Defining Gender Disparities in Pain Management
Prevalence rates of most musculoskeletal pain conditions are higher among women than men. Reasons for these prevalence disparities likely include sex differences in basic pain mechanisms and gender differences in psychosocial factors.
The purposes of this review were to (1) identify reasons for differences in pain prevalence between men and women, (2) assess whether musculoskeletal pain conditions are differently treated in men and women, and (3) identify reasons for sex/gender disparities in pain treatment.
A MEDLINE search was conducted using the terms “pain” or “musculoskeletal pain” and “gender differences” or “sex differences” with “health care,” “health services,” and “physician, attitude.” Articles judged relevant were selected for inclusion.
Where Are We Now?
Higher pain prevalence in women is consistently observed but not well understood. The relative contributions of sex differences in pain mechanisms and gender differences in psychosocial factors (eg, coping, social roles) to explaining differences in prevalence are not yet clear. Gender disparities in the amount of healthcare use for pain may be partially explained by the experience of higher-intensity pain in women. Pain intensity also seems to be a major factor influencing treatment, especially the prescription of medications for acute pain. However, clinicians’ gender stereotypes, as well as the clinician’s own gender, appear to influence diagnostic and treatment decisions for more persistent pain problems.
Where Do We Need To Go?
The ultimate goal is optimal pain control for each individual, with gender being one difference between individuals.
How Do We Get There?
Further research is needed to address all three major purposes, with particular attention to whether gender-specific pain treatment may sometimes be warranted.
KeywordsGender Difference Pain Condition Musculoskeletal Pain Gender Stereotype Pain Treatment
I thank the editors and anonymous reviewers for helpful suggestions.
- 8.Dworkin SF, Von Korff M, LeResche L. Epidemiologic studies of chronic pain: a dynamic-ecologic perspective. Ann Behav Med. 1992;14:3–11.Google Scholar
- 15.Greenspan JD, Craft RM, LeResche L, Arendt-Nielsen L, Berkley KJ, Fillingim RB, Gold MS, Holdcroft A, Lautenbacher S, Mayer EA, Mogil JS, Murphy AZ, Traub RJ; Consensus Working Group of the Sex, Gender, and Pain SIG of the IASP. Studying sex and gender differences in pain and analgesia: a consensus report. Pain 2007;132(Suppl 1):S26–S45.PubMedCrossRefGoogle Scholar
- 16.Gureje O, Von Korff M, Kola L, Demyttenaere K, He Y, Posada-Villa J, Lepine JP, Angermeyer MC, Levinson D, de Girolamo G, Iwata N, Karam A, Borges GL, de Graaf R, Browne MO, Stein DJ, Haro JM, Bromet EJ, Kessler RC, Alonso J. The relation between multiple pains and mental disorders: results from the World Mental Health Surveys. Pain. 2008;135:82–91.PubMedCrossRefGoogle Scholar
- 24.LeResche L. Gender considerations in the epidemiology of chronic pain. In: Crombie IK, Croft PR, Linton SJ, LeResche L, Von Korff M, eds. Epidemiology of Pain. Seattle, WA: IASP Press; 1999:43–52.Google Scholar
- 25.LeResche L. Epidemiologic perspectives on sex differences in pain. In: Fillingim RB, ed. Sex, Gender and Pain: Progress in Pain Research and Management. Vol 17. Seattle, WA: IASP Press; 2000:233–249.Google Scholar
- 33.Pernold G, Mortimer M, Wiktorin C, Tornqvist EW, Vingård E; Musculoskeletal Intervention Center-Norrtälje Study Group. Neck/shoulder disorders in a general population: natural course and influence of physical exercise: a 5-year follow-up. Spine (Phila Pa 1976). 2005;30:E363–E368.Google Scholar
- 51.Von Korff M, Wagner EH, Dworkin SF, Saunders KW. Chronic pain and use of ambulatory health care. Psychosom Med. 1991;53:61–79.Google Scholar