***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract The aim of the current investigation was to compare the effects of two different attentional strategies ( focused vs. avoidance ) on how males and females respond to experimentally induced pain . One hundred healthy adults were instructed to either attend towards or away from cold pressor pain . Measures of pain tolerance , pain threshold and recovery were taken , as were self‐report measures of sensory and affective pain experiences . As expected , gender was found to moderate tolerance to pain : males were found to be more tolerant to cold pressor pain than females . With respect to the self‐report measures , males reported less sensory pain when they attended toward the pain than when they avoided it . However , a similar effect was not found in women , suggesting that attentional focusing may only be a useful strategy for males . These results are discussed in light of previous research ABSTRACT . Currently , there are no clear methods for identifying children vulnerable to frequent school absences . Our study examined relationships between gender and laboratory pain reactivity to the cold-pressor task ( CPT ) , and parent-involved school absences and self-initiated school nurse visits in 57 children ( 36 female ; ages 8–10 years ) . Using multiple regression analyses , CPT pain ratings , tolerance , and gender were analyzed in relation to nurse visits and absences collected prospect ively across 2 years . We found that higher pain ratings and female gender predicted more absences ; female gender also predicted increased nurse visits for acute complaints with documented physical findings . Our results suggest that laboratory pain reactivity is a potentially useful indicator of vulnerability to parent-involved functional impairment , as indexed by school absences , and that girls are more likely than boys to miss school and visit the nurse for acute illnesses . Limitations and pathways for further study are discussed This 2-year follow-up study examined the effects of a brief behavioral intervention on task-based coping and pain reactivity to the cold pressor task ( CPT ) . In the original study by Fanurik et al. ( 1993 ) , 64 children ( aged 8 to 10 ) whose coping style was categorized as “ attender ” or “ distracter , ” based on primary coping strategy during baseline CPT trials , received a 5-minute  intervention ( attention-focusing , distraction training , or control , r and omly assigned ) . In the present study , 51 ( 32 female ) of the original sample were readministered the CPT , and their coping style and pain responsivity were reassessed . Both distracters and attenders given distraction training preferred use of distraction at follow-up . The distraction training group also demonstrated greater tolerance at follow-up compared to controls , although pain ratings did not differ by intervention group . Our findings suggest that a brief distraction intervention has long-term effects on task-based coping and experimental pain reactivity OBJECTIVE To test whether a head-mounted display helmet enhances the effectiveness of videogame distraction  for children experiencing cold pressor pain . METHOD Forty-one children , aged 6 - 14 years , underwent one or two baseline cold pressor trials followed by two distraction trials in which they played the same videogame with and without the helmet in counterbalanced order . Pain threshold ( elapsed time until the child reported pain ) and pain tolerance ( total time the child kept the h and submerged in the cold water ) were measured for each cold pressor trial . RESULTS Both distraction conditions result ed in improved pain tolerance relative to baseline . Older children appeared to experience additional benefits from using the helmet , whereas younger children benefited equally from both conditions . The findings suggest that virtual reality technology can enhance the effects of distraction for some children . Research is needed to identify the characteristics of children for whom this technology is best suited Summary Quantitative sensory testing in 7‐ and 14‐year‐olds based on a priori sample size calculations revealed higher pain sensitivity in 7‐year‐olds , but no sex‐related differences and similar detection thresholds . ABSTRACT There are controversial discussion s regarding developmental‐ and sex‐related differences in somatosensory perception , which were found , eg , when comparing younger children ( 6–8 years ) , older children ( 9–12 years ) , and adolescents ( 13–16 years ) using quantitative sensory testing ( QST ) . The aim of our current study was to systematic ally assess the impact of age and sex using the QST protocol of the German Research Network on Neuropathic Pain ( DFNS ) . QST , including thermal and mechanical detection and pain thresholds , was assessed in 86 healthy 7‐year‐old children ( 42 girls and 44 boys ) and 87 healthy 14‐year‐old adolescents ( 43 girls and 44 boys ) . The sample size was calculated a priori to detect medium‐sized effects as found in the previous studies with adequate power . Developmental and sex differences were tested using univariate analysis of variance . Children were more sensitive to most pain stimuli , except cold pain stimuli , compared with adolescents , but did not differ in mechanical and thermal detection thresholds except in regard to cold stimuli . Sex had an impact only on warm detection , with girls being more sensitive . There were no interactions between age and sex . In conclusion , developmental changes during the puberty appear to influence pain perception , whereas sex effects in childhood are negligible . At present , it is not clear what brings about the differences between adult men and women that are apparent in epidemiological studies . Our results contradict the hypothesis that differences in peripheral nerve‐fiber functioning underlie sex effects OBJECTIVE To investigate the impact of experimentally manipulated state anxiety and the influence of anxiety-related variables on children 's memories for pain . METHODS A total of 110 children ( 60 boys ) between the ages of 8 and 12 years were r and omly assigned to complete a state anxiety induction task or a control task . Following experimental manipulation , children completed a laboratory pain task , pain ratings , and question naire measures of anxiety-related variables . 2 weeks later , children provided  pain ratings  based on their memories of the pain task . RESULTS The experimental manipulation effectively induced state anxiety ; however , pain memories did not differ between groups . Irrespective of group assignment , children with higher state anxiety had more negative pain memories . State anxiety uniquely predicted children 's pain memories over and above other well established factors . Anxiety sensitivity and trait anxiety were significant predictors of recalled pain-related fear . CONCLUSIONS These data highlight the importance of anxiety in the development of children 's memories for pain Abstract Alterations in neural activity due to pain and injury in early development may produce long‐term effects on sensory processing and future responses to pain . To investigate persistent alterations in sensory perception , we performed quantitative sensory testing ( QST ) in extremely preterm ( EP ) children ( n = 43 ) recruited from the UK EPICure cohort ( born less than 26 weeks gestation in 1995 ) and in age and sex matched term‐born controls ( TC ; n = 44 ) . EP children had a generalized decreased sensitivity to all thermal modalities , but no difference in mechanical sensitivity at the thenar eminence . EP children who also required neonatal surgery had more marked thermal hypoalgesia , but did not differ from non‐surgical EP children in the measures of neonatal brain injury or current cognitive ability . Adjacent to neonatal thoracotomy scars there was a localized decrease in both thermal and mechanical sensitivity that differed from EP children with scars relating to less invasive procedural interventions or from those without scars . No relationship was found between sensory perception thresholds and current pain experience or pain coping styles in EP or TC children . Neonatal care and surgery in EP children are associated with persistent modality‐specific changes in sensory processing . Decreases in mechanical and thermal sensitivity adjacent to scars may be related to localized tissue injury , whereas generalized decreases in thermal sensitivity but not in mechanical sensitivity suggest central ly mediated alterations in the modulation of C‐fibre nociceptor pathways , which may impact on responses to future pain or surgery The aim of this study was to compare the intra- and inter-rater reliability of  pressure pain threshold ( PPT ) and manual palpation ( MP ) of orofacial structures in symptomatic and symptom-free children for temporom and ibular disorders ( TMD ) . Fourteen children reporting pain in masticatory muscles or the temporom and ibular joint and 16 symptom-free children were r and omly assessed on three different occasions : by rater-1 in the first and third session and by rater-2 in the second session . The trained raters applied algometry and MP as recommended by the Research Diagnostic Criteria for TMD . Intraclass correlation coefficients and the Kappa statistic were used to assess the levels of reliability of PPT and MP , respectively . Excellent intra- and inter-rater reliability levels were observed for PPT values at most of the examined sites for symptom-free children and excellent and moderate reliability levels for children reporting pain . For MP , moderate and poor intra-rater and inter-rater reliability levels were observed for most sites in both groups . Algometry showed higher reliability levels for both groups of children and is recommended for pain assessment in children in association with MP OBJECTIVE Using a mixed model design , this study examined the effects of interactive versus passive distraction on healthy preschool-aged children 's cold pressor pain tolerance . METHODS Sixty-one children aged 3 - 5 years were r and omly assigned to one of the following : interactive distraction , passive distraction , or no distraction control . Participants underwent a baseline cold pressor trial followed by interactive distraction trial , passive distraction trial , or second baseline trial . One or two additional trials followed . Children originally assigned to distraction received the alternate distraction intervention . Controls participated in both interactive and passive distraction trials in counterbalanced order . RESULTS Participants showed significantly higher pain tolerance during both interactive and passive distraction relative to baseline . The two distraction conditions did not differ . CONCLUSIONS Interactive and passive video game distraction appear to be effective for preschool-aged children during laboratory pain exposure . Future studies should examine whether more extensive training would enhance effects of interactive video game distraction OBJECTIVE The present study investigated parental attention and sensitivity to their child 's pain and the moderating role of child 's facial pain expressiveness and induced threat . METHODS Sixty-two parents ( 49 mothers ; 13 fathers ) of schoolchildren observed their child undergoing painful and nonpainful heat trials  and were requested to rate the presence of pain after each trial . Painful versus nonpainful trials were signaled by the presence of either a yellow or blue circle ; one color served as a cue for possible pain delivery ( i.e. , conditioned pain cue ) , whereas the other served as a cue for a nonpainful trial . A subsequent visual search task ( VST ) assessed attention to pain cues by asking parents to identify a target presented within the conditioned pain cue or one of several other colored circles . Parents were r and omly assigned to a " high threat " or " low threat " group in which either threatening or neutral information about the child 's pain was provided . RESULTS Signal detection analyses indicated that parents ' ability to detect pain ( i.e. , sensitivity ) was enhanced for parents in the high-threat group and for parents whose children expressed high pain . Visual search analyses indicated attentional engagement to child pain only among parents in the high-threat group whose child showed high-pain expressiveness . In all other circumstances , a tendency to avoid pain cues was observed . CONCLUSIONS These findings attest to the importance of pain-related threat in underst and ing parent attention to child pain . Theoretical and clinical implication s and future research directions are discussed OBJECTIVE To provide an experimental investigation of the impact of maternal behavior on children 's  pain experiences . METHOD Participants were 120 healthy children ( 60 boys , 60 girls ) between the ages of 8 and 12 years and their mothers . Mothers were r and omly assigned and trained to interact with their children in one of three ways while the children were exposed to lab-induced cold pressor pain : ( 1 ) a pain-promoting interaction , ( 2 ) a pain-reducing interaction , and ( 3 ) a no training control group . Training was based on behaviors presumed to have the expected impact , as based on correlational studies reported in the literature . Children 's pain experiences during the cold pressor were assessed using self-reports of intensity and affect , coding of facial activity , tolerance , and heart rate responsiveness . RESULTS Girls whose mothers interacted with them in the pain-promoting manner reported more pain than daughters of mothers in the control group , who in turn reported more pain than girls whose mothers interacted with them in the pain-reducing manner . This effect was not significant for boys . Maternal interaction type had no effect on children 's pain affect , facial activity , tolerance , or heart rate . CONCLUSIONS Results indicate that maternal behavior can have a direct impact on their daughters ' subjective reports of pain . These data support the importance of social learning factors in influencing children 's pain experiences BACKGROUND Adult studies have demonstrated that increased resting blood pressure ( BP ) levels correlate with decreased pain sensitivity . However , few studies have examined the relationship between BP and experimental pain  sensitivity among children . OBJECTIVES This study investigated the association between resting BP levels and experimental pain tolerance , intensity , and unpleasantness in healthy children . We also explored whether these BP-pain relationships were age and gender dependent . METHODS Participants underwent separate 4-trial blocks of cutaneous pressure and thermal pain stimuli , and 1 trial of a cold pain stimulus in counterbalanced order . RESULTS A total of 235 healthy children ( 49.6 % female ; mean age 12.7 [ 2.9 ] years ; age range 8 - 18 years ) participated . The study revealed specific gender-based BP-pain relationships .  Girls with higher resting systolic BP levels were found to have lower thermal intensity ratings than girls with lower resting systolic BP levels ; this relationship was stronger among adolescent girls than among younger girls . Among young girls ( 8 - 11 years ) , those with higher resting diastolic BP ( DBP ) levels were found to have lower cold intensity and unpleasantness as well as lower thermal intensity ratings than did young girls with lower resting DBP levels ; these DBP-pain response relationships were not seen among adolescent girls . CONCLUSIONS Age , rather than rest 
    Output:
    
The systematic review indicated that , across different experimental pain tasks , the majority of studies reported no significant differences between boys and girls on pain-related outcomes .
These findings suggest that developmental stage may be relevant for underst and ing sex differences in pain