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Using this approach, Hamberg and colleagues177 found that when the neck pain case was a woman, female and male medical students were more likely to provide nonspecific somatic diagnoses, address psychosocial variables in the history, and to prescribe analgesic and psychoactive medications. This review of recent clinical and epidemiologic findings generally indicates that women are at increased risk for many chronic pain conditions, and women tend to report higher levels of acute procedural pain. These sex differences appear smaller (or nonexistent) in children and appear to emerge or increase in magnitude during adolescence. Inevitably, these sex differences in clinical pain are driven by multiple biopsychosocial factors, which will be discussed below. We have previously suggested that sex differences in nociceptive processing, which would be manifested in responses to experimentally induced pain, represent one potentially important contributing factor.
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- The results from 22 studies that examined sex differences in experimental cold pain are presented in the lower portion of Table 6.
- These sex differences in both resting and pain-related μ-opioid receptor binding may contribute not only to sex differences in basal pain perception but also to differences in sensitivity to opioid medications.
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Recently, questionnaires have been developed based on the analysis of the characteristics of pain (ie, pain descriptors) that discriminate pain due to a definite neurological lesion. Torrance et al409 estimated the prevalence of pain of predominantly neuropathic origin using a random sample of 6000 adults from family practices in three United Kingdom cities using a 5-item neuropathic pain scale developed by Bennett.28 Females (6%) showed greater prevalence of neuropathic pain (lasting longer than 3 months) compared with males (3%). Using a large representative sample of the French population, Bouhassira et al44 assessed neuropathic pain using their symptom-based screen for pain with neuropathic qualities43 and found higher 3-month prevalence in females (8%) compared with males (6%). Neither study reported sex differences in the effects of age, pain intensity, or depression.
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Most of the studies reviewed above address quantitative differences, which refers to whether females and males display different amounts of pain or analgesia. In contrast, qualitative sex differences are present when a given variable influences pain or analgesia differently in women versus men. Because qualitative differences may indicate sex-specific pain mechanisms they represent the most compelling rationale for the development of sex-specific pain treatments. Thus, even in the absence of quantitative sex differences, researchers should conduct analyses to uncover potential qualitative sex differences, which simply involves including sex as a moderator in the statistical model. Responses to the TRPV1 agonist capsaicin have been compared across sexes, and three of these five studies reveal significant sex-related differences in subjective pain ratings, suggesting higher sensitivity in females (Table 8).
Combining the data from Table 11 with the studies reviewed by Miaskowski and Levine,277 there is some suggestion that when using PCA women consume lower doses of morphine. Interestingly, the two studies showing lower morphine requirements for men involved provider administered morphine.16,62 It is tempting to speculate that men may be less willing to report pain or request analgesics from a provider, which would explain their lower opioid consumption in the provider-administered settings. Alternatively, one could argue that women benefit more from the increased sense of control that accompanies self-administration of opioids. Additional research will be required to confirm or refute these possibilities.
