Conditioned pain modulation is a crucial physiological mechanism for regulating pain perception. Age, body mass index, and psychosocial status (i.e., symptoms of anxiety, social isolation, perceived stress, catastrophising, kinesiophobia, and symptoms of depression) may influence the efficiency of this mechanism. However, these elements are commonly investigated separately.

The current study evaluated the relationship between demographic features and psychosocial status and the efficiency of conditioned pain modulation in participants with and without musculoskeletal pain. We also investigated the same relationship stratifying by health condition (participants with musculoskeletal pain and asymptomatic individuals).

A cross-sectional study was conducted with 100 patients with musculoskeletal pain and 100 asymptomatic individuals. Participants answered questionnaires about sociodemographic characteristics and psychosocial status (Brief Screening Questions and Brief Psychological Screening Questions). The cold pressor test was the psychophysical method used to assess conditioned pain modulation. The difference between pre-and post-test pressure pain threshold values calculated conditioned pain modulation efficiency. Negative values indicated conditioned pain modulation inefficiency, while null or positive values were considered a typical conditioned pain modulation response. A logistic regression model was fitted to examine the relationship between independent variables (demographic features and psychosocial status) and the conditioned pain modulation efficiency.

The mean age of the sample was 33.17 (±16.78) years, and the mean body mass index was 25.75 (±5.46) kg/m². The symptomatic group had significantly higher age [symptomatic = 40.53 ± 19.51, asymptomatic = 25.74 ± 8.58; p < 0.001] and body mass index [symptomatic = 26.56 ± 5.81, asymptomatic = 24.93 ± 4.98; p = 0.035] than the asymptomatic group. Conditioned pain modulation was inefficient in 43 (21.50%) of the sample. Age (OR = 1.03; 95% CI: 1.01–1.05) was the only variable associated with inefficient pain modulation, considering the total group. Symptoms of anxiety (OR = 3.99; 95% CI: 1.05–15.1) and age (OR = 1.03; 95% CI: 1.00–1.06) were associated with inefficient pain modulation among the symptomatic group.

Increasing age and greater levels of anxiety higher the likelihood of presenting inefficient pain modulation in participants with musculoskeletal pain. The findings suggest that symptoms of anxiety are the strongest psychosocial predictor of pain response.

Psychosocial status should be incorporated into pain management in clinical practice, allowing for more individualised approaches. In addition, addressing symptoms of anxiety may be crucial for contributing to regulating pain perception.