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Overall, each study reported sex differences in at least one pain outcome, but, similar to heat pain, discrepancies among pain outcomes occur between indices of cold pain within studies. For example, Jones et al205 observed sex-related differences for cold pain tolerance but not threshold. Based on the present set of studies, it appears that sex differences in cold pain are consistent, particularly for suprathreshold measures such as tolerance and pain ratings.
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Moreover, the inconsistency of findings from brain imaging studies can be attributed not only to the vast methodological differences across studies but also to their small sample sizes. Sex differences in endogenous pain modulation have received more limited attention, but the available evidence suggests that males and females may differ in this regard as well, though the direction and magnitude of the effects are quite variable. The mechanisms and practical importance of these sex differences merit further investigation in future studies.
- Also, only recently has evidence emerged indicating that men may exhibit greater DNIC than women, and recent findings suggest that DNIC may be particularly predictive of clinical pain.101,108,453 Additional data regarding sex differences in responses to analgesic medications have been quite mixed and general conclusions are difficult to draw.
- The goal of this section is to examine whether more recent studies corroborate these findings.
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- Consistent with our previous reviews, current human findings regarding sex differences in experimental pain indicate greater pain sensitivity among females compared with males for most pain modalities, including more recently implemented clinically relevant pain models such as temporal summation of pain and intramuscular injection of algesic substances.
- The article concludes with a discussion of potential biopsychosocial mechanisms that may underlie sex differences in pain, and considerations for future research are discussed.
- A number of recent studies have tested for sex differences in chronic musculoskeletal pain at any site.
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However, 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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