Phase and Sex Effects in Pain Perception: A Critical Review (original) (raw)
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Menstrual cycle phase does not influence gender differences in experimental pain sensitivity
European Journal of Pain, 2010
Influence of menstrual cycle phase on experimental pain sensitivity in women and on gender differences in pain sensitivity was examined in 48 men and 49 women in response to cold pressor, heat, and ischemic pain. Each woman was tested at three points in their menstrual cycle in randomized order, the early follicular, late follicular, and luteal phases, while men were also tested three times, controlling for number of days between test sessions. Cycle phase was confirmed via serum hormone levels. As expected, women were significantly more sensitive to cold pain (p < .01), to heat pain (p < .0001), and to ischemic pain (p < .01) than men. However, pain perception during each task was not influenced by the menstrual cycle in women, nor did the menstrual cycle influence the magnitude of the gender differences in pain sensitivity. These results indicate that although women are more sensitive to a variety of noxious stimuli than men, menstrual cycle phase does not appear to moderate those differences in healthy men and women.
The relationship of gender to pain
Pain Management Nursing, 2000
Gender differences have been identified in the perception of pain intensity for both acute and chronic pain and with responses to analgesics. Women seem to show lower pain thresholds, a greater ability to discriminate painful sensations, higher pain ratings, and a lower tolerance for pain. Although some pain syndromes, such as facial pain, are more common in women, gender-related responses to pain are not completely consistent. The study of gender differences in relation to pain is relatively new, yet promising. This article reviews the evidence for how gender may play a role in reports of pain intensity, measurements of patient responses, and differences in response to pain therapies. Literature that addresses pain perception and response in acute and chronic nonmalignant and cancer pain states, experimentally induced pain, and responses to analgesics are reviewed in terms of their relationship to gender. Although there are conflicting results for experimental and clinical studies, there is agreement among investigators that certain factors, such as perceptual ability and physiologic mechanisms, do explain gender-related differences to pain and its treatment. Gender is an important variable and should be taken into account in both research and the clinical practice of pain management.
A meta-analytic review of pain perception across the menstrual cycle
Pain, 1999
The purpose of this article is to review the sixteen published studies that examine associations between the perception of experimentally induced pain across menstrual cycle phases of healthy females. We also performed a meta-analysis to quantitatively analyze the data and attempt to draw conclusions. The results suggest that there are relatively consistent patterns in the sensitivity to painful stimulation. These patterns are similar across stimulus modality with the exception of electrical stimulation. The magnitude of the effect was approximately 0.40 across all stimulation. For pressure stimulation, cold pressor pain, thermal heat stimulation, and ischemic muscle pain, a clear pattern emerges with the follicular phase demonstrating higher thresholds than later phases. When the effect size was pooled across studies (excluding electrical) comparisons involving the follicular phase were small to moderate (periovulatory phase, d thr = 0.34; luteal phase, d thr = 0.37; premenstrual phase, d thr = 0.48). The pattern of effects was similar for tolerance measures. Electrical stimulation was different than the other stimulus modalities, showing the highest thresholds for the luteal phase. When the effect size was pooled across studies for electrical stimulation, effect sizes were small to moderate (menstrual (d thr = −0.37), follicular d thr = −0.30) periovulatory d thr = −0.61), and premenstrual d thr = 0.35) phases. This paper raises several important questions, which are yet to be answered. How much and in wha way does this menstrual cycle effect bias studies of female subjects participating in clinical trials? Furthermore, how should studies of clinical pain samples control for menstrual related differences in pain ratings and do they exist in clinical pain syndromes? What this paper does suggest is that the menstrual cycle effect on human pain perception is too large to ignore.
Pain, 2012
This systematic review summarizes the results of 10 years of laboratory research on pain and sex/gender. An electronic search strategy was designed by a medical librarian to access multiple databases. A total of 172 articles published between 1998 and 2008 were retrieved, analyzed, and synthesized. The second set of results presented in this review (129 articles) examined various biopsychosocial factors that may contribute to differences in pain sensitivity between healthy women and men. The results revealed that the involvement of hormonal and physiological factors is either inconsistent or absent. Some studies suggest that temporal summation, allodynia, and secondary hyperalgesia may be more pronounced in women than in men. The evidence to support less efficient endogenous pain inhibitory systems in women is mixed and does not necessarily apply to all pain modalities. With regard to psychological factors, depression may not mediate sex differences in pain perception, while the role of anxiety is ambiguous. Cognitive and social factors appear to partly explain some sex-related differences. Finally, past individual history may be influential in female pain responses. However, these conclusions must be treated with much circumspection for various methodological reasons. Furthermore, some factors/mechanisms remain understudied in the field. There is also a need to assess and improve the ecological validity of findings from laboratory studies on healthy subjects, and perhaps a change of paradigm needs to be considered at this point in time to better understand the factors that influence the experience of women and men who suffer from acute or chronic pain.
Sex differences in pain perception and interpretation
2013
This study tries to explain the importance of sex differences in the perception of pain and its treatment. The study examines sex differe nces not only between men and women, but more generally – between males and females. The study deals with both experimental and clinical findings. Generally speaking, women have lower pain thresholds and they also differ in their response to analgesic therapy (e.g. opioids). We focused our attention on a description of painful symptoms and syndromes, their pathophysiology and treatment. This study aims to contribute to a better understanding of the pathophysiology of chronic pain, particularly since it affects about 30% of the population. Proper treatment should be based on the pathophysiology and pharmacology of pain phenomena. The study also presents therapeutic experiences and possible clinical applications. Our article intends to promote good clinical practice based on evidence-based medicine.
Indian journal of physiology and pharmacology
A b s t r a c t : G e n d e r d i f f e r e n c e s i n p a i n p e r c e p t i o n h a v e b e e n r e p o r t e d i n literature. However, most such studies have ignored the role of female sex hormones in influencing pain response across menstrual cycle (MC). In this study, we have investigated the variation in pain response on different days o f t h e m e n s t r u a l c y c l e . N i n e t y s u b j e c t s ( 6 0 f e m a l e s ) w e r e s u b j e c t e d t o experimental pain of cold pressor task, on days 1, 7, 14, and 21 of the MC (females), and on four consecutive Mondays of a month (males). Male subjects showed no variation in pain response. Females reported higher pain sensitivity on days 7 and 14 of MC. We suggest that experimental pain studies involving female menstruating subjects should be carried out only during a particular phase of the cycle, and this phase should be reported in literature to increase the reproducibility of the experiment.
Visceral pain: gender differences in response to experimental and clinical pain
European Journal of Pain, 2004
Gender differences in response to visceral pain have important implications for experimental studies and when evaluating clinical pain. Few studies have in details explored specific gender differences in response to experimental stimulation of selected visceral organs or specific visceral diseases. Lower pain threshold to e.g. oesophageal distension has however been shown in females. The effect of female sex hormones on visceral function and pain is studied in greater details in both experimental and clinical studies. Pronounced differences in pain sensitivity are found across the menstrual phases. This may also interact with pharmacological interventions. For clinicians assessing the pain level of female patients in the reproductive age group should take into consideration the physiological and clinical effects of the menstrual cycle and the somatic segmental sites related to the uterus and cervix when clinically evaluating the pain and assessing for disease activity.
Image: the Journal of Nursing Scholarship, 1995
Apparent gender differences have been identified in epidemiologic surveys ofpatients with pain and in clinical studies of responses to pain. Women are reported to have lower pain thresholds and lower pain tolerance than men have. Whether women are more willing to report pain than men are or experience pain differently than men do is unclear. However, beliefs about gender differences and pain affect nurses' decisions made regarding the treatment ofpain. This article reviews the literature addressing pain in women and suggests how clinical practice is affected. Literature from Medline (1 966 to 1994)' CINAHL (1 983 to 1994)' and Psych-Lit (1 967 to 1994) data bases was searched using the key words pain, gender, and sex. Comments in the manuscript reflect only those studies addressing epidemiology, experimentallyinduced pain, or pain in the clinical setting. Studies describing gender differences in an animal model were not included. Limitations of space required that representative examples of studies in the major areas be included; others describing similar design and outcome were not included.
Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings
The Journal of Pain, 2009
Sex-related influences on pain and analgesia have become a topic of tremendous scientific and clinical interest, especially in the last 10 to 15 years. Members of our research group published reviews of this literature more than a decade ago, and the intervening time period has witnessed robust growth in research regarding sex, gender, and pain. Therefore, it seems timely to revisit this literature. Abundant evidence from recent epidemiologic studies clearly demonstrates that women are at substantially greater risk for many clinical pain conditions, and there is some suggestion that postoperative and procedural pain may be more severe among women than men. Consistent with our previous reviews, current human findings regarding sex differences in experimental pain indicate greater pain sensitivity among females compared with males for most pain modalities, including more recently implemented clinically relevant pain models such as temporal summation of pain and intramuscular injection of algesic substances. The evidence regarding sex differences in laboratory measures of endogenous pain modulation is mixed, as are findings from studies using functional brain imaging to ascertain sex differences in pain-related cerebral activation. Also inconsistent are findings regarding sex differences in responses to pharmacologic and non-pharmacologic pain treatments. The article concludes with a discussion of potential biopsychosocial mechanisms that may underlie sex differences in pain, and considerations for future research are discussed. Perspective-This article reviews the recent literature regarding sex, gender, and pain. The growing body of evidence that has accumulated in the past 10 to 15 years continues to indicate substantial sex differences in clinical and experimental pain responses, and some evidence suggests that pain treatment responses may differ for women versus men.