Table 2a: Characteristics of included studies investigating pressure pain.

Study Study Participants [Sample size (M/F; age)] Classification of Obesity Noxious Stimuli Outcome Measure Data Obese
Data Non-Obese
P value
Authors’ Conclusion Methodological Quality Score (%)

Reviewers’ Comment
McKendall and Haier (1982) [31] N = 60(28/32; 20-67 years)
N obese = 26(8/18)
N non-obese = 34(20/14)
Obese >130% ideal body weight
Non-obese <130% ideal body weight
Constant blunt pressure applied at 3lbs applied to finger using a “pressure bearing device” Pain Threshold 59.4+48.15s
Obese more sensitive to noxious stimuli than non-obese 55%
Pain Tolerance 81.88+56.09s 131.03+ 51.14s <0.01
Raymond et al. (1995) [27]

N = 104(0/104; 19-50 years)
N obese without binge eating disorder [non-BED] = 33(0/33)
N obese with binge eating disorder [BED] = 27(027)
N non-obese [control] = 44(0/44)
BMI Blunt pressure applied at 64gs-1 to finger using an Ugo Basile analgesia meter Pain Threshold
non-BED= 384+24g
BED =453+31g
356+19g [control]


No difference in sensitivity to noxious stimuli between obese and non-obese individuals 48%
No statistically significant correlation coefficient (r) between BMI and pain threshold or tolerance
Pain Tolerance non-BED =544+32g
552+29g [control] 0.297
Khimich (1997) [32] N = 206 (114/92;18-84 years)
N obese (stage II-III) = Not reported
N overweight (stage I obese) = Not reported
N ‘non-obese’=Not reported
Used Broca index [details not reported] into
Obese (stage II-III)
Obese stage I (overweight) Normal
Needle (sharp) pressure applied to the forearm Expression of mild pain [assumed to be pain threshold]

Expression of severe pain [assumed to be pain tolerance]
72.9g [SD not reported]

Normal = 40.5g [SD not reported]
Overweight = 57.6g [SD not reported]
Not reported

Obese less sensitive to noxious stimuli than non-obese 21%
Minimal detail provided in report Overweight measure for pain tolerance reported as 91.3g in Abstract and 91.8g in Results
116.2g [SD not reported] Normal = 76.5g [SD not reported]
Overweight=91.8g [SD not reported]
Not reported
Astita et al. (2015) [29] 38 adults (18 women) were grouped as normal weight(n=22) or obese (n=16) BMI Somedic Algometer applied at thenar eminence Pain Threshold 340.93±93.58kPa 447.45±203.72kPa 0.039 Obese more sensitive to blunt pressure stimuli than non-obese 73%
Tashani et al. (2017) [30] 72 healthy participants (37 women) divided into 3 groups according to their BMI:
Overweight= 24
Obese= 25
BMI values were:
Obese= 34.4+3.90 kg/m2
Normal =22.1+2.04 kg/m2
Somedic Algometer
applied at thenar eminence
Pain Threshold 620.72+423.81kPa 1154.70+847.18kPa 0.005 Obese more sensitive to blunt pressure stimuli than non-obese 88%