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Pain perception to the cold pressor test during the menstrual cycle in relation to estrogen levels and a comparison with men

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Abstract

Animal and human research has shown that pain sensitivity changes during the menstrual cycle. This has sometimes been ascribed to hormonal variations. The aim of the present study was to examine how perception of pain, induced by the cold pressor test to the dominant hand, was related to gender and phases of the menstrual cycle. A repeated-meausres design was used, where twenty-two female students participated at two different phases of the menstrual cycle (days 2–4 and days 20–24). A control group of nineteen male students participated on two occasions, separated by a three week period. The cycle phase during which each woman began her participation was randomized. Pain was induced using the cold pressor test. Pain threshold was determined as the duration of time between when the subject first reported pain and exposure to the painful stimulus. Pain tolerance was determined as the duration of time until the subject withdraw her/his hand from the test water because the pain was too intensive. The results showed that men tolerated significantly greater pain than women. Women’s pain threshold was significantly higher during the second phase of the menstrual cycle. Systolic pressure was higher in men than women, increasing more in men in response to cold pressor testing than women. Further research, including measurments of plasma hormone levels during the menstrual cycle, is needed to clarify the role played by estrogens in pain perception.

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References

  • Amandusson, Å., Hallbeck, M., Hallbeck, A.L., Hermansson, O., and Blomqvist, A. (1999). Estrogen-induced alterations of spinal cord endkephalin gene expression.Pain 83, 243–248.

    Article  PubMed  Google Scholar 

  • Berkley, K.J. (1997). Sex differences in pain,Behavioral and Brain Sciences. 20 (3):371–380.

    PubMed  Google Scholar 

  • Borg, G. (1982). A category scale with ratio properties for intermodal and interindividual comparisons. In: Geissler H-G, Petzold P., eds.,Psychophysical Judgment and the Process of Perception. (pp. 25–33). Berlin: VEB Deutcher Verlag der Wissenschaften.

    Google Scholar 

  • Borg, G. (1990). A general model for interindividual comparison. In: Baker WJ, Hyland ME, van Henewijk R., Terwee S. (eds.)Recent Trends in Theoretical Psychology (pp. 439–444). New York: Springer Verlag.

    Google Scholar 

  • Buchanan, H. M., and Midgley, J.-A. (1987). Evalution of pain threshold using a simple pressure algometer.Clinical Rheumatology, 6:510–517.

    Article  PubMed  Google Scholar 

  • Feine, J.S., Bushnell, M.C., Miron, D., and Duncan G.H. (1991). Sex differences in the perception of noxious heat stimuli.Pain 44:255–262.

    Article  PubMed  Google Scholar 

  • Fillingim, R. B., and Maxiner, W. (1995). Gender differences in the responses to noxious stimuli.Pain Forum 4 (4):209–221.

    Article  Google Scholar 

  • Fillingim, R. B., Maxiner, W., Girdler, S. S., Light, K. C., Brennan Harris, M., Sheps, D. S., and Mason, G. A. (1997). Ischemic but not thermal pain sensitivity varies across the menstrual cycle.Psychosomatic Medicine 59:512–520.

    PubMed  Google Scholar 

  • Goolkasian, P. (1980). Cyclic changes in pain perception: An ROC analysis.Percept Psychofysics 27:499–504.

    Article  Google Scholar 

  • Goolkasian, P. (1983). An ROC analysis of pain reactions in dysmenorrheic and nondysmenorrheic woman.Percept Psychophysics 34:381–386.

    Article  Google Scholar 

  • Hahn, EF., and Fishman, J. (1985). Castration affects male rat brain opiate receptor content.Neuroendocrinology 41:60–63.

    Article  PubMed  Google Scholar 

  • Hammer, RPJ. (1984). The sexually dimorphic region of the preoptic area in rats contains denser receptor binding sites in females.Brain Research 308:172–176.

    Article  PubMed  Google Scholar 

  • Hapidou, EG., and De Catanzaro, D. (1988). Sensitivity to cold pressor pain in dysmenorrheic and nondysmenorrheic women as a function of menstrual cycle phase.Pain 34:277–283.

    Article  PubMed  Google Scholar 

  • Hastrup, J.L., Light, K. C., and Obrist, P.A. (1980). Relationship of cardiovascular stress response to parental history of hypertension and to sex differences.Psychophysiology 17:317–318.

    Google Scholar 

  • Hogeweg, J. A., Langereis, M. J., Bernards, A. T. M., Faber, J. A. J., and Helders, P. (1992). Measuring pain threshold, method and characteristics in healthy subjects.Scandinavian Journal of Rehabilitation Medicine, 24:99–103.

    PubMed  Google Scholar 

  • Honkasalo, M.-L. (1985). Om symtomens betydelse.Socialmedicinsk tidskrift 8–9:413–415.

    Google Scholar 

  • Honkasalo, M.-L. (1989). Kvinnors symptom-lidandet och njutningens språk?Kvinnovetenskaplig tidskrift 1: 12–21.

    Google Scholar 

  • Johanisson, K. (1995).Den mörka kontinenten. Kvinnan, medicinen och fin-de-siècle. Norsteds.

  • Kroenke, K., and Spitzer, R. L. (1998). Gender differences in the reporting of physical and somatoform symptoms.Psychosomatic Medicine 60: 150–155.

    PubMed  Google Scholar 

  • Larkin, WD., Reilly, JP., and Kittler, LB. (1986). Individual differences in sensitivity to transient electrocutaneous stimulation. IEEE TransBiomed Eng 33:495–504.

    Article  PubMed  Google Scholar 

  • Lautenbacher, S., and Strian, F. (1991). Sex differences in pain and thermal sensitivity: the role of body size.Percept Psychophysics 50: 179–183.

    Article  Google Scholar 

  • Levine, FM, and De Simone LL. (1991). The effects of experimenter gender on pain report in male and female subjects.Pain 44:69–72.

    Article  PubMed  Google Scholar 

  • Liberson, CW., and Liberson, WT. (1975). Sex differences in autonomic responses to electric shock.Psychophysiology 12:182–186.

    Article  PubMed  Google Scholar 

  • Linton, S. J. (1994). The role of psychological factors in back pain and its remediation.Pain Reviews, 1: 231–243.

    Google Scholar 

  • Löfvander, M. (1998). Smärtbeteende-symtom eller Kommunikation?Läkartidningen, 95 (11), 1112–1118.

    PubMed  Google Scholar 

  • Maixner, W., and Humphrey, C. (1993). Gender differences in pain and cardiovascular responses to forarm ischemia.Clinical Journal of Pain 8:16–25.

    Article  Google Scholar 

  • Meh, D., and Denislic, M. (1994). Quantitative assessment of thermal and pain sensitivity.Journal of Neurologic Science 127:164–169.

    Article  Google Scholar 

  • Merskey, H., and Spear, F. G. (1967).Pain: Psychological and Psychiatric Aspects. London, Baillière, Tindall & Cassell.

    Google Scholar 

  • Mirowsky, J., and Ross, C. E. (1995). Sex differences in distress: Real or artifact?American Sociological Review, 60, 449–468.

    Article  Google Scholar 

  • Otto, MW., and Dougher, MJ. (1985). Sex differences and personality factors in responsivity to pain.Perceptual and Motor Skills 61:383–390.

    PubMed  Google Scholar 

  • Polefrone, J.M., and Manuck, S.B. (1988). Effects of menstrual phase and parental history of hypertension on cardiovascular response to cognitive challenge.Psychosomatic Medicine 50:26–36.

    Google Scholar 

  • Procacci, P., Zoppi, M., Maresca, M. et al., (1974). Studies of the pain threshold in man. Bonica JJ (ed)Advances in Neurology. New York, Raven Press Vol 4: 107–113.

    Google Scholar 

  • Riley, JL., Robinson, ME., Wise, EA., and Price, DD. (1999). A meta-analytic review of pain perception across the menstrual cycle.Pain 81:225–235.

    Article  PubMed  Google Scholar 

  • Rao, SS., Ranganekar, AG., and Saifi, AQ. (1987). Pain threshold in relation to sex hormones.Indian J Physiol Pharmacol 31:250–254.

    PubMed  Google Scholar 

  • Romano, G.J., Harlan, R. E., Shivers, B. D., Howells, R. D., and Pfaff, D.W. (1988). Estrogen increases proenkephalin messenger ribonucleic acid levels in the ventromedical hypothalamus of the rat.Molecular Endocrinology 2:1320–1328.

    Article  PubMed  Google Scholar 

  • Ryan, S. R., and Maier, S. F. (1988). The estrous cycle and estrogen modulate stress-induced analgesia.Behaviour Neuroscience 102:371–380.

    Article  Google Scholar 

  • Schalling, D. (1986). The development of the KSP-inventory. In B. af Klinteberg, D. Schalling, and D. Magnusson (eds.),Self-report assessment of personality traits. Reports from the Project Individual Development and Adjustment, Department of Psychology, University of Stockholm, No. 64.

  • Schalling, D., Edman G., and Åsberg, M. (1983). Impulsive cognitive style and inability to tolerate boredom: Psychobiological studies of temperamental vulnerability. In M. Zukerman (ed.),Biological bases of sensation seeking, impulsivity and anxiety. Hillsdale, NewJersey: Lawrence Erlbaum Associates.

    Google Scholar 

  • Schalling, D., Åsberg, M., Edman, G., and Oreland, L. (1987). Markers for vulnerability to psychopathology: Temperaments, traits associated with platelet MAO activity.Acta Psychiatrica Scandinavica 76:172–182.

    Article  PubMed  Google Scholar 

  • Sternbach, R. A. (1975). Psychology of pain.International Journal of Psychiatry in Medicine 6:63–73.

    Article  PubMed  Google Scholar 

  • Stoney, C.M., Davis, M.C., and Matthews, K.A. (1987). Sex differences in physiological responses to stress and in coronary heart disease: A casual link?Phychophysiology 24: 127–131.

    Article  Google Scholar 

  • Tedford, WH., Warren, DEJ, and Flynn, WE. (1977). Alteration of shock aversion thresholds during the menstrual cycle.Percept Psychophysics 21:193–196.

    Article  Google Scholar 

  • Tersman, Z., Collins, A., and Eneroth, P. (1991). Cardiovascular responses to psychological and physiological stressors during the menstrual cycle.Psychomatic Medicine 53:185–197.

    Google Scholar 

  • Tibblin, G., Bengtsson, C., Furunes, B., and Lapidus, L. (1990). Symptoms by age and sex.Scandinavian Journal of Primary Health Care 8:9–17.

    Article  PubMed  Google Scholar 

  • Turner, J.R. (1994).Cardiovascular Reactivity and Stress. Patterns of Physiological Response. Plenum Press, New York.

    Google Scholar 

  • Velle, W. (1987). Sex differences in sensory functions.percept Biological Medicine 30: 490–522.

    Google Scholar 

  • Woodrow, K. M., Friedman, G., Sieglaub, A. B., and Collen, M. F. (1972). Pain tolerance: Differences according to age, sex and race.Psychosomatic Medicine 34(6):548–556.

    PubMed  Google Scholar 

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Hellström, B., Lundberg, U. Pain perception to the cold pressor test during the menstrual cycle in relation to estrogen levels and a comparison with men. Integrative Physiological and Behavioral Science 35, 132–141 (2000). https://doi.org/10.1007/BF02688772

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