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Current Review of Pain

, Volume 4, Issue 1, pp 24–30 | Cite as

Sex, gender, and pain: Women and men really are different

  • Roger B. Fillingim
Article

Abstract

Sex-related differences in the experience of both clinical and experimentally induced pain have been widely reported. Specifically, females are at greater risk for developing several chronic pain disorders, and women exhibit greater sensitivity to noxious stimuli in the laboratory compared with men. Several mechanisms have been proposed to account for these sex differences. Psychosocial factors such as sex role beliefs, pain coping strategies, mood, and pain-related expectancies may underlie these effects. In addition, there is evidence that familial factors can alter pain responses, and these intergenerational influences may differ as a function of sex. Sex hormones are also known to affect pain responses, which may mediate the sex differences. Although the magnitude of these effects has not been well characterized, there are potentially important practical implications of sex differences in pain responses. These implications are discussed, and directions for future research are delineated.

Keywords

Chronic Pain Fibromyalgia Migraine With Aura Pain Response Fibromyalgia Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Berkley KJ: Sex differences in pain. Behav Brain Sci 1997, 20:371–380. Provides a scholarly review of the literature on sex, gender, and pain. Sex-related influences on both clinical and experimental pain responses are addressed, and basic animal research suggesting mechanisms underlying sex differences is reviewed.PubMedGoogle Scholar
  2. 2.
    LeResche L: Gender considerations in the epidemiology of chronic pain. In Epidemiology of Pain. Edited by Crombie IK. Seattle: IASP Press; 1999:43–52.Google Scholar
  3. 3.
    Unruh AM: Gender variations in clinical pain experience. Pain 1996, 65:123–167.CrossRefPubMedGoogle Scholar
  4. 4.
    Mayer EA, Naliboff B, Lee O, et al.: Review article: genderrelated differences in functional gastrointestinal disorders. Aliment Pharmacol Ther 1999, 13(suppl 2):65–69.CrossRefPubMedGoogle Scholar
  5. 5.
    Lipton RB, Stewart WF: Migraine headaches: epidemiology and comorbidity. Clin Neurosci 1998, 5:2–9.PubMedGoogle Scholar
  6. 6.
    Schwartz BS, Stewart WF, Simon D, Lipton RB: Epidemiology of tension-type headache. JAMA 1998, 279:381–383.CrossRefPubMedGoogle Scholar
  7. 7.
    LeResche L: Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 1997, 8:291–305.CrossRefPubMedGoogle Scholar
  8. 8.
    Wolfe F, Ross K, Anderson J, et al.: The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheumatol 1995, 38:19–28.CrossRefGoogle Scholar
  9. 9.
    Andersson HI, Ejlertsson G, Leden I, Rosenberg C: Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain 1993, 9:174–182.CrossRefPubMedGoogle Scholar
  10. 10.
    Forgays DG, Rzewnicki R, Ober AJ, Forgays DK: Headache in college students: a comparison of four populations. Headache 1993, 33:182–190.CrossRefPubMedGoogle Scholar
  11. 11.
    Lester N, Lefebvre JC, Keefe FJ: Pain in young adults: I. Relationship to gender and family pain history. Clin J Pain 1994, 10:282–289.CrossRefPubMedGoogle Scholar
  12. 12.
    Rajala U, Keinanen-Kiukaanniemi S, Uusimaki A, Kivela SL: Musculoskeletal pains and depression in a middle-aged Finnish population. Pain 1995, 61:451–457.CrossRefPubMedGoogle Scholar
  13. 13.
    Skovron ML, Szpalski M, Nordin M, et al.: Sociocultural factors and back pain. A population-based study in Belgian adults. Spine 1994, 19:129–137.CrossRefPubMedGoogle Scholar
  14. 14.
    Sternbach RA: Survey of pain in the United States: the Nuprin Pain Report. Clin J Pain 1986, 2:49–53.CrossRefGoogle Scholar
  15. 15.
    Kandrack MA, Grant KR, Segall A: Gender differences in health related behaviour: some unanswered questions. Soc Sci Med 1991, 32:579–590.CrossRefPubMedGoogle Scholar
  16. 16.
    Verbrugge LM: The twain meet: empirical explanations of sex differences in health and mortality. J Health Soc Behav 1989, 30:282–304.CrossRefPubMedGoogle Scholar
  17. 17.
    Novy DM, Nelson DV, Averill PM, Berry LA: Gender differences in the expression of depressive symptoms among chronic pain patients. Clin J Pain 1996, 12:23–29.CrossRefPubMedGoogle Scholar
  18. 18.
    Averill PM, Novy DM, Nelson DV, Berry LA: Correlates of depression in chronic pain patients: a comprehensive examination. Pain 1996, 65:93–100.CrossRefPubMedGoogle Scholar
  19. 19.
    Haley WE, Turner JA, Romano JM: Depression in chronic pain patients: relation to pain, activity, and sex differences. Pain 1985, 23:337–343.CrossRefPubMedGoogle Scholar
  20. 20.
    Weir R, Browne G, Tunks E, et al.: Gender differences in psychosocial adjustment to chronic pain and expenditures for health care services used. Clin J Pain 1996, 12:277–290.CrossRefPubMedGoogle Scholar
  21. 21.
    Spertus IL, Burns J, Glenn B, et al.: Gender differences in associations between trauma history and adjustment among chronic pain patients. Pain 1999, 82:97–102.CrossRefPubMedGoogle Scholar
  22. 22.
    Edwards RR, Augustson E, Fillingim RB: Sex-specific effects of pain-related anxiety on adjustment to chronic pain. Clin J Pain, in press.Google Scholar
  23. 23.
    Fillingim RB, Maixner W: Gender differences in the responses to noxious stimuli. Pain Forum 1995, 4:209–221.CrossRefGoogle Scholar
  24. 24.
    Riley JL, Robinson ME, Wise EA, et al.: Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain 1998, 74:181–187. Provides a statistical summary of the studies that have investigated sex-related differences in experimental pain responses. The authors found that effect sizes generally ranged from moderate to large, but effects were smallest for studies examining sex differences in responses to heat pain.CrossRefPubMedGoogle Scholar
  25. 25.
    Fillingim RB, Maixner W, Kincaid S, Silva S: Sex differences in temporal summation but not sensory-discriminative processing of thermal pain. Pain 1998, 75:121–127.CrossRefPubMedGoogle Scholar
  26. 26.
    Fillingim RB, Maddux V, Shackelford JM: Sex differences in heat pain thresholds as a function of assessment method and rate of rise. Somatosens Motor Res 1999, 16:57–62.CrossRefGoogle Scholar
  27. 27.
    Otto MW, Dougher MJ: Sex differences and personality factors in responsivity to pain. Percept Mot Skills 1985, 61:383–390.CrossRefPubMedGoogle Scholar
  28. 28.
    Levine FM, De Simone LL: The effects of experimenter gender on pain report in male and female subjects. Pain 1991, 44:69–72.CrossRefPubMedGoogle Scholar
  29. 29.
    Feine JS, Bushnell MC, Miron D, Duncan GH: Sex differences in the perception of noxious heat stimuli. Pain 1991, 44:255–262.CrossRefPubMedGoogle Scholar
  30. 30.
    Geisser ME, Robinson ME, Pickren WE: Differences in cognitive coping strategies among pain-sensitive and pain-tolerant individuals on the cold pressor test. Behav Ther 1992, 23:31–42.CrossRefGoogle Scholar
  31. 31.
    Jensen MP, Turner JA, Romano JM, Karoly P: Coping with chronic pain: a critical review of the literature. Pain 1991, 47:249–283.CrossRefPubMedGoogle Scholar
  32. 32.
    Keefe FJ, Kashikar-Zuck S, Opiteck J, et al.: Pain in arthritis and musculoskeletal disorders: the role of coping skills training and exercise interventions. J Orthop Sports Phys Ther 1996, 24:279–290.CrossRefPubMedGoogle Scholar
  33. 33.
    McGrath PA: Psychological aspects of pain perception. Arch Oral Biol 1994, 39(suppl):55S-62S.CrossRefPubMedGoogle Scholar
  34. 34.
    Young LD: Psychological factors in rheumatoid arthritis. J Consult Clin Psychol 1992, 60:619–627.CrossRefPubMedGoogle Scholar
  35. 35.
    Kroenke K, Spitzer RL: Gender differences in the reporting of physical and somatoform symptoms. Psychosom Med 1998, 60:150–155.CrossRefPubMedGoogle Scholar
  36. 36.
    Moldin SO, Scheftner WA, Rice JP, et al.: Association between major depressive disorder and physical illness. Psychol Med 1993, 23:755–761.CrossRefPubMedGoogle Scholar
  37. 37.
    Zelman DC, Howland EW, Nichols SN, Cleeland CS: The effects of induced mood on laboratory pain. Pain 1991, 46:105–111.CrossRefPubMedGoogle Scholar
  38. 38.
    Cornwall A, Donderi DC: The effect of experimentally induced anxiety on the experience of pressure pain. Pain 1988, 35:105–113.CrossRefPubMedGoogle Scholar
  39. 39.
    Dougher MJ, Goldstein D, Leight KA: Induced anxiety and pain. J Anxiety Disord 1987, 1:259–264.CrossRefGoogle Scholar
  40. 40.
    Graffenried BV, Adler R, Abt K, et al.: The influence of anxiety and pain sensitivity on experimental pain in man. Pain 1978, 4:253–263.CrossRefGoogle Scholar
  41. 41.
    Fillingim RB, Keefe FJ, Light KC, et al.: The influence of gender and psychological factors on pain perception. J Gender Cult Health 1996, 1:21–36.Google Scholar
  42. 42.
    Keefe FJ, Kashikar-Zuck S, Robinson E, et al.: Pain coping strategies that predict patients’ and spouses’ ratings of patients’ self-efficacy. Pain 1997, 73:191–199.CrossRefPubMedGoogle Scholar
  43. 43.
    Kashikar-Zuck S, Keefe FJ, Kornguth P, et al.: Pain coping and the pain experience during mammography: a preliminary study. Pain 1997, 73:165–172.CrossRefPubMedGoogle Scholar
  44. 44.
    Lester N, Lefebvre JC, Keefe FJ: Pain in young adults--III: Relationships of three pain-coping measures to pain and activity interference. Clin J Pain 1996, 12:291–300.CrossRefPubMedGoogle Scholar
  45. 45.
    Fillingim RB, Wilkinson CS, Powell T: Self-reported abuse history and pain complaints among healthy young adults. Clin J Pain 1999, 15:85–91.CrossRefPubMedGoogle Scholar
  46. 46.
    Lefebvre JC, Lester N, Keefe FJ: Gender differences in pain location and pain coping strategy use in a college sample [abstract]. Proc Am Pain Soc 1994, 13:A-81.Google Scholar
  47. 47.
    Jensen MP, Karoly P: Control beliefs, coping efforts, and adjustment to chronic pain. J Consult Clin Psychol 1993, 59:431–438.CrossRefGoogle Scholar
  48. 48.
    Keefe FJ, Lefebvre JC, Maixner W, et al.: Self-efficacy for arthritis pain: relationship to perception of thermal laboratory pain stimuli. Arthritis Care Res 1997, 10:177–184.CrossRefPubMedGoogle Scholar
  49. 49.
    Bandura A, O’Leary A, Taylor CB, et al.: Perceived self-efficacy and pain control: opioid and nonopioid mechanisms. J Pers Soc Psychol 1987, 53:563–571.CrossRefPubMedGoogle Scholar
  50. 50.
    Benedetti F, Amanzio M: The neurobiology of placebo analgesia: from endogenous opioids to cholecystokinin. Prog Neurobiol 1997, 52:109–125.CrossRefPubMedGoogle Scholar
  51. 51.
    Frid M, Singer G, Rana C: Interactions between personal expectations and naloxone: effects on tolerance to ischemic pain. Psychopharmacology 1979, 65:225–231.CrossRefPubMedGoogle Scholar
  52. 52.
    Pellegrino MJ, Waylonis GW, Sommer A: Familial occurrence of primary fibromyalgia. Arch Phys Med Rehab 1989, 70:61–63.Google Scholar
  53. 53.
    Buskila D, Neumann L, Hazanov I, Carmi R: Familial aggregation in the fibromyalgia syndrome. Sem Arthritis Rheumatol 1996, 26:605–611.CrossRefGoogle Scholar
  54. 54.
    Buskila D, Neumann L: Fibromyalgia syndrome (FM) and nonarticular tenderness in relatives of patients with FM. J Rheumatol 1997, 24:941–944.PubMedGoogle Scholar
  55. 55.
    Schrader H, Obelieniene D, Bovim G, et al.: Natural evolution of late whiplash syndrome outside the medicolegal context. Lancet 1996, 347:1207–1211.CrossRefPubMedGoogle Scholar
  56. 56.
    Ottman R, Hong S, Lipton RB: Validity of family history data on severe headache and migraine. Neurology 1993, 43:1954–1960.CrossRefPubMedGoogle Scholar
  57. 57.
    Messinger HB, Spierings EL, Vincent AJ, Lebbink J: Headache and family history. Cephalalgia 1991, 11:13–18.CrossRefPubMedGoogle Scholar
  58. 58.
    Ehde DM, Holm JE, Metzger DL: The role of family structure, functioning, and pain modeling in headache. Headache 1991, 31:35–40.CrossRefPubMedGoogle Scholar
  59. 59.
    Turkat ID, Kuczmierczyk AR, Adams HE: An investigation of the aetiology of chronic headache. The role of headache models. Brit J Psychiatry 1984, 145:665–666.CrossRefGoogle Scholar
  60. 60.
    Aromaa M, Rautava P, Helenius H, Sillanpaa ML: Factors of early life as predictors of headache in children at school entry. Headache 1998, 38:23–30.CrossRefPubMedGoogle Scholar
  61. 61.
    Katon W, Egan K, Miller D: Chronic pain: lifetime psychiatric diagnoses and family history. Am J Psychiatry 1985, 142:1156–1160.CrossRefPubMedGoogle Scholar
  62. 62.
    Edwards PW, Zeichner A, Kuczmierczyk AR, Boczkowski J: Familial pain models: the relationship between family history of pain and current pain experience. Pain 1985, 21:379–384.CrossRefPubMedGoogle Scholar
  63. 63.
    Koutantji M, Pearce SA, Oakley DA: The relationship between gender and family history of pain with current pain experience and awareness of pain in others. Pain 1998, 77:25–31.CrossRefPubMedGoogle Scholar
  64. 64.
    Neumann L, Buskila D: Quality of life and physical functioning of relatives of fibromyalgia patients. Sem Arthritis Rheumatol 1997, 26:834–839.CrossRefGoogle Scholar
  65. 65.
    Fillingim RB, Edwards RR, Powell T: Sex-dependent effects of reported familial pain history on clinical and experimental pain responses. Pain 1999, in press. Google Scholar
  66. 66.
    Bachiocco V, Scesi M, Morselli AM, Carli G: Individual pain history and familial pain tolerance models: relationships to post-surgical pain. Clin J Pain 1993, 9:266–271.CrossRefPubMedGoogle Scholar
  67. 67.
    Craig KD, Prkachin KM: Social modeling influences on sensory decision theory and psychophysiological indexes of pain. J Pers Soc Psychol 1978, 36:805–815.CrossRefPubMedGoogle Scholar
  68. 68.
    Turkat ID, Guise BJ: Test of reliability of perception of parental and childhood illness behavior. Percept Mot Skills 1983, 57:101–102.CrossRefPubMedGoogle Scholar
  69. 69.
    Hall JA: Gender effects in decoding nonverbal cues. Psych Bull 1978, 85:845–857.CrossRefGoogle Scholar
  70. 70.
    Orozco S, Ehlers CL: Gender differences in electrophysiological responses to facial stimuli. Biol Psychiatry 1998, 44:281–289.CrossRefPubMedGoogle Scholar
  71. 71.
    Otta E, Folladore AF, Hoshino RL: Reading a smiling face: messages conveyed by various forms of smiling. Percept Mot Skills 1996, 82:1111–1121.CrossRefPubMedGoogle Scholar
  72. 72.
    Lundqvist LO: Facial EMG reactions to facial expressions: a case of facial emotional contagion? Scand J Psychol 1995, 36:130–141.CrossRefPubMedGoogle Scholar
  73. 73.
    Boyatzis CJ, Chazan E, Ting CZ: Preschool children’s decoding of facial emotions. J Genetic Psychol 1993, 154:375–382.CrossRefGoogle Scholar
  74. 74.
    Dimberg U, Lundquist LO: Gender differences in facial reactions to facial expressions. Biol Psychol 1990, 30:151–159.CrossRefPubMedGoogle Scholar
  75. 75.
    Mogil JS, Wilson SG, Bon K, et al.: Heritability of nociception I: responses of 11 inbred mouse strains on 12 measures of nociception. Pain 1999, 80:67–82.CrossRefPubMedGoogle Scholar
  76. 76.
    Ulrich V, Gervil M, Kyvik KO, et al.: Evidence of a genetic factor in migraine with aura: a population-based Danish twin study. Ann Neurol 1999, 45:242–246.CrossRefPubMedGoogle Scholar
  77. 77.
    Ziegler DK, Hur YM, Bouchard TJJ, et al.: Migraine in twins raised together and apart. Headache 1998, 38:417–422.CrossRefPubMedGoogle Scholar
  78. 78.
    Ogilvie AD, Russell MB, Dhall P, et al.: Altered allelic distributions of the serotonin transporter gene in migraine without aura and migraine with aura. Cephalalgia 1998, 18:23–26.CrossRefPubMedGoogle Scholar
  79. 79.
    Perdriger A, Guggenbuhl P, Chales G, et al.: Positive association of the HLA DMB1*0101-0101 genotype with rheumatoid arthritis. Rheumatology (Oxford) 1999, 38:448–452.CrossRefGoogle Scholar
  80. 80.
    Reveille JD: The genetic contribution to the pathogenesis of rheumatoid arthritis. Curr Opin Rheumatol 1998, 10:187–200.CrossRefPubMedGoogle Scholar
  81. 81.
    Yunus MB, Khan MA, Rawlings KK, et al.: Genetic linkage analysis of multicase families with fibromyalgia syndrome. J Rheumatol 1999, 26:408–412.PubMedGoogle Scholar
  82. 82.
    Mogil JS: The genetic mediation of individual differences in sensitivity to pain and its inhibition. Proc Natl Acad Sci U S A 1999, 96:7744–7751.CrossRefPubMedCentralPubMedGoogle Scholar
  83. 83.
    Macgregor AJ, Griffiths GO, Baker J, Spector TD: Determinants of pressure pain threshold in adult twins: evidence that shared environmental influences predominate. Pain 1997, 73:253–257.CrossRefPubMedGoogle Scholar
  84. 84.
    Fillingim RB, Ness TJ: Sex-related hormonal influences on pain and analgesic responses. Neurosci Biobehav Rev 1999, in press. Google Scholar
  85. 85.
    Boyle CA, Berkowitz GS, Kelsey JL: Epidemiology of premenstrual symptoms. Am J Pub Health 1987, 77:349–350.CrossRefGoogle Scholar
  86. 86.
    Facchinetti F, Martignoni E, Fioroni L, et al.: Opioid control of the hypothalamus-pituitary-adrenal axis cyclically fails in menstrual migraine. Cephalalgia 1990, 10:51–56.CrossRefPubMedGoogle Scholar
  87. 87.
    Heitkemper MM, Jarrett M, Cain KC, et al.: Daily gastrointestinal symptoms in women with and without a diagnosis of IBS. Dig Diseases Sci 1995, 40:1511–1519.CrossRefGoogle Scholar
  88. 88.
    Huerta-Franco MR, Malacara JM: Association of physical and emotional symptoms with the menstrual cycle and life-style. J Reprod Med 1993, 38:448–454.PubMedGoogle Scholar
  89. 89.
    Anderberg UM, Marteinsdottir I, Hallman J, Backstrom T: Variability in cyclicity affects pain and other symptoms in female fibromyalgia syndrome patients. J Musculoskeletal Pain 1998, 6:5–22.CrossRefGoogle Scholar
  90. 90.
    Stewart WF, Lipton RB, Celentano DD, Reed ML: Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors. JAMA 1992, 267:64–69.CrossRefPubMedGoogle Scholar
  91. 91.
    LeResche L, Saunders K, Von Korff MR, et al.: Use of exogenous hormones and risk of temporomandibular disorder pain. Pain 1997, 69:153–160. mines the risk of being diagnosed with temporomandibular disorder (TMD) as a function of exogenous hormone use. In post-menopausal women, use of estrogen replacement was associated with a 30% greater likelihood of being diagnosed with TMD. For pre-menopausal women, use of oral contraceptives was associated with a 20% increased risk of TMD. This large scale study is the first to document a connection between exogenous hormone use and TMDCrossRefPubMedGoogle Scholar
  92. 92.
    Riley JL III, Robinson ME, Wise EA, Price DD: A meta-analytic review of pain perception across the menstrual cycle. Pain 1999, 81:225–235.CrossRefPubMedGoogle Scholar
  93. 93.
    Mogil JS, Sternberg WF, Kest B, et al.: Sex differences in the antagonism of stress-induced analgesia: effects of gonadectomy and estrogen replacement. Pain 1993, 53:17–25.CrossRefPubMedGoogle Scholar
  94. 94.
    Kavaliers M, Choleris E: Sex differences in N-methyl Daspartate involvement in kappa opioid and non-opioid predator-induced analgesia in mice. Brain Res 1997, 768:30–36.CrossRefPubMedGoogle Scholar
  95. 95.
    France CR, Suchowiecki S: A comparison of diffuse noxious inhibitory controls in men and women. Pain 1999, 81:77–84.CrossRefPubMedGoogle Scholar
  96. 96.
    Fillingim RB, Maixner W: The influence of resting blood pressure and gender on pain responses. Psychosom Med 1996, 58:326–332.CrossRefPubMedGoogle Scholar
  97. 97.
    Miaskowski C, Levine JD: Does opioid analgesia show a gender preference for females? Pain Forum 1999, 8:34–44.CrossRefGoogle Scholar
  98. 98.
    Messinis IE, Lolis D: Treatment of premenstrual mastalgia with tamoxifen. Acta Obstet Gynecol Scand 1988, 67:307–309.CrossRefPubMedGoogle Scholar
  99. 99.
    Kontostolis E, Stefanidis K, Navrozoglou I, Lolis D: Comparison of tamoxifen with danazol for treatment of cyclical mastalgia. Gynecol Endocrinol 1997, 11:393–397.CrossRefPubMedGoogle Scholar
  100. 100.
    McDermott MT, Hofeldt FD, Kidd GS: Tamoxifen therapy for painful idiopathic gynecomastia. South Med J 1990, 83:1283–1285.CrossRefPubMedGoogle Scholar
  101. 101.
    Esterling BA, L’Abate L, Murray EJ, Pennebaker JW: Empirical foundations for writing in prevention and psychotherapy: mental and physical health outcomes. Clin Psychol Rev 1999, 19:79–96.CrossRefPubMedGoogle Scholar

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© Current Science Inc 2000

Authors and Affiliations

  • Roger B. Fillingim
    • 1
  1. 1.Department of PsychologyUniversity of Alambama at BirminghamBirminghamUSA

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