were asked to rate the extent to which they
experienced each particular emotion (e.g., “alert”,
“distressed”, “excited”, “nervous”) with reference
to a 5-point scale: 1 = “very slightly or not at all”,
2=“a little”,3=“moderately”,4=“quite a bit”
and 5 = “very much”. The scales have been shown
to be highly internally consistent (α = 0.84–0.90),
largely uncorrelated (r = −0.12 to −0.23) and
stable at appropriate levels over a two-month
time period (r = 0.39–0.71; Watson et al., 1988).
So far the PANAS scales have been used in
just a few studies on memory of pain in which
different types of pain have been recalled: dental
pain induced by tooth restoration (Bąbel, 2014b),
experimental pain induced by forehead cold
pressor task (Gedney & Logan, 2004, 2006),
migraine and non-migraine headaches (Bąbel,
2014a), post-operative pain, post-partum pain
induced by vaginal delive ry and post-partum
pain induced by caesarean section (Bąbel et al.,
2015). Experienced negative affect measured by
PANAS correlated positively with the recalled
intensity of experimental pain induced by fore-
head cold pressor task (Gedney & Logan, 2006),
and it was found to be a positive predictor of the
recalled intensity of experimental pain induced by
forehead cold pressor task (Gedney & Logan,
2004). Both the recalled and experienced negat-
ive affect measured by PANAS were found to be
positive predictors of both the recalled intensity
and unpleasantness of the post-partum pain
induced by vaginal delivery (Bąbel et al., 2015).
Recalled negative affect measured by PANAS
was also found to be a positive predictor of the
recalled intensity of dental pain induced by tooth
restoration (Bąbel, 2014b). Experienced positive
affect measured by PANAS was found to be a
positive predictor of both the recalled intensity
and unpleasantness of the post-partum pain
induced by caesarean section (Bąbel et al., 2015)
and a negative predictor of both the recalled
intensity and unpleasantness of dental pain
induced by tooth restoration (Bąbel, 2014b).
Recalled positive affect measured by PANAS
was found to be a negative predictor of both the
recalled intensity and unpleasantn ess of headache
(Bąbel, 2014a). Moreover, both the experienced
and recalled positive affect measured by PANAS
correlated negatively with both the recalled
intensity and unpleasantness of headache, and
both the experienced and recalled negative affect
measured by PANAS correlated positively with
both the recalled intensity and unpleasantness of
headache (Bąbel, 2014a ).
Procedure
The study consisted of two phases. The first was
conducted immediately after each participant had
reached the finishing line of the marathon. He or
she was asked to rate the intensity and the
unpleasantness of pain they felt at that moment,
using the two NRS, and to rate the emotions they
felt at that moment, using the PANAS. Three or
six months after completion of the marathon
(depending on the experimental group), the
second phase of the study was conducted. The
participants were emailed a link to an online
survey in which they were asked to rate the
intensity and the unpleasantness of pain they
had felt immediately after they reached the
finishing line of the marathon, using two NRS. It
was emphasised that they were being asked to
recall and describe how they remembered the pain
they felt during the first phase of the study, rather
than to recall how they had rated the pain on the
same scales in the first phase of the study.
Statistical analysis
Statistical comparisons were performed using a
repeated measures, analysis of variance
(ANOVA) design, with length of recall delay
(three and six months) as a between-subjects
factor and type of pain rating (experienced and
recalled) as a within-subjects factor. Separate
ANOVAs were conducted for pain intensity and
pain unpleasantness.
To test whether the experienced pain ratings
and the positive and negative affect influenced
the memory of pain, two forward stepwise mul-
tiple regression analyses were performed with
experienced pain intensity or pain unpleasantness
and positive and negative affect as independent
variables and recalled pain intensity or unplea-
santness as the dependent variables. The order of
entering the variables into the equation was not
predefined a priori. Rather, it was determined by
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the amount of variance explained by a new
variable, while controlling for other variables
already in the equation. All the analyses were
carried out using the STATISTICA data analysis
software system versi on 10 (StatSoft Inc., Tulsa,
OK, USA), with the exception of the compromise
power analyses which were performed using
G*Power 3.1.9.2 (Faul, Erdfelder, Buchner, &
Lang, 2009; Faul, Erdfelder, Lang, & Buchner,
2007). The level of significance was set at p < .05
for rejecting the null hypothesis in all the statist-
ical analyses.
RESULTS
ANOVA revealed a statistically significant main
effect of type of pain rating on pain intensity
(F
(1, 60)
= 25.14, p < .001, η
2
= 0.30, power = 0.99),
indicating that the participants later recalled less
intense pain than they reported immediately after
completion of the marathon (see Figure 1). No
significant main effect of recall delay (F
(1, 60)
=
0.76, p > .05, η
2
= 0.01, power = 0.71) and no
significant interaction between pain rating and
recall delay (F
(1, 60)
= 2.74, p > .05, η
2
= 0.04,
power = 0.91) were found.
ANOVA further revealed a statistically signi-
ficant main effect of type of pain rating on pain
unpleasantness (F
(1, 60)
= 18.63, p < .001, η
2
=
0.24, power = 0.99), indicating that the partici-
pants later recalled less unpleasant pain than they
reported immediate ly after completion of the
marathon (see Figure 2). No significant main
effect of recal l delay (F
(1, 60)
= 0.08, p > .05, η
2
=
0.001, power = 0.53) and no significant interaction
between pain rating and recall delay (F
(1, 60)
=
2.54, p > .05, η
2
= 0.04, power = 0.90) were found.
By analysing individual results, it was found
that 2 participants recalled both the pain intensity
and unpleasantness accurat ely (i.e., in the exactly
same way), 11 participants overestimated both
the pain intensity and unpleasantness and 35
participants underestimated both pain intens ity
and unpleasantness. The results of the rest of the
participants (14) were inconsistent (e.g., they
underestimated pain intensity but overestimated
pain unpleasantness), so it was impossible to
identify their memory style. As comparing three
Figure 1. NRS ratings of the experienced and recalled pain intensity in two study groups, recalling pain three or six months after
the marathon. Regardless of the length of recall delay, the subjects recalled less intense pain than they reported immediately after
completion of the marathon.
MEMORY OF PAIN INDUCED BY PHYSICAL EXERCISE 5
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groups of participants that differ so much in their
number is unjustified, it was decided not to do it.
Given that both ANOVAs revealed no statist-
ically significant main effects of recall delay,
stepwise multiple regression analyses were per-
formed on the entire sample studied. The first
stepwise regression was performed with experi-
enced pain intensity and positive and negative
affect as independent variables and recalled pain
intensity as a dependent variable. Negative affect
entered as a significant predictor (β = 0.40, p <
.01) in step 1, accounting for a significant portion
of the variance in recalled pain intensity (COR
R
2
= 0.14, p < .01, power = 0.80). The step 2
variables (negative affect a nd experienced pain
intensity) accounted for 24% of the total vari-
ance in recalled pain intensity (COR R
2
= 0.24,
p < .001, power = 0.94). Both negative affect (β =
0.35, p < .01) and experienced pain intensity (β =
0.33, p < .01) were significant predictors of
recalled pain intensity. The step 3 variables
(negative affect, experienced pain intensity and
positive affect) accounted for 27% of the total
variance (COR R
2
= 0.27, p < .001, power = 0.96).
Both negative affect (β = 0.36, p < .01) and
experienced pa in intensity (β = 0.4, p < .001) were
significant predictors of recalled pain intensity,
but positive affect was not a significant predictor
(β = 0.22, p < .07; see Table 2 ).
The second stepwise regression was perform ed
with experienced pain unpleasantness and posit-
ive and negative affect as independent variables
and recalled pain unpleasantness as a dependent
variable. Experienced pain unpleasantness was a
significant predictor of recalled pain unpleasant-
ness in step 1 (β = 0.41, p < .001), accounting for a
significant portion of the variance in recalled pain
unpleasantness (COR R
2
= 0.15, p < .001, power
= 0.81). The step 2 variables (experienced pain
unpleasantness and negative affect) accounted for
22% of the total variance in recalled pain
unpleasantness (COR R
2
= 0.22, p < .001, power
= 0.92). Both the experienced pain unpleasant-
ness (β = 0.39, p < .001) and negative affect (β =
0.29, p < .01) were significant predictors of the
recalled pain unpleasantness. The step 3 vari-
ables (experi enced pain unpleasantness, negative
affect and positive affect) accounted for 23% of
the total variance (COR R
2
= 0.23, p < .001,
power = 0.94). Although both the experienced
Figure 2. NRS ratings of the experienced and recalled pain unpleasantness in two study groups, recalling pain three or six months
after the marathon. Regardless of the length of recall delay, the subjects recalled less unpleasant pain than they reported
immediately after completion of the marathon.
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pain unpleasantness (β = 0.43, p < .001) and
negative affect (β = 0.31, p < .01) were significant
predictors of the recalled pain unpleasantness,
positive affect was not a significant predictor (β =
0.15, p > .05; see Table 3).
DISCUSSION
The major finding of the study is that pain
induced by running a marathon is not remem-
bered accurately. Both the recalled pain intensity
and the recalled unpleasantness are underesti-
mated. These findings are in line with the results
of studies that show that recalled acute (Bruck
et al., 1995; Eli et al., 2000; Norvell et al., 1987)
and experimental (De Pascalis et al., 2008 ; Fors &
Götestam, 1996; Rode et al., 2001), but not
chronic, pain may be underestimated. Indeed,
the pain induced by physical exercise is a type
of acute pain. It should be also noted that
memory of labour pain is often underestimated
(Bennett, 1985; Lowe & Roberts, 1988; Norvell
et al., 1987; Simkin, 1992; Waldenström, 2003).
Niven and Murphy-Black (2000), who reviewed
the studies on memory of labour pain, concluded
that “labor pain intensity is remembered accur-
ately or decreases on recall”. Labour pain and
pain induced by running a marathon share an
important feature, i.e., both types of acute pain
are harbingers of a happy event: having a child or
completing a marathon. In other words, both
childbirth and running a marathon are emotion-
ally positive experiences. In contrast, chronic pain
and most other types of acute pain (e.g., surgical
and dental) are related to negative events, i.e.,
illness or painful med ical procedures. One of the
reasons for underestimation of the memory of
labour pain and pain induced by physical exercise
may be the positive dimension of these types of
pain experience.
The length of recall delay had no effect on the
results of the current study. Although previous
studies have shown that the length of delay
between pain experience and its recall is an
important factor influencing the memory of pain
(Broderick et al., 2008; Feine et al., 1998; Gedney
et al., 2003), only a few of th ese studies have
involved a recall delay period of longer than a
month (Cog an, Perkowski, & Anderson, 1988;
TABLE 2
Results of the forward stepwise multiple regression analysis predicting the recalled pain intensity
Independent variables
β
t p COR R
2
Fp
Step 1
Negative affect 0.40 3.32 0.01 0.14 11.00 0.01
Step 2
Negative affect 0.35 3.05 0.01
Experienced pain intensity 0.33 2.89 0.01 0.24 10.35 0.001
Step 3
Negative affect 0.36 3.22 0.01
Experienced pain intensity 0.4 3.4 0.001
Positive affect 0.22 1.87 0.07 0.27 8.36 0.001
TABLE 3
Results of the forward stepwise multiple regression analysis predicting the recalled pain unpleasantness
Independent variables
β
t p COR R
2
Fp
Step 1
Experienced pain unpleasantness 0.41 3.42 0.001 0.15 11.71 0.001
Step 2
Experienced pain unpleasantness 0.39 3.45 0.001
Negative affect 0.29 2.56 0.01 0.22 9.69 0.001
Step 3
Experienced pain unpleasantness 0.43 3.67 0.001
Negative affect 0.31 2.69 0.01
Positive affect 0.15 1.31 0.2 0.23 7.11 0.001
MEMORY OF PAIN INDUCED BY PHYSICAL EXERCISE 7
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Gedney et al., 2003; Haas, Nyiendo, & Aickin,
2002; McGorry, Webster, Snook, & Hsiang, 1999;
Tasmuth, Estlanderb, & Kalso, 1996). Moreover,
three recent studies in which the same recall
delays of three and six months were used also
found no effect of the length of recall delay on
pain recall (Bąbel, 2014a, 2014b;Bąbel et al.,
2015). Interestingly, the only studies to use a
between-subjects design are these three recent
studies, the current study and Cogan and colla-
borators’ study (1988) which also found no effect
of recall delay on pain recall. It is possible that
the comparison of pain recall at longer recall
delays than used in the current study would
reveal the influence of the length of recall delay
on the memory of pain induced by physical
exercise, or that the results of the studies in which
a within-subjects design was applied are biased by
repeated pain recall. However, it cannot be
excluded that the length of recall delay has no
impact on the memory of the specific type of pain
induced by physical exercise.
According to the results of the current study,
two factors influence the memory of pain induced
by running a marathon: experienced pain and
negative affect. These factors accounted for 24%
of the total variance in predicting the recalled pain
intensity and 22% of the total variance in predict-
ing the recalled pain unpleasantness. The pain and
negative affect experienced were found to have a
similar impact on the prediction of the recalled
pain. Adding positive affect to the regression
equation did not significantly change the percent-
age of the predicted variance (the experienced pain
and negative and positive affect accounted for 27%
of the total variance in predicting the recalled pain
intensity and 23% of the total variance in predict-
ing the recalled pain unpleasantness). Moreover,
positive affect was not a significant predictor of
both the recalled pain intensity and the recalled
pain unpleasantness.
The impact of experienced pain on recalled
pain revealed in the current study is in line with
the results of previous studies (Bąbel, 2014a;
Bąbel et al., 2015; Jantsch et al., 2009; Noel et al.,
2012b). Similarly, the influence of negative affect
on recalled pain is in line with the previous
findings showing that negative affect (Bąbel et al.,
2015; Gedney & Logan, 2004, 2006), state anxiety
(Bąbel, 2014a, 2014b;Bąbel et al., 2015; Eli et al.,
2000; Gedney et al., 2003; Noel et al., 2012b) and
distress (Everts et al., 1999; Jamison et al., 1989)
are related to the memory of pain. Moreover, the
results of the current study support Gedney and
Logan’s(2004) model of acute pain memory
recall. According to their model, pain is accur-
ately recalled both immediately after a painful
experience and after a short delay. At intermedi-
ate periods of recall delay, variance in the
prediction of recall is shared between the experi-
enced pain and negative affect at the time of pain
experience. With greater periods of recall delay,
negative affect at the time of the pain experience
increasingly predicts the level of pain recall. In
the current study, the length of recall delay was
three or six months and may be treated as
intermediate in terms of Gedney and Logan’s
(2004) model. However, this model accounts only
for recalled pain intensity and exaggeration of the
recalled pain. The results of the current study
suggest that a similar model may explain recalled
pain unpleasantness and underestimation of the
recalled pain. Some support for this view also
comes from the results of previous studies which
showed that negative affect, i.e., pre-treatment
anxiety, predicts memory of pain (Bąbel, 2014a,
2014b;Bąbel et al., 2015; Gedney et al., 2003),
and that state anxiety at the moment of recall
predicts underest imation of pain recall (Eli et al.,
2000). In summary, the results of the current
study support and extend Gedney and Logan’s
(2004) model of acute pain memory recall by
showing that, three to six months after running a
marathon, the variance in the prediction of
underestimated pain recall, with respect to both
pain intensity and unpleasantness, is shared
between experienced pain and negative affect at
the time of the pain experience.
No definite conclusions can be draw n from the
findings concerning the influence on pain recall of
positive affect at the time of the pain experience.
Positive affect was not a significant predictor of
the recalled pain intensity (β = 0.22, p < .07);
adding it to the regression equation increased the
percentage of predicted variance of the recalled
pain intensity and unpleasantness by just 3% and
1%, respectively. However, the results of the
recent studies have shown that positive affect
has an effect on memory of pain (Bąbel, 2014a,
2014b;Bąbel et al., 2015).
The effect of affect on the memory of pain is
well documented, as well as the effect of affect on
memory in general. Affect increases not only the
likelihood of remem bering some information or
an event but also the vividness with which it is
remembered (see Kensinger & Schacter, 2008, for
review). Different explanations for the way that
affect influences memor y have been offered,
8BĄBEL
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including network (affective state is a node in the
memory network and is used as a retrieval cue),
attentional (high levels of affective arousal tend
to cause forgetting of the details of events,
resulting from the limited attentional capacity at
encoding), energy (affective arousal at the time of
encoding determines directly whether a particular
memory enters long-term memory for storage),
motivational (those who are in a positive frame of
mind take chances and expend efforts more
willingly, and this way their memory is impr oved)
and integrated trace explanations (cognitive-per-
ceptual and affective features are integrated into
a single memory trace, so one type of feature can
be a cue for the other; see Leichtman, Ceci, &
Ornstein (1992) for review). These explanations
can account for the effect of affect on the memory
of pain induced by physical exercise that has been
found in the current study.
The results of the current study may seem to
have no clinical relevance to the understanding of
pain in general. However, the recent study by
Bąbel and collaborators (2015)hasshownthatthe
memory of pain is influenced by the meaning and
affective value of the pain experience. The authors
compared three specific types of acute pain: post-
partum pain induced by vaginal delivery, post-
partum pain induced by caesarean section and
post-operative pain induced by gynaecological sur-
gery. Both vaginally induced and caesarean-
induced post-partum pain are associated with the
happy event of having a child, whereas post-
operative pain is associated with negative events
(i.e., illness or painful medical procedures).
Although post-operative pain induced by gynaeco-
logical surgery and post-partum pain induced by
caesarean section are induced by invasive medical
procedures, they have a very different meaning and
affective value. On the other hand, birth by
caesarean section has similar meaning and affective
value as birth by vaginal delivery, although they
are very different medical procedures. The three
groups of participants differed in terms of the
accuracy of memory of pain and affect as well as
in the terms of the predictors of recalled pain
intensity and unpleasantness, and the proportion of
variance predicted by the same independent
variables.
The results of the current study in some way
extend the results of Bąbel and collaborators’
(2015) research. As mentioned above, running a
marathon shares an important feature with post-
partum pain, i.e., both types of acute pain are
harbingers of a happy event (having a child or
completing a marathon) and are emotionally
positive experiences. Taking together the results
of the current study and Bąbel and collaborators’
(2015) study may help to understand the role of
positive affect in pain in general and specifically
in memory of pain. However, it would be prema-
ture to draw any conclusions as further evidence
is needed .
Some limitations of the current study sho uld be
acknowledged. First, acute pain induced by phys-
ical exercise was studied, and the results may not
be generalisable to clinical (either acute or
chronic) or experimental pain. Second, a specific
mode of physical exercise was studied, i.e., run-
ning a marathon, and the results may not be
generalisable to pain induced by other modes of
physical exercise. Third, recall delays different from
those examined in this study, i.e., different from
three and six months, may yield different results.
Fourth, although the same measures of pain (NRS)
were used in both phases of the study, in the first
phase a paper and pencil method of pain assess-
ment was applied, and in the second phase an
online survey was conducted.
This study appears to be the first to investigate
memory of pain induced byphysicalexerciseand
one of only four studies to attempt to determine the
effect of positive affect on the memory of pain
(Bąbel, 2014a, 2014b;Bąbel et al., 2015). Moreover,
the current study is also one of only a few
investigations on memory of pain in which both
pain intensity and unpleasantness were measured
(Bąbel, 2014a, 2014b;Bąbel et al., 2015;Bryant,
1993;DePascalisetal.,2002;Feineetal.,1998;
Gedney et al., 2003;Koyama,Koyama,Kroncke,&
Coghill, 2004;Priceetal.,1999;Smith,Gracely,&
Safer, 1998). It was found that both recalled pain
intensity and unpleasantness are underestimated,
and that experienced pain and negative affect
influence the memory of pain induced by physical
exercise. Although the results of the current study
cannot substantiate the hypothesis that positive
affect influences the memory of pain, they should
stimulate further research on this topic. An import-
ant area of the future research seems to be the
effect of affect that precedes the painful experiences
on both the experienced and recalled pain. For
example, Noel and collaborators’ (2012c)modelof
acute pain memory development in childhood
suggests that children with higher levels of both
general anxiety (e.g., state/trait anxiety and anxiety
sensitivity) and fear and anxiety that is specific to
pain itself (e.g., fear of pain, pain anxiety and pain
catastrophising) tend to develop pain memories
MEMORY OF PAIN INDUCED BY PHYSICAL EXERCISE 9
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that are characterised by amplified estimations of
sensory and affective threat over time. It would be
also interesting to find out whether the fulfilment of
the runners’ goals and expectations related to how
they would perform would have an effect on the
memory of pain. Moreover, further investigations
are needed into the effect of the length of recall
delay on the memory of pain induced by physical
exercise. The memory of pain induced by other
modes of physical exercise should also be studied to
allow comparisons between different forms of
exercise and with memories of other types of acute
pain.
ACKNOWLEDGMENTS
I would like to thank Patryk Mazurkiewicz and Niwad
Putteeraj for their assistance with the preparation of
the study materials and data collection.
DISCLOSURE STATEMENT
No potential conflict of interest was reported by the
author.
FUNDING
This work was supported by the National Science
Centre in Poland [grant number N N106 009940].
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