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"Multiple factors influence both clinical and experimental pain in a sex-dependent manner," stated Roger B. Fillingim, PhD, at the 20th Annual Scientific Meeting of the American Pain Society, held April 19-22, 2001, in Phoenix, Arizona. "Men and women are at different risks for developing pain."

Recent research has shown that a variety of chronic pain disorders are more common in women than in men, Fillingim said. Other studies point out that women report more pain in population-based surveys, and it has been demonstrated in experimental pain studies that women are more sensitive to pain. Women have lower pain thresholds, lower tolerance, and increased sensitivity to painful stimuli, these studies found.

Fillingim, of the University of Florida College of Dentistry, Public Health Services and Research, Gainesville, Florida, and his colleagues asked in their study: "Are these findings related? Are the laboratory findings related to the clinical findings? Are the findings linked by common mechanisms?"

They explored three sets of factors that seemed to influence pain reporting:

* psychological coping, including both passive coping and catastrophizing;

* sex hormones; and

* family history of pain

"What we find is that for women, sex hormones are definitely major factors influencing both experimental and clinical pain," stated Fillingim. Results of his study, he reported, "show that postmenopausal women using hormone replacement therapy (HRT) are more sensitive to pain than are their postmenopausal non-HRT using counterparts and men."

Data suggest that coping is related to both experimental and clinical pain. Fillingim referred to another study presented at the conference that showed a coping strategy known as catastrophizing (having strongly negative, almost hysterical emotions about a situation) plays a significant part in pain. Women who catastrophize report more intensity of pain than do women and men that do not catastrophize.

Passive coping (wishing it would go away, thinking you can't stand it any longer, etc.) also influenced pain reporting. Women using passive coping reported more pain than did women who didn't rely on this psychological mechanism. Men, whether they used passive coping or not, did not report significant differences in pain.

"Family history has about the same effect," added Fillingim. He and his colleagues found that more clinical pain and lower pain thresholds and tolerance were reported by women whose immediate family members said they were experiencing pain. Men did not show this effect.

"These are three separate factors that seem to influence pain more in women than in men and may certainly explain some of the sex differences and how women respond in terms of clinical pain," he stated.

Fillingim referred to other research that has demonstrated sex differences related to pain relief. These studies showed that women experience greater relief from kappa opioids and morphine; men show greater relief from ibuprofen and cutaneous anesthetic creams. When it comes to the practice of non-pharmacologic pain relief, women show greater improvements after rehabilitation and multidisciplinary treatment protocols than do men.

"We would like to heighten the awareness of the importance of sex as a factor that can influence pain," concluded Fillingim in his take-home message for attendees. "We are not yet at the point where we can tailor pain treatment for women versus men, but as we gather more research data, we hope that eventually we will have clinical guidelines that can be used to customize pain therapy depending on a patient's sex, psychological profile, and medical condition."

This article was prepared by Women's Health Weekly editors from staff and other reports.

Copyright 2000, Women's Health Weekly

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