Sex Differences in Pain and Pain‐Related Disability among Primary Care Patients with Chronic Musculoskeletal Pain

Regenstrief Institute, Inc., Indianapolis, Indiana
Pain Medicine (Impact Factor: 2.3). 01/2010; 11(2):232 - 239. DOI: 10.1111/j.1526-4637.2009.00760.x


Background.  Although previous research suggests women report more severe pain than men, evidence for sex-related differences in pain-related disability is conflicting. Also, the impact of psychological factors on sex differences in disability is uncertain.Objective.  The purpose of this study is to assess sex differences in pain-related disability and evaluate whether they are accounted for by psychological factors.Methods.  Analysis of baseline data from the Stepped Care for Affective disorders and Musculoskeletal Pain study. Participants included 241 male and 249 female primary care patients with moderately severe persistent pain of the back, hip, or knee. Multivariable log-linear models were used to determine the association between sex and pain-related disability and whether sex differences persisted after adjustment for psychiatric comorbidity and potential psychological mediators.Results.  Compared with men, women reported worse pain intensity, greater pain-related interference with function, and more disability days due to pain. They also had worse depression, anxiety, and self-efficacy. Sex differences in pain interference with function and pain disability days remained significant in multivariable models. Depression, poor self-efficacy, and fear of reinjury were independently associated with disability in both men and women.Conclusions.  Women report greater pain-related disability than do men, even after controlling for depression, anxiety, and other psychological factors. Pain management strategies that target functional disability may be particularly important in the treatment of women with pain.

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    • "More women than men were referred to rehabilitation. An explanation could be simply the fact that the prevalence of pain is higher in women than men [37], [38]. Another explanation could be that men with pain are more often referred to specialist treatment and therefore get more precise diagnoses and treatment than women [7]. "
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    ABSTRACT: Background There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education. Methods The population consisted of consecutive patients (n = 595 women, 266 men) referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS). Results Low-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30–0.98), even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high- and low-educated men. Conclusion Our findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.
    Full-text · Article · May 2014 · PLoS ONE
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    • "However, it has been reported that female healthcare professionals considered pain behaviors more acceptable than their male counterparts [19]. Similarly, it has also been reported that women who have chronic musculoskeletal pain have greater pain-related disability than do men [20]. This may be pertinent to physiotherapy and nursing cohorts, where high levels of occupational LBP [18, 21] and predominance of the female gender are present. "
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    ABSTRACT: Objectives. Beliefs held by healthcare providers are part of the complex recovery of a patient with low-back pain (LBP). The aim of this study was to investigate the attitudes and beliefs of Irish university healthcare students towards LBP. Methods. Physiotherapy (n = 107), medicine (n = 63), nursing, and midwifery (n = 101) students completed the survey. Demographic data, LBP related beliefs [Back Beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire physical subsection (FABQ-PA)] were collected. Results. Two hundred and seventy-one students responded (response rate 29%). Student physiotherapists had significantly lower FABQ (P < 0.001) scores than medical (95% CI [−5.492, −1.406]) and nursing students (95% CI [−7.718, −22.307]). Physiotherapy students had significantly higher BBQ scores (P < 0.0001) than medical (95% CI [1.490, 5.406]) and nursing students (95% CI [6.098, 11.283]). Beliefs of physiotherapy and medical students were significantly better among fourth-year year than first-year students (P < 0.0001) but were not significantly different for nursing students (P = 0.820 for FABQ and P = 0.810 for BBQ). Conclusions. Physiotherapy students had more positive beliefs towards LBP than medical and nursing students. Physiotherapy and medical students' beliefs towards LBP significantly improved over the course of their studies.
    Full-text · Article · Apr 2014 · Pain Research and Treatment
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    • "Clinically this is relevant because research has demonstrated that a greater percentage of chronic pain sufferers are women [4] [7]. Women also report more areas of bodily pain [8] [9] and more pain-related disability compared to men [10]. Given that pain is such a prevalent and debilitating condition with serious health and economic consequences, the Institute of Medicine has stressed the need to improve healthcare delivery of pain management , including individualized treatment approaches [1]. "
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    ABSTRACT: The purpose of this paper was to examine the relationship of sex and pain-related fear in pain intensity reports to thermal stimuli and whether sex differences in reported pain intensity were mediated by pain-related fear. 177 participants, 124 female (23.5 ± 4.5 years old), filled out a demographic and fear of pain questionnaire (FPQ-III). Experimental pain testing was performed using thermal stimuli applied to the lower extremity. Participants rated the intensity of pain using the numerical pain rating scale (NPRS). Independent t-tests, Sobel's test, and linear regression models were performed to examine the relationships between sex, fear of pain, and pain sensitivity. We found significant sex differences for thermal pain threshold temperatures (t = 2.04, P = 0.04) and suprathreshold pain ratings for 49°C (t = -2.12, P = 0.04) and 51°C (t = -2.36, P = 0.02). FPQ-severe score mediated the effect of suprathreshold pain ratings of 49° (t = 2.00, P = 0.05), 51° (t = 2.07, P = 0.04), and pain threshold temperatures (t = -2.12, P = 0.03). There are differences in the pain sensitivity between sexes, but this difference may be mediated by baseline psychosocial factors such as fear of pain.
    Full-text · Article · Jan 2014 · Pain Research and Treatment
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