Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings

Roger B. Fillingim, PhD

University of Florida College of Dentistry
North Florida/South Georgia Veterans Health System
Gainesville, Florida

The effects of sex and gender on the subjective experience of pain and analgesic response have generated marked scientific and clinical interest over the last decade. Women are at greater risk for many painful conditions and are more sensitive to experimentally induced pain. Gender differences are observed in responses to pharmacologic and nonpharmacologic treatments as well. For instance, physical therapy appears to be more effective for men with back pain, whereas women may respond betted to intensive dynamic back exercises. These observed pain-related gender differences are governed by intimately related biological and psychosocial mechanisms, including stereotypic gender roles; coping and catastrophizing; gonadal hormones, and the endogenous dopaminergic, serotonergic, and opioid systems. Clinicians should consider sex differences in pain be taken into consideration in clinical pain management. Identifying genetic, psychological, and environmental contributions to sex differences in pain perception and analgesia may lead to sex-specific assessment approaches, diagnostic criteria, and management strategies for certain pain disorders.

References

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.
Greenspan JD, Craft RM, LeResche L, et al. Studying sex and gender differences in pain and analgesia: A consensus report. Pain. 2007; 132 Suppl 1:S26-S45.
Unruh AM. Gender variations in clinical pain experience. Pain. 1996;65:123-167.
Hansen FR, Bendix T, Skov P, et al. Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain: A randomized, observer-blind trial. Spine. 1993;18:98-108.

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