Research Article| Volume 246, 103084, May 2023

The sensory and affective components of pain differentially shape pupillary dilatation during cold pressor tests

  • Peter D. Drummond
    Corresponding author at: School of Psychology, College of Health and Education, Murdoch University, 6150, Western Australia, Australia.
    School of Psychology and Centre for Healthy Ageing, College of Health and Education, Murdoch University, South Street, Murdoch, WA, Australia
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  • Katie J.R. Clark
    School of Psychology and Centre for Healthy Ageing, College of Health and Education, Murdoch University, South Street, Murdoch, WA, Australia
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      • Distress increases tonic sympathetic pupillary drive during cold pressor tests.
      • Pain increases phasic sympathetic pupillary drive during cold pressor tests.
      • Phasic influences persist whereas tonic influences decline during repeated tests.
      • Phasic and tonic effects may reflect different aspects of locus coeruleus function.
      • Both effects should be assessed in patients with suspected locus coeruleus deficits.


      Nociceptive and affective stimuli increase reflex sympathetic outflow to the pupils. To investigate effects of stimulus intensity, unpleasantness and distress on these pupillary reflexes, and to assess their stability, healthy participants immersed their hand in ice-water three times (for 20, 40 and 60 s; or 60, 40 and 20 s; or three times for 60 s) (N = 21 in each condition). Each ice-water immersion was preceded by a 90 s warm water immersion. To evaluate phasic sympathetic influences on pupil diameter, pupillary re-dilatation after 1 s of bright light was assessed during the last 10 s of each immersion. By-and-large, pain ratings and pupil diameter were greater during longer than shorter ice-water immersions, and ice-water immersions facilitated pupillary re-dilatation after the flash stimulus. However, mean pupil diameter during ice- and warm water immersions, minor ipsilateral amplification of the pupillary response, and ratings of pain unpleasantness and distress decreased across the experiment. Together, these findings suggest that nociceptive input increased sympathetic pupillary tone and amplified phasic increases in sympathetic activity after exposure to light. However, tonic sympathetic influences on pupil diameter and lateralization decreased across repeated immersions, possibly as novel or threatening aspects of the experience declined. Pupillary nociceptive and affective reflexes involve the locus coeruleus, an integral component of neural circuits that heighten cortical arousal and regulate pain. As these reflexes appear to reflect different aspects of sensory and affective processing, their combined assessment might increase the sensitivity and specificity of tests of locus coeruleus function in patients with suspected deficits.


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