ORIGINAL ARTICLE Ultra-Marathon Runners Are Different: Investigations into Pain Tolerance and Personality Traits of Participants of the TransEurope FootRace 2009 Wolfgang Freund, MD*; Frank Weber, MD † ; Christian Billich, MD*; Frank Birklein, MD ‡ ; Markus Breimhorst, MS ‡ ; Uwe H Schuetz, MD* ,§ *Department of Diagnostic and Interventional Radiology, University Hospitals Ulm, Ulm, Germany; † Department of Neurology, German Armed Forces Hospital, Ulm, Germany; ‡ Department of Neurology, University Medical Centre Mainz, Mainz, Germany; § Outpatient Rehabilitation Centre, University Hospitals Ulm, Ulm, Germany & Abstract Introduction: Susceptibility to pain varies among individu- als and may predispose to a higher risk for pain disorders. Thus, it is of interest to investigate subjects who exhibit higher resistance to pain. We therefore tested pain tolerance and assessed personality traits of ultra-marathon athletes who are able to run 4487 km (2789 mi) over 64 days without resting days and compare the results to controls. Methods: After approval of the local ethics committee and with informed consent, 11 participants of the TransEurope FootRace (TEFR09 participants) and 11 matched (age, sex, and ethnicity) controls without marathon experience in the last 5 years were enrolled. They were tested for cold pain tolerance (cold pressor [CP] test), and the 240 item trait and character inventory (TCI) as well as the general self-efficacy (GSE) test were obtained. Results: TransEurope FootRace participants had a highly significant greater cold pain tolerance in the CP test than controls (P = 0.0002). While the GSE test showed no differ- ences, the TCI test provided TEFR09 participants to be less cooperative and reward dependent but more spiritually transcendent than the controls. Significant positive correla- tions were found between the CP test pain score at 180 seconds and several TCI subscales showing that higher pain scores correlate with higher reward dependence, depen- dence, cooperativeness, empathy, and pure-hearted con- science. Conclusions: Personality profiles as well as pain tolerance of our sample of TEFR09 participants differ from normal controls and—as obtained in previous studies—probably also from chronic pain patients. Low pain perception may predis- pose a person to become a long-distance runner. It remains unclear, however, whether low pain perception is cause or consequence of continuous extreme training. & Key Words: adaptation, psychological assessment, pain, hyperalgesia, pain threshold, pain tolerance, marathon run- ners, endurance athletes INTRODUCTION In 2009, the second TransEurope FootRace (TEFR09) took place. It was the second European transcontinental Address correspondence and reprint requests to: Wolfgang Freund, MD, Diagnostische und Interventionelle Radiologie, Universit€ atsklinikum, Albert-Einstein-Allee 23, D-89081 Ulm, Germany. E-mail: freund-ulm@ t-online.de. Wolfgang Freund and Frank Weber are equally contributed to this work. Submitted: October 23, 2012; Accepted: November 12, 2012 DOI. 10.1111/papr.12039 © 2013 The Authors Pain Practice © 2013 World Institute of Pain, 1530-7085/13/$15.00 Pain Practice, Volume 13, Issue 7, 2013 524–532