Skip to main content

Advertisement

Log in

Defining Gender Disparities in Pain Management

  • Symposium:AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium
  • Published:
Clinical Orthopaedics and Related Research®

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Berkley KJ. Sex differences in pain. Behav Brain Sci. 1997;20:371–380.

    PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  3. Cairns BE, Gazerani P. Sex-related differences in pain. Maturitas. 2009;63:292–296.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  7. Dworkin SF, Von Korff MR, LeResche L. Multiple pains and psychiatric disturbance: an epidemiologic investigation. Arch Gen Psychiatry. 1990; 47:239–244.

    PubMed  CAS  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  12. Fillingim RB, Gear RW. Sex differences in opioid analgesia: clinical and experimental findings. Eur J Pain. 2004;8:413–425.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google 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 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  31. Marcus DA. Clinical review: interrelationships of neurochemicals, estrogen, and recurring headache. Pain. 1995;62:129–139.

    Article  PubMed  CAS  Google Scholar 

  32. Paller CJ, Campbell CM, Edwards RR, Dobs AS. Sex-based differences in pain perception and treatment. Pain Med. 2009;10:289–299.

    Article  PubMed  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 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  36. Raftery KA, Smith-Coggins R, Chen AH. Gender-associated differences in emergency department pain management. Ann Emerg Med. 1995;26:414–421.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  42. Somerville BW. The influence of progesterone and estradiol upon migraine. Headache. 1972;12:93–102.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  47. Unruh AM, Ritchie J, Mersky H. Does gender affect appraisal of pain and pain coping strategies? Clin J Pain. 1999;15:31–40.

    Article  PubMed  CAS  Google Scholar 

  48. Von Korff M, Dworkin SF, LeResche L, Kruger A. An epidemiologic comparison of pain complaints. Pain. 1988;32:173–183.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  50. Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50:133–149.

    Article  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 

  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.

    Article  PubMed  Google Scholar 

  53. Wijnhoven HA, de Vet HC, Picavet HS. Sex differences in consequences of musculoskeletal pain. Spine (Phila Pa 1976). 2007;32:1360–1367.

    Article  Google Scholar 

Download references

Acknowledgments

I thank the editors and anonymous reviewers for helpful suggestions.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Linda LeResche ScD.

Additional information

The institution of the author (LL) has received funding from Johnson & Johnson (New Brunswick, NJ). The author is an investigator on this grant. The author certifies that she has no other commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

About this article

Cite this article

LeResche, L. Defining Gender Disparities in Pain Management. Clin Orthop Relat Res 469, 1871–1877 (2011). https://doi.org/10.1007/s11999-010-1759-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-010-1759-9

Keywords

Navigation