Skip to main content

Schmerzmedizin aus einer interkulturellen und geschlechterspezifischen Perspektive

Pain medicine from intercultural and gender-related perspectives

Zusammenfassung

Sowohl die Sozialisation als auch das Geschlecht des Schmerzpatienten scheinen Bedeutung für die Art und Schwere der Symptome, den Umgang mit ihnen sowie die Prognose und den Therapieerfolg zu haben. Interkulturell sind die unterschiedliche Wahrnehmung und sprachliche Umsetzung körperlicher und emotionaler Funktionen und Beschwerden von elementarer Bedeutung, wenn man Schmerzklagen von Menschen mit Migrationshintergrund verstehen will. Wesentlich ist, dass die schon mit Patienten aus unserem Kulturkreis schwierige Gestaltung der gelingenden Arzt-Patient-Beziehung dadurch weiter problematisiert ist, weil das Verstehen maßgeblich durch den kulturellen Hintergrund geprägt wird. In epidemiologischen Studien überwiegt das weibliche Geschlecht fast einheitlich hinsichtlich der Prävalenz von Schmerzen und Schmerzerkrankungen. Allerdings weisen neuere Untersuchungen darauf hin, dass diese Unterschiede möglicherweise geringer als primär angenommen und möglicherweise sekundär durch Begleiterkrankungen und psychosoziale Faktoren erklärbar sind, die bei Frauen vermehrt auftreten, z. B. Depressionen und Katastrophisierungsneigung. Biologische Faktoren scheinen zwar von Bedeutung zu sein; dies spiegelt sich aber weniger in simplen somatischen Veränderungen, z. B. verminderten Schmerzschwellen, wider als in komplexen genetischen, psychologischen und hormonell bedingten Interaktionen. Bildgebende und psychophysiologische Untersuchungen deuten auf eine besondere Bedeutung der Beeinflussung hemmender Einflüsse aus dem zentralen Nervensystem hin. Inwieweit diese Aspekte klinische Relevanz haben und welche therapeutischen Aspekte bei Männern und Frauen möglicherweise differenziert beachtet werden müssen, ist aber bisher noch ziemlich unklar. Vor allem humane experimentelle Untersuchungen und Studien mit Patienten sind erforderlich, um hier Klarheit zu schaffen.

Abstract

Cultural setting and sex and gender of the patient are important factors affecting the occurrence, severity, clinical course and prognosis of pain and pain-related diseases. Intercultural differences in the perception and verbal expression of symptoms and emotional function are fundamental and it is important to realize these differences in order to understand patients with a migration background. A trusting doctor-patient relationship is generally very sensitive and it is even more difficult to establish when differences in the cultural background impair mutual understanding. Regarding sex and gender there is evidence that females are more susceptible to developing chronic pain conditions, experience more severe pain and respond differently to pain therapy; however, results of recent studies indicate that females are not that different to males when comparing several modalities of experimental pain (although some differences exist). Similarly, sex and gender differences in postoperative pain seem to exist but the differences are relatively small when pain scores are compared. Other aspects, such as the response to analgesics and role of psychosocial factors should be addressed when sex and gender aspects are studied. Similarly, sex and gender differences in the prevalence of chronic pain exist but the results of some studies, e.g. those controlling for confounders, are not very clear. Research is needed to delineate the role of specific aspects affecting sex and gender differences and the underlying mechanisms (e.g. reduced inhibitory control, hormones, psychological aspects and social factors). Altogether, we need to open our minds to some intercultural and sex and gender aspects in the clinical setting. For sex and gender differences we may need a more biopsychosocial approach to understand the underlying differences and differentiate between sex and gender and sex and gender-associated aspects for acute and chronic pain.

This is a preview of subscription content, access via your institution.

Literatur

  1. 1

    Baarnhielm S (2004) Restructuring illness meaning through the clinical encounter: a process of disruption and coherence. Cult Med Psychiatry 28:41–65

    Article  PubMed  Google Scholar 

  2. 2

    Bartley EJ, Fillingim RB (2013) Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth 111:52–58

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  3. 3

    Berkley KJ (1992) Vive la difference! Trends Neurosci 15:331–332

    CAS  Article  PubMed  Google Scholar 

  4. 4

    Berkley KJ (1997) Sex differences in pain. Behav Brain Sci 20:371–380, 435–513

    CAS  PubMed  Google Scholar 

  5. 5

    Csordas TJ (1994) Embodiment and experience. The existential ground of culture and self. Cambridge University Press, Cambrigde (Cambridge Studies in Medical Anthropology)

    Google Scholar 

  6. 6

    Ebigbo PO (1997) Somatisierungserscheinungen bei Nigerianern in Psychiatrie im Kulturvergleich. VWB, Berlin

    Google Scholar 

  7. 7

    Edmond SN, Keefe FJ (2015) Validating pain communication: current state of the science. Pain 156:215–219

    Article  PubMed  Google Scholar 

  8. 8

    Fillingim RB, King CD, Ribeiro-Dasilva MC et al (2009) Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 10:447–485

    PubMed Central  PubMed  Google Scholar 

  9. 9

    Fillingim RB, Maixner W, Kincaid S et al (1998) Sex differences in temporal summation but not sensory-discriminative processing of thermal pain. Pain 75:121–127

    CAS  Article  PubMed  Google Scholar 

  10. 10

    Finocchi C, Strada L (2014) Sex-related differences in migraine. Neurol Sci 35(Suppl 1):207–213

    Article  PubMed  Google Scholar 

  11. 11

    Flood P, Wong CA (2013) Chronic pain secondary to childbirth: does it exist? Anesthesiology 118:16–18

    Article  PubMed  Google Scholar 

  12. 12

    Freudenmann RW, Schonfeldt-Lecuona C (2005) Das Syndrom der genitalen Retraktion aus Sicht der transkulturellen Psychiatrie. Chinesisches Suo yang, Indonesisches Koro und nichtasiatische Formen (Koro-ähnliche Symptome). Nervenarzt 76:569–580

    CAS  Article  PubMed  Google Scholar 

  13. 13

    Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S et al (2014) Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology 120:1237–1245

    Article  PubMed  Google Scholar 

  14. 14

    Greenspan JD, Craft RM, Leresche L et al (2007) Studying sex and gender differences in pain and analgesia: a consensus report. Pain 132(Suppl 1):S26–S45

    Google Scholar 

  15. 15

    https://www.destatis.de/DE/PresseService/Presse/Pressemitteilungen/2014/06/PD14_193_125.html. Zugegriffen: 23. Juni 2015

  16. 16

    http://www.iasp-pain.org/SIG/SexGender. Zugegriffen: 23. Juni 2015

  17. 17

    Hauser W, Kuhn-Becker H, Von Wilmoswky H et al (2011) Demographic and clinical features of patients with fibromyalgia syndrome of different settings: a gender comparison. Gend Med 8:116–125

    Article  PubMed  Google Scholar 

  18. 18

    Juni A, Cai M, Stankova M et al (2010) Sex-specific mediation of opioid-induced hyperalgesia by the melanocortin-1 receptor. Anesthesiology 112:181–188

    CAS  Article  PubMed  Google Scholar 

  19. 19

    Kirmayer LJ (2001) Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. J Clin Psychiatry 62(Suppl 13):22–28

    PubMed  Google Scholar 

  20. 20

    Kirmayer LJ, Groleau D (2001) Affective disorders in cultural context. Psychiatr Clin North Am 24:465–478

    CAS  Article  PubMed  Google Scholar 

  21. 21

    Kraus M (2006) Somatisierung im kulturellen Kontext. In: Wohlfart E, Zaumseil M (Hrsg) Transkulturelle Psychiatrie – Interkulturelle Psychotherapie. Springer, Heidelberg, S 364–376

    Google Scholar 

  22. 22

    Kunz M, Gruber A, Lautenbacher S (2006) Sex differences in facial encoding of pain. J Pain 7:915–928

    PubMed  Google Scholar 

  23. 23

    Laderman C (1992) Malay medicine, Malay person. In: Nichter M (Hrsg) Anthropological approaches to the study of ethnomedicine. OPA, Amsterdam

  24. 24

    Linton SJ (2015) Intricacies of good communication in the context of pain: does validation reinforce disclosure? Pain 156:199–200

    Article  PubMed  Google Scholar 

  25. 25

    Maixner W, Fillingim R, Booker D et al (1995) Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain 63:341–351

    CAS  Article  PubMed  Google Scholar 

  26. 26

    Mogil JS, Wilson SG, Chesler EJ et al (2003) The melanocortin-1 receptor gene mediates female-specific mechanisms of analgesia in mice and humans. Proc Natl Acad Sci U S A 100:4867–4872

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  27. 27

    Niesters M, Dahan A, Kest B et al (2010) Do sex differences exist in opioid analgesia? A systematic review and meta-analysis of human experimental and clinical studies. Pain 151:61–68

    Article  PubMed  Google Scholar 

  28. 28

    Popescu A, Leresche L, Truelove EL et al (2010) Gender differences in pain modulation by diffuse noxious inhibitory controls: a systematic review. Pain 150:309–318

    Article  PubMed  Google Scholar 

  29. 29

    Racine M, Tousignant-Laflamme Y, Kloda LA et al (2012) A systematic literature review of 10 years of research on sex/gender and experimental pain perception – part 1: are there really differences between women and men? Pain 153:602–618

    Article  PubMed  Google Scholar 

  30. 30

    Racine M, Tousignant-Laflamme Y, Kloda LA et al (2012) A systematic literature review of 10 years of research on sex/gender and pain perception – part 2: do biopsychosocial factors alter pain sensitivity differently in women and men? Pain 153:619–635

    Article  PubMed  Google Scholar 

  31. 31

    Ruda MA (1993) Gender and pain. Pain 53:1–2

    CAS  Article  PubMed  Google Scholar 

  32. 32

    Schnabel A, Poepping DM, Gerss J et al (2012) Sex-related differences of patient-controlled epidural analgesia for postoperative pain. Pain 153:238–244

    Article  PubMed  Google Scholar 

  33. 33

    Sherman JJ, Leresche L (2006) Does experimental pain response vary across the menstrual cycle? A methodological review. Am J Physiol Regul Integr Comp Physiol 291:R245–R256

    Article  Google Scholar 

  34. 34

    Singelis TM, Sharley WF (1995) Culture, self-construal, and embarrassability. J Cross Cult Psychol 26:622–644

    Article  Google Scholar 

  35. 35

    Smith YR, Stohler CS, Nichols TE et al (2006) Pronociceptive and antinociceptive effects of estradiol through endogenous opioid neurotransmission in women. J Neurosci 26:5777–5785

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  36. 36

    Stewart SH, Taylor S, Baker JM (1997) Gender differences in dimensions of anxiety sensitivity. J Anxiety Disord 11:179–200

    CAS  Article  PubMed  Google Scholar 

  37. 37

    Stewart WF, Linet MS, Celentano DD et al (1991) Age- and sex-specific incidence rates of migraine with and without visual aura. Am J Epidemiol 134:1111–1120

    CAS  PubMed  Google Scholar 

  38. 38

    Tousignant-Laflamme Y, Marchand S (2009) Excitatory and inhibitory pain mechanisms during the menstrual cycle in healthy women. Pain 146:47–55

    Article  PubMed  Google Scholar 

  39. 39

    Unruh AM (1996) Gender variations in clinical pain experience. Pain 65:123–167

    CAS  Article  PubMed  Google Scholar 

  40. 40

    Vincent K, Warnaby C, Stagg CJ et al (2013) Brain imaging reveals that engagement of descending inhibitory pain pathways in healthy women in a low endogenous estradiol state varies with testosterone. Pain 154:515–524

    CAS  Article  PubMed  Google Scholar 

  41. 41

    Werber A, Zimmermann-Stenzel M, Moradi B et al (2014) Awareness of the German population of common available guidelines of how to cope with lower back pain. Pain Physician 17:217–226

    PubMed  Google Scholar 

  42. 42

    White KP, Speechley M, Harth M et al (1999) The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. J Rheumatol 26:1570–1576

    CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to M. Schiltenwolf.

Ethics declarations

Interessenkonflikt

M. Schiltenwolf und E.M. Pogatzki-Zahn geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schiltenwolf, M., Pogatzki-Zahn, E. Schmerzmedizin aus einer interkulturellen und geschlechterspezifischen Perspektive. Schmerz 29, 569–575 (2015). https://doi.org/10.1007/s00482-015-0038-9

Download citation

Schlüsselwörter

  • Geschlechtsbezogene Unterschiede
  • Arzt-Patient-Beziehung
  • Interkulturelle Unterschiede
  • Epidemiologie
  • Migrationshintergrund

Keywords

  • Sex differences
  • Physician-patient relations
  • Intercultural differences
  • Epidemiology
  • Migration background