Scientific Programme
Sports and Exercise Medicine and Health
IS-MH13 - Pain, performance and physical activity: a multidisciplinary approach
Date: 10.07.2026, Time: 08:00 - 09:15, Session Room: Auditorium B (STCC)
Description
Pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” Pain is commonly experienced during physical activity (PA), whether for leisure, rehabilitation, or sport, and it affects motivation, engagement, adherence, and performance. Emotion, motivation and cognition also shape pain, contributing to substantial variability in pain experience between and within individuals. Pain is a subjective experience, whereas nociception refers to the neural encoding of noxious stimuli. In this context, a multidisciplinary approach integrating exercise physiology, neuroscience, and psychology is needed to understand how pain impacts PA and performance. This symposium is grounded in such an approach, aiming to explore how pain affects performance from the muscles to the brain, considering both nociceptive processing and the subjective experience of pain. Dr. Aboodarda will review how muscle pain alters neurophysiological and perceptual responses to exercise, leading to impaired performance. Dr. Pageaux will discuss how pain increases task difficulty and how greater effort can compensate, allowing performance to be maintained. Dr. Becker will examine how motivation modulates pain perception and how chronic pain in turn affect motivation. This symposium will benefit researchers and applied sport scientists interested in understanding pain’s role in regulating performance and promoting sustained PA.
Chair(s)
Benjamin Pageaux
Université de Montréal, École de kinésiologie et des sciences l'activité physique (EKSAP)
Canada
Speaker A
Jalal Aboodarda
University of Calgary, Kinesiology
Canada
Read CVECSS Lausanne 2026: IS-MH13 [35095]
Experimental Muscle Pain Impairs Endurance Performance: Decoding the Psychophysiological Mechanisms
Muscle pain perceived during high-intensity exercise can play a significant role in determining endurance performance. Exercise-induced muscle pain arises from the activation of group III (thinly myelinated) and group IV (unmyelinated) afferent fibers in response to elevated intramuscular pressure and high concentrations of metabolic by-products (e.g., H⁺, ATP, and lactate) (Amann et al., 2012). These fibers terminate in the dorsal horn of the spinal cord, after which nociceptive signals are transmitted to numerous cortical and subcortical structures for pain processing. Prior studies suggest that activation of these afferent fibers modulate endurance performance through centrally mediated alterations in cortical brain activity and motor unit firing rate/recruitment (Graven-Nielsen et al., 2002). However, exercise-induced muscle pain is invariably accompanied by impaired muscle contractile function and cardiorespiratory responses (e.g., elevated heart rate and ventilation). These concurrent responses complicate the isolation of pain's specific effects on corticomotor function. Accordingly, to investigate the exclusive effects of pain, some investigators have employed experimental muscle pain models—e.g., blood flow occlusion of non-exercised, remote muscles—and demonstrated that experimental muscle pain impairs endurance performance; however, the psychophysiological mechanisms underlying this effect remain unclear. To address this gap, our recent studies have induced experimental muscle pain during various isometric and dynamic tasks while recording a comprehensive array of neuromuscular, cardiorespiratory, and perceptual responses (Aboodarda et al., 2020). This integrative approach has revealed that central and peripheral indices of neuromuscular function, as well as corticomotor excitability and inhibition, may remain unaltered by experimental muscle pain; however, the pain interventions upregulate ratings of exercise-induced perceived fatigue and effort, leading to impairment in endurance performance. In this presentation, Dr. Aboodarda will present a comprehensive, integrated perspective on the psychophysiological responses to experimental pain and provide evidence-based insights into the mechanisms by which pain impairs exercise performance. Amann, M. (2012). Significance of group III and IV muscle afferents for the endurance exercising human. Clin Exp Pharmacol Physiol, 39(9), 831–835. Graven-Nielsen, T. et al. (2002). Inhibition of maximal voluntary contraction force by experimental muscle pain: A centrally mediated mechanism. Muscle Nerve, 26(5), 708–712. Aboodarda, S. J. et al. (2020). Effects of pre‐induced fatigue vs. concurrent pain on exercise tolerance, neuromuscular performance and corticospinal responses of locomotor muscles. J Physiol, 598(2), 285–302.
Speaker B
Benjamin Pageaux
Université de Montréal, École de kinésiologie et des sciences l'activité physique (EKSAP)
Canada
Read CVECSS Lausanne 2026: IS-MH13 [16158]
Facing pain is effortful: a multidisciplinary approach to explain the effects of pain on performance
Pain alters human behavior as well as physical and cognitive performance (e.g., Bank et al., 2013; Buhle & Wager, 2010). It is generally proposed that pain reduces performance. However, decreased performance in the presence of pain is not systematically observed. Using a multidisciplinary approach at the intersection of sport and exercise sciences, psychology, physiology, and neuroscience, this presentation will draw upon current literature on experimental pain to propose that maintaining performance in the presence of pain may be possible, at the cost of increased effort. I will start the presentation by defining performance, considering distinctions between maximal strength, endurance, and psychomotor (motor skill) performance. I will also provide an overview of the motivational intensity theory (Richter et al., 2016). This theoretical framework will be used to explain how pain may influence performance. Briefly, based on the motivational intensity theory, it can be predicted that we maintain optimal performance in cognitive and motor tasks by increasing effort as task difficulty rises, and that performance declines when we are no longer able or willing to invest additional effort—when task difficulty exceeds perceived capability or when the value of the goal decreases. Since pain is proposed to increase task difficulty, we can therefore hypothesize that performance in the presence of pain can be maintained by increasing the effort invested in the task. Next, I will describe how pain increases task difficulty. I will consider (i) the physiological aspect of pain, as nociceptive signaling inhibits motor command (Bank et al., 2013), and (ii) the psychological and cognitive aspects, as pain is aversive and captures attentional resources (Torta et al., 2017). Finally, I will conclude with experimental and neuroimaging data from our laboratory illustrating that perceived effort increases in the presence of pain in order to maintain performance. Interestingly, this increase in perceived effort occurs across both physical and cognitive domains, suggesting a unified concept of effort and its perception rather than a dichotomy between physical/motor and cognitive effort. Bank, P. J., Peper, C. E., Marinus, J., Beek, P. J., & Van Hilten, J. J. (2013). Motor consequences of experimentally induced limb pain: a systematic review. European journal of pain. Buhle, J., & Wager, T. D. (2010). Performance-dependent inhibition of pain by an executive working memory task. Pain. Richter, M., Gendolla, G. H. E., & Wright, R. A. (2016). Three decades of research on motivational intensity theory: What we have learned about effort and what we still don't know. Advances in motivation science. Torta, D. M., Legrain, V., Mouraux, A., & Valentini, E. (2017). Attention to pain! A neurocognitive perspective on attentional modulation of pain in neuroimaging studies. Cortex.
Speaker C
Susanne Becker
Heinrich Heine University Düsseldorf, Department of Experimental Psychology
Germany
Read CVECSS Lausanne 2026: IS-MH13 [41464]
Pain and motivation: how motivational conflicts modulate pain perception and the impact of chronic pain
Understanding how pain interacts with motivation and goal-directed behavior is essential to explain athletes’ decisions to persist or withdraw in the presence of pain. Importantly, pain is more than the conscious perception of nociceptive signals. Pain acts as a very strong motivator – it shapes our decision-making and behavior, promoting avoidance of injury and tissue damage. What happens if we perceive pain while pursuing a goal at the same time? This creates a motivational conflict. By weighting costs and benefits, avoidance/escape of pain and approach of the goal has to be prioritized (Fields, 2004). This weighting is not only a cognitive process. Rather, conflicting motivations lead to a top-down modulation of pain perception. If an individual decides to approach the goal at the cost of receiving pain, endogenously mediate pain inhibition occurs. In contrast, the decision to avoid/escape the pain at the cost of not achieving the goal, results in endogenous pain facilitation. Such perceptual effects foster optimal decision-making dependent on the external situation and internal factors such as the homeostatic state. Based on such intersections and known overlaps in underlying neurophysiological mechanisms, it has been discussed whether pain and reward are the two sides of the same coin or the two ends of a hedonic continuum with emotion and motivation as the common currency (Leknes & Tracey, 2008). Importantly, with chronic pain alterations in the intersections of pain and motivation, specifically reward-driven motivation, have been observed. Even more, such alterations have been suggested to contribute to the development and maintenance of chronic pain. Specifically, impaired goal-directed motivation and anhedonia have been reported in chronic pain attributed to altered processing of rewarding stimuli (Borsook et al., 2016). Interestingly, the specific type of such alterations is dependent on the type of reward. While patients with chronic pain show less effort to gain monetary rewards, the processing of rewards of relevance to these patients such as pain relief and pain avoidance is not altered or even increased compared to healthy participants. Moreover, some data suggest that altered processing of reward can predict the transition from subacute to chronic pain. It is conceivable that impaired motivation impacts engagement and endurance in physical activity. Potential pathogenetic roles of altered motivation in chronic pain, particularly with relation to physical activity, will be discussed. Borsook, D., Linnman, C., Faria, V., Strassman, A. M., Becerra, L., & Elman, I. (2016). Reward deficiency and anti-reward in pain chronification. In Neuroscience and Biobehavioral Reviews 68: 282–297. Fields, H. (2004). State-dependent opioid control of pain. Nature Reviews Neuroscience, 5(7), 565–575. Leknes, S., & Tracey, I. (2008). A common neurobiology for pain and pleasure. Nature Reviews Neuroscience, 9(4), 314–320.