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Clinical Orthopaedics and Related Research®

, Volume 469, Issue 7, pp 1871–1877 | Cite as

Defining Gender Disparities in Pain Management

Symposium:AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium

Abstract

Background

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.

Questions/purposes

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.

Methods

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.

Keywords

Gender Difference Pain Condition Musculoskeletal Pain Gender Stereotype Pain Treatment 
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.

Notes

Acknowledgments

I thank the editors and anonymous reviewers for helpful suggestions.

References

  1. 1.
    Berkley KJ. Sex differences in pain. Behav Brain Sci. 1997;20:371–380.PubMedGoogle Scholar
  2. 2.
    Buchman AS, Shah RC, Leurgans SE, Boyle PA, Wilson RS, Bennett DA. Musculoskeletal pain and incident disability in community-dwelling older adults. Arthritis Care Res (Hoboken). 2010;62:1287–1293.CrossRefGoogle Scholar
  3. 3.
    Cairns BE, Gazerani P. Sex-related differences in pain. Maturitas. 2009;63:292–296.PubMedCrossRefGoogle Scholar
  4. 4.
    Campbell C, Weisner C, LeResche L, Ray T, Saunders K, Merrill JO, Banta-Green C, Sullivan MD, Silverberg MJ, Boudreau D, Von Korff M. Age and sex trends in long-term opioid analgesic use for non-cancer pain. Am J Public Health. 2010;100:2541–2547.PubMedCrossRefGoogle Scholar
  5. 5.
    Côté D, Coutu MF. A critical review of gender issues in understanding prolonged disability related to musculoskeletal pain: how are they relevant to rehabilitation? Disabil Rehabil. 2010;32:87–102.PubMedCrossRefGoogle Scholar
  6. 6.
    Crook J, Moldofsky H. The probability of recovery and return to work from work disability as a function of time. Qual Life Res. 1994;3(Suppl 1):S97–S103.PubMedCrossRefGoogle Scholar
  7. 7.
    Dworkin SF, Von Korff MR, LeResche L. Multiple pains and psychiatric disturbance: an epidemiologic investigation. Arch Gen Psychiatry. 1990; 47:239–244.PubMedGoogle Scholar
  8. 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
  9. 9.
    Egol KA, Tejwani NC, Walsh MG, Capla EL, Koval KJ. Predictors of short-term functional outcome following ankle fracture surgery. J Bone Joint Surg Am. 2006;88:974–979.PubMedCrossRefGoogle Scholar
  10. 10.
    Faber E, Burdorf A, Bierma-Zeinstra SM, Miedema HS, Koes BW. Determinants for improvement in different back pain measures and their influence on the duration of sickness absence. Spine (Phila Pa 1976) 2006;31:1477–1483.CrossRefGoogle Scholar
  11. 11.
    Feleus A, Bierma-Zeinstra SM, Bernsen RM, Miedema HS, Verhaar JA, Koes BW. Management decisions in nontraumatic complaints of arm, neck, and shoulder in general practice. Ann Fam Med. 2009;7:446–454.PubMedCrossRefGoogle Scholar
  12. 12.
    Fillingim RB, Gear RW. Sex differences in opioid analgesia: clinical and experimental findings. Eur J Pain. 2004;8:413–425.PubMedCrossRefGoogle Scholar
  13. 13.
    Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. Sex, gender and pain: a review of recent clinical and experimental findings. J Pain. 2009;10:447–485.PubMedCrossRefGoogle Scholar
  14. 14.
    Green CR, Wheeler JR, LaPorte F. Clinical decision making in pain management: contributions of physician and patient characteristics to variations in practice. J Pain. 2003;4:29–39.PubMedCrossRefGoogle Scholar
  15. 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. 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
  17. 17.
    Hamberg K, Risberg G, Johansson EE, Westman G. Gender bias in physicians’ management of neck pain: a study of the answers in a Swedish national examination. J Womens Health Gend Based Med. 2002;11:653–666.PubMedCrossRefGoogle Scholar
  18. 18.
    Heins JK, Heins A, Grammas M, Costello M, Huang K, Mishra S. Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department. J Emerg Nurs. 2006;32:219–224.PubMedCrossRefGoogle Scholar
  19. 19.
    Jinks C, Jordan KP, Blagojevic M, Croft P. Predictors of onset and progression of knee pain in adults living in the community: a prospective study. Rheumatology. 2008;47:368–374.PubMedCrossRefGoogle Scholar
  20. 20.
    John MT, Miglioretti DL, LeResche L, Von Korff M, Critchlow CW. Widespread pain as a risk factor for dysfunctional temporomandibular disorder pain. Pain. 2003;102:257–263.PubMedCrossRefGoogle Scholar
  21. 21.
    Jüni P, Low N, Reichenbach S, Villiger PM, Williams S, Dieppe PA. Gender inequity in the provision of care for hip disease: population-based cross-sectional study. Osteoarthritis Cartilage. 2010;18:640–645.PubMedCrossRefGoogle Scholar
  22. 22.
    Keefe FJ, Lefebvre JC, Egert JR, Affleck G, Sullivan MJ, Caldwell DS. Relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing. Pain. 2000;87:325–334.PubMedCrossRefGoogle Scholar
  23. 23.
    Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.PubMedGoogle Scholar
  24. 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. 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
  26. 26.
    LeResche L, Mancl L, Sherman JJ, Gandara B, Dworkin SF. Changes in temporomandibular pain and other symptoms across the menstrual cycle. Pain. 2003;106:253–261.PubMedCrossRefGoogle Scholar
  27. 27.
    LeResche L, Mancl LA, Drangsholt MT, Huang G, Von Korff M. Predictors of onset of facial pain and temporomandibular disorders in early adolescence. Pain. 2007;129:269–278.PubMedCrossRefGoogle Scholar
  28. 28.
    LeResche L, Mancl LA, Drangsholt MT, Saunders K, Korff MV. Relationship of pain and symptoms to pubertal development in adolescents. Pain. 2005;118:201–209.PubMedCrossRefGoogle Scholar
  29. 29.
    LeResche L, Sherman JJ, Huggins KH, Saunders K, Mancl LA, Lentz G, Dworkin SF. Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study. J Orofac Pain. 2005;19:193–201.PubMedGoogle Scholar
  30. 30.
    Leveille SG, Zhang Y, McMullen W, Kelly-Hayes M, Felson DT. Sex differences in musculoskeletal pain in older adults. Pain. 2005;116:332–338.PubMedCrossRefGoogle Scholar
  31. 31.
    Marcus DA. Clinical review: interrelationships of neurochemicals, estrogen, and recurring headache. Pain. 1995;62:129–139.PubMedCrossRefGoogle Scholar
  32. 32.
    Paller CJ, Campbell CM, Edwards RR, Dobs AS. Sex-based differences in pain perception and treatment. Pain Med. 2009;10:289–299.PubMedCrossRefGoogle Scholar
  33. 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
  34. 34.
    Pokela N, Bell JS, Lihavainen K, Sulkava R, Hartikainen S. Analgesic use among community-dwelling people aged 75 years and older: a population-based interview study. Am J Geriatr Pharmacother. 2010;8:233–244.PubMedCrossRefGoogle Scholar
  35. 35.
    Popescu A, LeResche L, Truelove EL, Drangsholt MT. Gender differences in pain modulation by diffuse noxious inhibitory controls—a systematic review. Pain. 2010;150:309–318.PubMedCrossRefGoogle Scholar
  36. 36.
    Raftery KA, Smith-Coggins R, Chen AH. Gender-associated differences in emergency department pain management. Ann Emerg Med. 1995;26:414–421.PubMedCrossRefGoogle Scholar
  37. 37.
    Ribeiro SC, Kennedy SE, Smith YR, Stohler CS, Zubieta JK. Interface of physical and emotional stress regulation through the endogenous opioid system and mu-opioid receptors. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29:1264–1280.PubMedCrossRefGoogle Scholar
  38. 38.
    Robinson ME, Riley JL 3rd, Myers CD, Papas RK, Wise EA, Waxenberg LB, Fillingim RB. Gender role expectations of pain: relationship to sex differences in pain. J Pain. 2001;2:251–257.PubMedCrossRefGoogle Scholar
  39. 39.
    Sadowski CA, Carrie AG, Grymonpre RE, Metge CJ, St John P. Access and intensity of use of prescription analgesics among older Manitobans. Can J Clin Pharmacol. 2009;16:e322–e330.PubMedGoogle Scholar
  40. 40.
    Safdar B, Heins A, Homel P, Miner J, Neighbor M, DeSandre P, Todd KH; Pain and Emergency Medicine Initiative Study Group. Impact of physician and patient gender on pain management in the emergency department—a multicenter study. Pain Med. 2009;10:364–372.PubMedCrossRefGoogle Scholar
  41. 41.
    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;26:5777–5785.PubMedCrossRefGoogle Scholar
  42. 42.
    Somerville BW. The influence of progesterone and estradiol upon migraine. Headache. 1972;12:93–102.PubMedCrossRefGoogle Scholar
  43. 43.
    Spies-Dorgelo MN, van der Windt DA, Prins AP, Dziedzic KS, van der Horst HE. Clinical course and prognosis of hand and wrist problems in primary care. Arthritis Rheum. 2008;59:1349–1357.PubMedCrossRefGoogle Scholar
  44. 44.
    Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the UW workforce. JAMA. 2003;290:2443–2454.PubMedCrossRefGoogle Scholar
  45. 45.
    Stubbs D, Krebs E, Bair M, Damush T, Wu J, Sutherland J, Kroenke K. Sex differences in pain and pain-related disability among primary care patients with chronic musculoskeletal pain. Pain Med. 2010;11:232–239.PubMedCrossRefGoogle Scholar
  46. 46.
    Stutts LA, Hirsh AT, George SZ, Robinson ME. Investigating patient characteristics on pain assessment using virtual human technology. Eur J Pain. 2010;14:1040–1045.PubMedCrossRefGoogle Scholar
  47. 47.
    Unruh AM, Ritchie J, Mersky H. Does gender affect appraisal of pain and pain coping strategies? Clin J Pain. 1999;15:31–40.PubMedCrossRefGoogle Scholar
  48. 48.
    Von Korff M, Dworkin SF, LeResche L, Kruger A. An epidemiologic comparison of pain complaints. Pain. 1988;32:173–183.CrossRefGoogle Scholar
  49. 49.
    Von Korff M, LeResche L, Dworkin SF. First onset of common pain symptoms: a prospective study of depression as a risk factor. Pain. 1993;55:251–258.CrossRefGoogle Scholar
  50. 50.
    Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50:133–149.CrossRefGoogle Scholar
  51. 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
  52. 52.
    Wijnhoven HA, de Vet HC, Picavet HS. Prevalence of musculoskeletal disorders is systematically higher in women than in men. Clin J Pain. 2006;22:717–724.PubMedCrossRefGoogle Scholar
  53. 53.
    Wijnhoven HA, de Vet HC, Picavet HS. Sex differences in consequences of musculoskeletal pain. Spine (Phila Pa 1976). 2007;32:1360–1367.CrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  1. 1.Department of Oral MedicineUniversity of WashingtonSeattleUSA
  2. 2.Department of Oral BiologyUniversity of WashingtonSeattleUSA
  3. 3.Group Health Research InstituteSeattleUSA

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