Pain and gender differences: A clinical approach
Keywords:
Analgesia, Anesthesia, Gender identity
Abstract
Introduction: Pain continues to be one of the most frequent complaints in clinical centers. Pain Consequently, understanding gender differences in relation to pain is important and critical for the clinical management of patients by the different healthcare services. Pain in patients of different gender is usually treated in the same way; however, there are several gender-associated factors involved in the management of pain, which sometimes are not taken into consideration in clinical practice.
Objective: To describe the differences between men and women as far as pain is concerned, taking into consideration anatomical, physiological, neural, hormonal, psychological, social and cultural factors in the practice of anesthesia.
Methodology: A non-systematic review was undertaken using the key words in the Pubmed/Medline, Science Direct, OVID, SciElo data bases.
Results and conclusions: Differences between men and women when it comes to pain involve anatomical, physiological, neural, hormonal, psychological, social and cultural factors. When examining those factors, it is found that women report pain more frequently, and have a lower threshold for pain than men. They usually complain more of muscle-skeletal, neuropathic, electrical shock and temperature-related pain, but respond better to opioids, in particular κ receptor-binding opioids.
References
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2. Beaton A. Crawford Williamson Long. Yale J Biol Med. 1946;19:189-93.
3. Jacobsohn PH. Horace Wells: discoverer of anesthesia. Anesth Prog. 1995;42:73-5.
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6. Moulton EA, Keaser ML, Gullapalli RP, Maitra R, Greenspan JD. Sex differences in the cerebral BOLD signal response to painful heat stimuli. Am J Physiol Regul Integr Comp Physiol. 2006;291:R257-67.
7. Bryant CD, Eitan S, Sinchak K, Fanselow MS, Evans CJ. NMDA receptor antagonism disrupts the development of morphine analgesic tolerance in male, but not female C57BL/6J mice. Am J Physiol Regul Integr Comp Physiol. 2006;291:R315-26.
8. Pool GJ, Schwegler AF, Theodore BR, Fuchs PN. Role of gender norms and group identification on hypothetical and experimental pain tolerance. Pain. 2007;129:122-9.
9. Cahill L. Why sex matters for neuroscience. Nat Rev Neurosci. 2006;7:477-84.
10. Derbyshire SWG. Gender, pain and the brain. Pain Clin Updat. 2008;16:1-4.
11. Chang L, Mayer EA, Labus JS, Schmulson M, Lee OY, Olivas TI, et al. Effect of sex on perception of rectosigmoid stimuli in irritable bowel syndrome. Am J Physiol Regul Integr Comp Physiol. 2006;291:R277-84.
12. Sherman JJ, LeResche L. Does experimental pain response vary across the menstrual cycle? A methodological review. Am J Physiol Regul Integr Comp Physiol. 2006;291: R245-56.
13. Riley III JL, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain. 1998;74:181-7.
14. Unruh AM. Gender variations in clinical pain experience. Pain. 1996;65:123-67.
15. Giamberardino MA, Berkley KJ, Iezzi S, de Bigontina P, Vecchiet L. Pain threshold variations in somatic wall tissues as a function of menstrual cycle, segmental site and tissue depth in non-dysmenorrheic women, dysmenorrheic women and men. Pain. 1997;71:187-97.
16. Stening K, Eriksson O, Wahren L, Berg G, Hammar M, Blomqvist A. Pain sensations to the cold pressor test in normally menstruating women: comparison with men and relation to menstrual phase and serum sex steroid levels. Am J Physiol Regul Integr Comp Physiol. 2007;293:1711-6.
17. Smith YR, Stohler CS, Nichols TE, Bueller JA, Koeppe RA, Zubieta JK. Pronociceptive and antinociceptive effects of estradiol through endogenous opioid neurotransmission in women. J Neurosci. 2006;26:5777-85.
18. Timmons BW, Hamadeh MJ, Tarnopolsky MA. No effect of short-term 17ß-estradiol supplementation in healthy men on systemic inflammatory responses to exercise. Am J Physiol Regul Integr Comp Physiol. 2006;291:R285-90.
19. Von Korff M, Dworkin SF, Le Resche L, Kruger A. An epidemiologic comparison of pain complaints. Pain. 1988;32:173-83.
20. LeResche L. Epidemiologic perspectives on sex differences in pain. In: Fillingim RB, editor. Sex, gender, and pain, progress in pain research and management, 17. Seattle: IASP Press; 2000. p. 2339.
21. Rollman GB, Lautenbacher S. Sex differences in musculoskeletal pain. Clin J Pain. 2001;17:20-4
22. LeResche L, Mancl LA, Drangsholt MT, Saunders K, Korff MV. Relationship of pain and symptoms to pubertal development in adolescents. Pain. 2005;118:201-9.
23. Keogh E, Eccleston C. Sex differences in adolescent chronic pain and pain-related coping. Pain. 2006;123:275-84.
24. Levine FM, De Simone LL. The effects of experimenter gender on pain report in male and female subjects. Pain. 1991;44:69-72.
25. Gijsbers K, Nicholson F. Experimental pain thresholds influenced by sex of experimenter. Percept Mot Skills. 2005;101:803-7.
26. Rolke R, Baron R, Maier C, Tôlle TR, Treede RD, Beyer A, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain. 2006;123:231-43.
27. Lariviere M, Goffaux P, Marchand S, Julien N. Changes in pain perception and descending inhibitory controls start at middle age in healthy adults. Clin J Pain. 2007;23: 506-10.
28. Pickering G, Jourdan D, Eschalier A, Dubray C. Impact of age, gender and cognitive functioning on pain perception. Gerontology. 2002;48:112-8.
29. Sullivan MJ, Rodgers WM, Kirsch I. Catastrophizing, depression and expectancies for pain and emotional distress. Pain. 2001;91:147-54.
30. Swimmer GI, Robinson ME, Geisser ME. Relationship of MMPI cluster type, pain coping strategy, and treatment outcome. Clin J Pain. 1992;8:131-7.
31. Thorn BE, Ward LC, Sullivan MJ, Boothby JL. Communal coping model of catastrophizing: conceptual model building. Pain. 2003;106:1-2.
32. Kest B, Sarton E, Dahan A. Gender differences in opioid mediated analgesia. Animal and human studies. Anesthesiology. 2000;93:539-47.
33. Aubrun F, Salvi N, Coriat P, Riou B. Sex- and age-related differences in morphine requirements for postoperative pain relief. Anesthesiology. 2005;103:156-60.
34. Cepeda MS, Carr D. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg. 2003;97:1464-8.
35. Rhudy JL, Grimes JS, Meagher MW. Fear-induced hypoalgesia in humans: effects on low intensity thermal stimulation and finger temperature. J Pain. 2004;5:458-68.
36. Sternberg WF, Bokat C, Kass L, Alboyadjian A, Gracely RH. Sex-dependent components of the analgesia produced by athletic competition. J Pain. 2001;2:65-74.
37. Koltyn KF, Trine MR, Stegner AJ, Tobar DA. Effect of isometric exercise on pain perception and blood pressure in men and women. Med Sci Sports Exerc. 2001;33:282-90.
38. Florez S, León M, Torres M, Reyes F, Serpa J, Ríos A. Manejo farmacológico del dolor neuropático. Rev Col Anest. 2010;37:356-72.
39. Torrance N, Smith BH, Bennett MI, Lee AJ. The epidemiology of chronic pain of predominantly neuropathic origin: results from a general population survey. J Pain. 2006;7: 281-9.
40. Velásquez JF, Manínez M. Medicina del dolor neuropático. Características clínicas y epidemiológicas. Medicina UPB. 2005;24:49-56.
41. Romberg R, Olofsen E, Sarton E, den Hartigh J, Taschner PE, Dahan A. Pharmacokinetic-pharmacodynamic modeling of morphine-6-glucuronide-induced analgesia in healthy volunteers: absence of sex differences. Anesthesiology. 2004;100:120-33.
42. Miaskowski C, Gear RW, Levine JD. Sex-related differences in analgesic responses. In: Fillingim R, editor. Sex, gender and pain. Seattle, WA: IASP Press; 2000. p. 209-30.
43. Gear RW, Miaskowski C, Gordon NC, Paul SM, Heller PH, Levine JD. The kappa opioid nalbuphine produces gender-and dose-dependent analgesia and antianalgesia in patients with postoperative pain. Pain. 1999;83:339-45.
44. Pud D, Yarnitsky D, Sprecher E, Rogowski Z, Adler R, Eisenberg E. Can personality traits and gender predict the response to morphine? An experimental cold pain study. Eur J Pain. 2006;10:103-12.
45. Averbuch M, Katzper M. A search for sex differences in response to analgesia. Arch Intern Med. 2000;160:3424-8.
46. Fassoulaki A, Melemeni A, Paraskeva A, Siafaka I, Sarantopoulos C. Postoperative pain and analgesic requirements after anesthesia with sevoflurane, desflurane or propofol. Anesth Analg. 2008;107:1715-9.
47. Meléndez HJ, Ramos JR. Eficacia de la asociación dipirona-meperidina en disminuir la necesidad de opioide en dolor agudo posterior a cirugía abdominal. Rev Col Anest. 2010;38:165-76.
48. Aubrun F, Kalfon F, Mottet P, Bellanger A, Langeron O, Coriant P, et al. Adjunctive analgesia with intravenous propacetamol does not reduce morphine related adverse effects. Br J Anaesth. 2003;90:314-9.
49. Cadavid Puentes AM, Montes DM, González MV, Urrea LM, Lescano WJ. Tolerabilidad y eficacia de morfina versus hidromorfona en analgesia epidural posquirrgica con bupivacaína: ensayo aleatorizado, doble ciego y controlado. Rev Col Anest. 2010;38:319-33.
50. Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth. 2005;95:584-91.
2. Beaton A. Crawford Williamson Long. Yale J Biol Med. 1946;19:189-93.
3. Jacobsohn PH. Horace Wells: discoverer of anesthesia. Anesth Prog. 1995;42:73-5.
4. Wizeman TM, Pardue M-L. Exploring the biological contributions to human health. In: Does sex matter? Washington: National Academy Press; 2001.
5. Rabinowicz T, Dean DE, Petetot JM, de Courten-Myers GM. Gender differences in the human cerebral cortex: more neurons in males; more processes in females. J Child Neurol. 1999;14:98-107.
6. Moulton EA, Keaser ML, Gullapalli RP, Maitra R, Greenspan JD. Sex differences in the cerebral BOLD signal response to painful heat stimuli. Am J Physiol Regul Integr Comp Physiol. 2006;291:R257-67.
7. Bryant CD, Eitan S, Sinchak K, Fanselow MS, Evans CJ. NMDA receptor antagonism disrupts the development of morphine analgesic tolerance in male, but not female C57BL/6J mice. Am J Physiol Regul Integr Comp Physiol. 2006;291:R315-26.
8. Pool GJ, Schwegler AF, Theodore BR, Fuchs PN. Role of gender norms and group identification on hypothetical and experimental pain tolerance. Pain. 2007;129:122-9.
9. Cahill L. Why sex matters for neuroscience. Nat Rev Neurosci. 2006;7:477-84.
10. Derbyshire SWG. Gender, pain and the brain. Pain Clin Updat. 2008;16:1-4.
11. Chang L, Mayer EA, Labus JS, Schmulson M, Lee OY, Olivas TI, et al. Effect of sex on perception of rectosigmoid stimuli in irritable bowel syndrome. Am J Physiol Regul Integr Comp Physiol. 2006;291:R277-84.
12. Sherman JJ, LeResche L. Does experimental pain response vary across the menstrual cycle? A methodological review. Am J Physiol Regul Integr Comp Physiol. 2006;291: R245-56.
13. Riley III JL, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain. 1998;74:181-7.
14. Unruh AM. Gender variations in clinical pain experience. Pain. 1996;65:123-67.
15. Giamberardino MA, Berkley KJ, Iezzi S, de Bigontina P, Vecchiet L. Pain threshold variations in somatic wall tissues as a function of menstrual cycle, segmental site and tissue depth in non-dysmenorrheic women, dysmenorrheic women and men. Pain. 1997;71:187-97.
16. Stening K, Eriksson O, Wahren L, Berg G, Hammar M, Blomqvist A. Pain sensations to the cold pressor test in normally menstruating women: comparison with men and relation to menstrual phase and serum sex steroid levels. Am J Physiol Regul Integr Comp Physiol. 2007;293:1711-6.
17. Smith YR, Stohler CS, Nichols TE, Bueller JA, Koeppe RA, Zubieta JK. Pronociceptive and antinociceptive effects of estradiol through endogenous opioid neurotransmission in women. J Neurosci. 2006;26:5777-85.
18. Timmons BW, Hamadeh MJ, Tarnopolsky MA. No effect of short-term 17ß-estradiol supplementation in healthy men on systemic inflammatory responses to exercise. Am J Physiol Regul Integr Comp Physiol. 2006;291:R285-90.
19. Von Korff M, Dworkin SF, Le Resche L, Kruger A. An epidemiologic comparison of pain complaints. Pain. 1988;32:173-83.
20. LeResche L. Epidemiologic perspectives on sex differences in pain. In: Fillingim RB, editor. Sex, gender, and pain, progress in pain research and management, 17. Seattle: IASP Press; 2000. p. 2339.
21. Rollman GB, Lautenbacher S. Sex differences in musculoskeletal pain. Clin J Pain. 2001;17:20-4
22. LeResche L, Mancl LA, Drangsholt MT, Saunders K, Korff MV. Relationship of pain and symptoms to pubertal development in adolescents. Pain. 2005;118:201-9.
23. Keogh E, Eccleston C. Sex differences in adolescent chronic pain and pain-related coping. Pain. 2006;123:275-84.
24. Levine FM, De Simone LL. The effects of experimenter gender on pain report in male and female subjects. Pain. 1991;44:69-72.
25. Gijsbers K, Nicholson F. Experimental pain thresholds influenced by sex of experimenter. Percept Mot Skills. 2005;101:803-7.
26. Rolke R, Baron R, Maier C, Tôlle TR, Treede RD, Beyer A, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain. 2006;123:231-43.
27. Lariviere M, Goffaux P, Marchand S, Julien N. Changes in pain perception and descending inhibitory controls start at middle age in healthy adults. Clin J Pain. 2007;23: 506-10.
28. Pickering G, Jourdan D, Eschalier A, Dubray C. Impact of age, gender and cognitive functioning on pain perception. Gerontology. 2002;48:112-8.
29. Sullivan MJ, Rodgers WM, Kirsch I. Catastrophizing, depression and expectancies for pain and emotional distress. Pain. 2001;91:147-54.
30. Swimmer GI, Robinson ME, Geisser ME. Relationship of MMPI cluster type, pain coping strategy, and treatment outcome. Clin J Pain. 1992;8:131-7.
31. Thorn BE, Ward LC, Sullivan MJ, Boothby JL. Communal coping model of catastrophizing: conceptual model building. Pain. 2003;106:1-2.
32. Kest B, Sarton E, Dahan A. Gender differences in opioid mediated analgesia. Animal and human studies. Anesthesiology. 2000;93:539-47.
33. Aubrun F, Salvi N, Coriat P, Riou B. Sex- and age-related differences in morphine requirements for postoperative pain relief. Anesthesiology. 2005;103:156-60.
34. Cepeda MS, Carr D. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg. 2003;97:1464-8.
35. Rhudy JL, Grimes JS, Meagher MW. Fear-induced hypoalgesia in humans: effects on low intensity thermal stimulation and finger temperature. J Pain. 2004;5:458-68.
36. Sternberg WF, Bokat C, Kass L, Alboyadjian A, Gracely RH. Sex-dependent components of the analgesia produced by athletic competition. J Pain. 2001;2:65-74.
37. Koltyn KF, Trine MR, Stegner AJ, Tobar DA. Effect of isometric exercise on pain perception and blood pressure in men and women. Med Sci Sports Exerc. 2001;33:282-90.
38. Florez S, León M, Torres M, Reyes F, Serpa J, Ríos A. Manejo farmacológico del dolor neuropático. Rev Col Anest. 2010;37:356-72.
39. Torrance N, Smith BH, Bennett MI, Lee AJ. The epidemiology of chronic pain of predominantly neuropathic origin: results from a general population survey. J Pain. 2006;7: 281-9.
40. Velásquez JF, Manínez M. Medicina del dolor neuropático. Características clínicas y epidemiológicas. Medicina UPB. 2005;24:49-56.
41. Romberg R, Olofsen E, Sarton E, den Hartigh J, Taschner PE, Dahan A. Pharmacokinetic-pharmacodynamic modeling of morphine-6-glucuronide-induced analgesia in healthy volunteers: absence of sex differences. Anesthesiology. 2004;100:120-33.
42. Miaskowski C, Gear RW, Levine JD. Sex-related differences in analgesic responses. In: Fillingim R, editor. Sex, gender and pain. Seattle, WA: IASP Press; 2000. p. 209-30.
43. Gear RW, Miaskowski C, Gordon NC, Paul SM, Heller PH, Levine JD. The kappa opioid nalbuphine produces gender-and dose-dependent analgesia and antianalgesia in patients with postoperative pain. Pain. 1999;83:339-45.
44. Pud D, Yarnitsky D, Sprecher E, Rogowski Z, Adler R, Eisenberg E. Can personality traits and gender predict the response to morphine? An experimental cold pain study. Eur J Pain. 2006;10:103-12.
45. Averbuch M, Katzper M. A search for sex differences in response to analgesia. Arch Intern Med. 2000;160:3424-8.
46. Fassoulaki A, Melemeni A, Paraskeva A, Siafaka I, Sarantopoulos C. Postoperative pain and analgesic requirements after anesthesia with sevoflurane, desflurane or propofol. Anesth Analg. 2008;107:1715-9.
47. Meléndez HJ, Ramos JR. Eficacia de la asociación dipirona-meperidina en disminuir la necesidad de opioide en dolor agudo posterior a cirugía abdominal. Rev Col Anest. 2010;38:165-76.
48. Aubrun F, Kalfon F, Mottet P, Bellanger A, Langeron O, Coriant P, et al. Adjunctive analgesia with intravenous propacetamol does not reduce morphine related adverse effects. Br J Anaesth. 2003;90:314-9.
49. Cadavid Puentes AM, Montes DM, González MV, Urrea LM, Lescano WJ. Tolerabilidad y eficacia de morfina versus hidromorfona en analgesia epidural posquirrgica con bupivacaína: ensayo aleatorizado, doble ciego y controlado. Rev Col Anest. 2010;38:319-33.
50. Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth. 2005;95:584-91.
How to Cite
1.
Gutiérrez Lombana W, Gutiérrez Vidal SE. Pain and gender differences: A clinical approach. Colomb. J. Anesthesiol. [Internet]. 2012 Jul. 1 [cited 2024 Apr. 23];40(3):207-12. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/408
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2012-07-01
How to Cite
1.
Gutiérrez Lombana W, Gutiérrez Vidal SE. Pain and gender differences: A clinical approach. Colomb. J. Anesthesiol. [Internet]. 2012 Jul. 1 [cited 2024 Apr. 23];40(3):207-12. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/408
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Narrative review
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