Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings PMC
5 min readHowever, more females (33%) reported reduced activities of daily living due to pain compared with males (15%). Ritter et al329 followed a large sample of patients that received a total knee arthroplasty for 5 years. Men reported less pain than females before and at all time points after surgery, but the pre-post change in pain did not differ between men and women for any time period. Nikolajsen and others297 found no difference between men and women in the prevalence or intensity of chronic hip pain in 1231 patients who had undergone total hip arthroplasty 12 to 18 months previously.
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- A study that assessed pain in patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction at an outpatient facility in the United States did not find sex differences in pain at the immediate postoperative evaluation.398 However, on the first day after surgery, females had higher mean VAS pain scores than males.
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- In addition to those alluded to above, several subsequent reviews of this rapidly expanding literature have been provided, often focusing on particular segments of research regarding sex, gender, and pain.
This confidentiality promotes a safe environment where users can be their most authentic selves. The most studied of the endogenous pain modulatory systems is the endogenous opioid system, and sex differences in the functioning of this system could arise based on several different mechanisms. First, sex differences could result from differences in the distribution, expression or sensitivity of opioid receptors in regions of the central nervous system involved in nociceptive processing. At rest, women have shown higher ฮผ-opioid receptor binding in various cortical and subcortical brain regions than men,456 whereas men exhibited greater ฮผ-opioid receptor binding in several brain regions than women in response to experimentally induced muscle pain. These sex differences in both resting and pain-related ฮผ-opioid receptor binding may contribute not only to sex differences in basal pain perception but also to differences in sensitivity to opioid medications.
Differences in cerebral activation between males and females have been evaluated in a number of studies. Studies have examined brain activity through a number of methods including positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) in response to different pain modalities. Given the reported sex differences in experimental pain perception, the use of neuroimaging is a promising tool that may reveal sex differences in central representations of pain. Table 9 lists several studies that have compared the central processing of pain between males and females. These studies have revealed a number of common cortical and subcortical areas activated by pain, but they have also observed sex-specific areas of activation.