Pain tolerance can be built, though the extent depends on the method, your genetics, and your starting point. Regular exercise, repeated exposure to controlled pain, mindfulness training, and even deliberate breathing patterns have all been shown to shift how much discomfort a person can endure before they say “enough.” The picture is more nuanced than simply toughening up, though, because the brain’s pain-processing system is a dynamic network that can be pushed in both directions, toward greater resilience or greater sensitivity.
What Pain Tolerance Actually Means
Pain tolerance and pain threshold sound similar but measure different things. Your pain threshold is the point at which a stimulus first registers as painful. Your pain tolerance is how long you can keep enduring that stimulus once it starts hurting. In lab studies, researchers typically measure this using a cold-water immersion test: you submerge your hand, note when it starts to hurt (threshold), and note when you pull it out (tolerance). The difference between those two times, in seconds, is your tolerance score.1PubMed Central. The mechanisms of pain tolerance and pain-related anxiety in acute pain
This distinction matters because the two can move independently. Research on patients with Alzheimer’s disease found that their ability to detect pain was identical to that of healthy people the same age, but their pain tolerance was substantially higher. The explanation was not that their nerves worked differently. It was that the cognitive and emotional factors shaping how they processed pain had changed.2PubMed. Pain threshold and tolerance in Alzheimer’s disease In other words, tolerance is not just a nerve thing. It is largely a brain thing, which is exactly why it can be trained.
Exercise Builds a Measurable Buffer
The strongest evidence for building pain tolerance comes from physical exercise. Studies comparing elite athletes with non-athletes consistently find that athletes tolerate significantly more pain. Endurance athletes in particular, such as long-distance runners and cross-country skiers, tolerate cold pain better than both team-sport athletes and non-athletes. They also report lower pain intensity to the same thermal stimulus.3PubMed Central. Pain Processing in Elite and High-Level Athletes Compared to Non-athletes A systematic review with meta-analysis confirmed that athletes show consistently higher pain tolerance across pressure, heat, cold, electrical, and ischemic pain, though differences in pain threshold were less consistent.4PubMed Central. Exercise-induced hypoalgesia after acute and regular exercise: experimental and clinical manifestations and possible mechanisms in individuals with and without pain
This is not just selection bias, where pain-tolerant people happen to become athletes. The mechanisms behind it are beginning to come into focus. After high-intensity interval training, athletes show a significant drop in pain perception that non-athletes do not. Brain imaging reveals that athletes experience a pronounced decrease in oxygenated hemoglobin across multiple brain regions after intense exercise, including the prefrontal cortex, which tracks how salient and unpleasant a pain signal feels. In athletes, the size of this prefrontal drop correlated with the size of their pain reduction. Non-athletes did not show this pattern.5PubMed. Profound neuronal differences during exercise-induced hypoalgesia between athletes and non-athletes revealed by functional near-infrared spectroscopy The researchers suggested that endurance training may produce physical changes in the brain’s blood vessel network and oxygen delivery, promoting greater neural efficiency during high-intensity effort.
Regular exercise also strengthens the body’s built-in pain-dampening system, known as conditioned pain modulation, where one painful stimulus reduces the intensity of another. People who are more physically active tend to have a stronger version of this response compared with more sedentary individuals.4PubMed Central. Exercise-induced hypoalgesia after acute and regular exercise: experimental and clinical manifestations and possible mechanisms in individuals with and without pain A well-functioning version of this system may protect against developing chronic pain over time.6PubMed Central. Descending pain modulation and chronification of pain
Repeated Exposure and Habituation
If you have ever taken a cold shower daily and noticed it got less awful after several days, you have experienced pain habituation. The brain learns that a repeated stimulus is not dangerous and dials down the alarm response. Habituation to pain happens through two layers: peripheral changes at the skin where the stimulus is applied, and central changes in how the brain processes the signal. When pain was applied to the same skin spot repeatedly in one study, pain ratings dropped in a temperature-dependent way. However, when the stimulus was moved to a different skin site, participants actually became more sensitive, a phenomenon called sensitization.7PubMed Central. The dynamics of pain: Evidence for simultaneous site-specific habituation and site-nonspecific sensitization in thermal pain
A scoping review of habituation research found evidence that both peripheral and central processes contribute, with some studies showing that habituation effects persist even when the stimulation site changes, pointing to top-down brain involvement.8PubMed Central. Habituation to pain: self-report, electroencephalography, and functional magnetic resonance imaging in healthy individuals. A scoping review and future recommendations In practical terms, this means that repeated cold-water immersion over several days tends to reduce how unpleasant it feels. One study on ankle ice-bath immersion found that pain ratings were significantly lower by day four compared with day one, with habituation occurring after about three sessions.9Journal of Sport Rehabilitation. Time Course of Habituation After Repeated Ice-Bath Immersion of the Ankle The researchers concluded that this was not simply about receptor sensitivity changing at the skin level.
That said, habituation is not guaranteed. A separate cold-pain study found only a non-significant trend toward decreasing pain over five days, without reaching the threshold for a documented habituation effect.10PubMed Central. Habituation to the perception of the qualities of cold-induced pain. Individual variability is large, and the type, duration, and intensity of the stimulus all matter. Habituation also has a fragile enemy: sleep deprivation. Chronic insufficient sleep has been shown to decrease habituation to pain and increase the brain’s tendency to amplify repeated pain signals instead of dampening them.11PubMed Central. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization
Your Brain’s Built-In Pharmacy
Underneath both exercise and habituation lies a shared neurochemical toolkit. When you are stressed or exercising intensely, the body releases endogenous opioids and endocannabinoids, two classes of molecules that dampen pain signals internally. In animal experiments, stress-induced pain relief was blocked by an opioid receptor blocker, confirming that endorphins were driving the effect. When those opioid pathways were blocked, endocannabinoids could step in and partially rescue the analgesic response, suggesting the two systems act as backups for each other.12PubMed. Endogenous cannabinoid modulation of restraint stress-induced analgesia in thermal nociception
This built-in redundancy is important for understanding why multiple approaches to building pain tolerance can work. Exercise floods your system with endorphins. Stress activates similar pathways. Mindfulness may tap into the same downstream circuitry through a different entry point. The brain has multiple levers to pull, and training any of them can shift the overall balance.
Mindfulness, Breathing, and Expectation
Mindfulness meditation has drawn increasing research attention as a pain modulator. Even brief training, on the order of a few 20-minute sessions, has been shown to reduce pain responses beyond what can be explained by distraction or relaxation alone. In a series of experiments, a short mindfulness regimen reduced pain during electrical stimulation more than a math-distraction task or a relaxation exercise. The training also raised pain threshold compared with pre-intervention levels.13PubMed Central. The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer Neuroimaging suggests that mindfulness alters how the brain appraises pain rather than blocking the sensory signal itself.14PubMed Central. Mindfulness meditation-related pain relief: evidence for unique brain mechanisms in the regulation of pain
But there is a wrinkle. When researchers used a balanced placebo design to tease apart the effects of actually receiving mindfulness training from simply believing you received it, belief turned out to be a powerful driver. Participants who believed they had received mindfulness training showed increased pain threshold and tolerance, regardless of whether they actually practiced mindfulness. Expectancy fully explained the effect on pain tolerance.15Pain. How do placebo effects contribute to mindfulness-based analgesia? Probing acute pain effects and interactions using a randomized balanced placebo design This does not mean mindfulness is “just placebo.” Placebo analgesia is a real neurological event that engages the body’s own opioid and pain-modulating systems.16PubMed Central. The Placebo Effect in Pain Therapies What it does suggest is that for novices using brief mindfulness exercises, the confidence that the technique will work matters at least as much as the technique itself.
Slow deep breathing is another practical tool. An experimental study found that slow, deep breaths reduced pain ratings compared with uncontrolled breathing across multiple temperatures, with the effect growing stronger as the stimulus became more intense.17The Journal of Pain. Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms The likely mechanism involves the vagus nerve, which connects the gut and the brain and regulates many autonomic functions. A study combining vagal-nerve-stimulating electrical treatment with controlled breathing found that the combination raised bone-pain thresholds significantly compared with a sham treatment.18PubMed. Modulation of vagal tone enhances gastroduodenal motility and reduces somatic pain sensitivity A systematic review noted that while paced slow breathing is associated with pain reduction in some studies, the exact physiological mechanism has not been pinned down conclusively.19Pain. Pain and respiration: a systematic review
Sleep Is a Precondition, Not an Extra
If you are trying to build pain tolerance while chronically sleep-deprived, you are fighting against yourself. A single night of total sleep deprivation was enough to impair the descending pain-inhibition system, amplify spinal excitability, and increase sensitivity to both cold and pressure pain in healthy volunteers.20PubMed Central. Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation and facilitates temporal summation of pain in healthy participants A systematic review and meta-analysis confirmed the pattern across multiple studies: total sleep deprivation significantly reduced both pain threshold and pain tolerance in healthy people, with moderate to large effect sizes, while partial sleep deprivation also increased spontaneous pain.21PubMed. The differential effects of sleep deprivation on pain perception in individuals with or without chronic pain: A systematic review and meta-analysis
Sleep loss does not just make you more sensitive in the moment. Chronic insufficient sleep specifically erodes habituation, the brain’s ability to tune out a repeated pain stimulus, while amplifying temporal summation, the tendency for repeated pain signals to pile up and feel worse over time.11PubMed Central. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization In practical terms, someone training regularly but sleeping poorly may find their gains in tolerance stalling or even reversing.
Genetics Set the Range, Not the Ceiling
About 40% of the variation in pain sensitivity across people is explained by genetics, with specific genetic variants creating two- to threefold differences in how sensitive someone is to pain.22PubMed Central. An evolutionary medicine perspective on pain and its disorders One of the best-studied genes is COMT, which affects the breakdown of catecholamines like dopamine and norepinephrine. Researchers have identified three common variants of the COMT gene that they labeled low pain sensitivity, average pain sensitivity, and high pain sensitivity. Together, these variants cover about 96% of the population, and the five possible combinations of them were strongly associated with differences in experimental pain sensitivity.23Human Molecular Genetics. Genetic basis for individual variations in pain perception and the development of a chronic pain condition COMT variation has also been linked to differences in how much opioid medication is needed for cancer pain relief.24PubMed. Variation in the COMT gene: implications for pain perception and pain treatment
A more striking genetic story involves red hair. People with natural red hair carry a loss-of-function variant of the MC1R gene, the same gene responsible for their hair color. Research has shown that both red-haired mice and red-haired humans have elevated baseline pain thresholds and increased sensitivity to opioid painkillers.25Journal of Medical Genetics. Melanocortin-1 receptor gene variants affect pain and μ-opioid analgesia in mice and humans The mechanism turned out to be surprisingly indirect: the non-functional MC1R reduces the production of a hormone in pigment cells, which in turn releases the brake on the brain’s opioid signaling system, effectively giving redheads a stronger built-in opioid response.26PubMed Central. Reduced MC4R signaling alters nociceptive thresholds associated with red hair
Genetics, then, explain why two people doing identical training may end up at different levels of pain tolerance. But since most of the variation is still non-genetic, there is plenty of room for environmental and behavioral factors to shift your position within your inherited range.
When the System Moves in the Wrong Direction
Pain tolerance does not always go up with exposure. In people with chronic pain conditions, repeated pain can trigger central sensitization, where the nervous system amplifies signals and essentially turns up the volume on pain processing. In that state, exercise can sometimes make things worse rather than better, and opioid medications may paradoxically increase pain sensitivity rather than reduce it. The normal logic of “more exposure equals greater tolerance” breaks down when the central nervous system is already in an amplified state.
A similar problem occurs when the brain’s descending pain-inhibition pathways weaken. Patients with hemophilia, for example, showed a significantly reduced conditioned pain modulation response compared with healthy controls, meaning their brains were less effective at turning down pain signals.27PubMed. Understanding the pain profile in patients with haemophilia: Impaired descending pain inhibition as measured by conditioned pain modulation Aging also weakens these pathways. Older adults show weaker connectivity between brain regions involved in pain suppression, which correlates with diminished conditioned pain modulation.28Frontiers in Pain Research. A review of descending pain modulation in humans Interestingly, the same review found evidence that certain interventions, including melatonin supplementation and non-invasive brain stimulation, may partially restore these inhibitory mechanisms even in older adults.
Hormones, Sex, and Adaptation Rate
Sex hormones play a documented role in how pain tolerance develops over time. In an experiment using repeated cold-pressor tests across multiple sessions, men and naturally cycling women adapted at different rates. Women not taking oral contraceptives showed a sharper initial increase in pain tolerance across sessions before leveling off, while men showed a slower, steadier climb. Women on oral contraceptives and men showed relatively stable pain thresholds across sessions, whereas naturally cycling women’s thresholds actually increased over repeated exposures.29PubMed. Sex differences and hormonal influences on response to cold pressor pain in humans This suggests that circulating sex hormones influence the rate at which the brain adapts to a repeated pain stimulus, not just baseline sensitivity.30PubMed. Sex differences in pain perception
Culture Shapes What Counts as Tolerable
Pain tolerance is not purely biological. Whether a community treats pain as a normal part of life or as something that demands immediate medical attention shapes how individuals within that community interpret and respond to pain.31PubMed Central. Cultural Influences on Pain Cultural and ethnic background influence the perception, expression, and management of pain in ways that extend beyond the biology of nerve fibers and brain regions.32PubMed Central. Cultural Framing and the Impact On Acute Pain and Pain Services An evolutionary perspective on this variation suggests that pain sensitivity is not a flaw but a calibrated system. It is tuned by vulnerability to injury, the reproductive cost of being injured, and the trade-off between pain avoidance and other activities that matter for survival.33Evolutionary Applications. The Evolutionary Biology of Female‐Biased Pain and Its Disorders In other words, different people in different contexts face different optimal set points for pain sensitivity. Building tolerance is not overcoming a flaw but adjusting a dial that was already set by a mix of genes, hormones, sleep, experience, and cultural expectation.
The Gut’s Emerging Role
A less obvious factor in pain tolerance is the gut microbiome. The community of microorganisms living in the digestive tract communicates with the brain through the gut-brain axis, influencing immune responses, inflammation, and even how the central nervous system processes pain signals. Short-chain fatty acids and other metabolites produced by gut bacteria modulate neuroinflammation and may influence how sensitive pain pathways become over time.34PubMed Central. Integrative review of the gut microbiome’s role in pain management for orthopaedic conditions Disruptions in the gut microbiome have been linked to central sensitization, the very process that turns acute pain chronic, through effects on microglia and immune cells in the brain and spinal cord.35PubMed Central. The Role of the Human Microbiome in the Pathogenesis of Pain
Researchers have proposed that targeting the gut microbiome through diet and probiotic interventions could become a strategy for managing chronic pain.36PubMed. Pain regulation by gut microbiota: molecular mechanisms and therapeutic potential This is still an early field, and no one is claiming a yogurt regimen will make you tolerate ice baths. But it fits the broader pattern: pain tolerance is not just about willpower or nerve endings. It is regulated by systems throughout the body, some of which can be modified by choices as mundane as what you eat and how well you sleep.