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Minding god/minding pain: Christian theological reflections on recent advances in pain research
Abstract
As Gregory Peterson's book Minding God illustrates, an ongoing encounter between theology and the cognitive sciences can provide rich insights to both disciplines. Similarly, reflection on recent advances in pain research can prove to be fertile ground in which further theological insights might take root. Pain researchers remind us that pain is both a sensory and an emotional experience. The emotional component of pain is critically important for the clinical management of people in pain, as it serves a communicative function—human connection occurs more readily through the expression of and response to emotion than through the sterile exchange of “objective” descriptions of sensory phenomena. But emotion, pain and communication also figure prominently in Christian theology. For example, doctrines of incarnation and eschatology raise questions about suffering, healing, and hope as well as about the nature of the divine–human relationship. In addition, there seems to be scientific evidence for (admittedly subtle) gender differences in the perception of and response to pain. Several feminist theologians have noted that a habitual theological emphasis on God's rationality tends to reinforce masculine images of God and demeans the validity of emotion in the divine-human relationship. Potential theological implications of the emotional and communicative aspects of pain and how this might affect women's religious experience-with a particular focus on Teresa of Avila-are explored.
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The analgesia produced by inhibitory G protein-coupled receptor agonists involves coordinated postsynaptic inhibition via G protein-coupled inwardly rectifying potassium channels (GIRKs) and presynaptic inhibition of neurotransmitter release through regulation of voltage-gated Ca(2+) channels. Here, we used mice lacking the GIRK2 channel subunit to assess the relative contribution of these two effector systems to nociceptive processing in male and female mice. Compared with female WT mice, male WT mice exhibited higher pain thresholds and enhanced opioid (morphine) and alpha(2)-adrenergic (clonidine) receptor-induced antinociception in a spinal reflex test. The GIRK2-null mutation reduced the "pain" threshold in male but not in female mice, effectively eliminating the sex differences in pain threshold. In addition, deletion of GIRK2 channels in mutant mice largely eliminated clonidine antinociception and significantly decreased morphine antinociception. Furthermore, the more pronounced morphine and clonidine-induced antinociception in male mice disappeared in the GIRK2 mutants. Based on the almost complete loss of clonidine-induced antinociception in the mutant mice, we conclude that it is primarily mediated by postsynaptic alpha(2)-adrenergic receptors. In contrast, the significant residual morphine effect in the mutant mice points to the presynaptic mu opioid receptor as a major contributor to its analgesic action. Finally, our results suggest that the reduced pain responsiveness of male compared with female mice results in part from GIRK2-coupled postsynaptic receptors that are activated by endogenous antinociceptive systems.
Christology claims a universal significance for Christ. Contemporary Christologies struggle with the implications of this claim, raising questions about the inclusivity of Christology from many perspectives, including questions arising from Jewish-Christian dialogue, dialogue with other religions, and most recently ecological concerns. My focus is on the inclusion of women in our understanding of Christology.
1st Issued as Paperback Bibliogr. na konci kapitol
Identifying the cancer patient who is at increased risk for suicide is the first step in prevention, and allows for appropriate psychosocial interventions to be initiated. The author presents a list of vulnerability factors that contribute to high suicide potential.
The question of suffering and its relation to organic illness has rarely been addressed in the medical literature. This article offers a description of the nature and causes of suffering in patients undergoing medical treatment. A distinction based on clinical observations is made between suffering and physical distress. Suffering is experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity. Suffering can include physical pain but is by no means limited to it. The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians' failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.
Pain is an important focus for consciousness research because it is an avenue for exploring somatic awareness, emotion, and the genesis of subjectivity. In principle, pain is awareness of tissue trauma, but pain can occur in the absence of identifiable injury, and sometimes substantive tissue injury produces no pain. The purpose of this paper is to help bridge pain research and consciousness studies. It reviews the basic sensory neurophysiology associated with tissue injury, including transduction, transmission, modulation, and central representation. In addition, it highlights the central mechanisms for the emotional aspects of pain, demonstrating the physiological link between tissue trauma and mechanisms of emotional arousal. Finally, we discuss several current issues in the field of pain research that bear on central issues in consciousness studies, such as sickness and sense of self.
The affective dimension of pain is made up of feelings of unpleasantness and emotions associated with future implications,
termed secondary affect. Experimental and clinical studies show serial interactions between pain sensation intensity, pain
unpleasantness, and secondary affect. These pain dimensions and their interactions relate to a central network of brain structures
that processes nociceptive information both in parallel and in series. Spinal pathways to limbic structures and medial thalamic
nuclei provide direct inputs to brain areas involved in affect. Another source is from spinal pathways to somatosensory thalamic
and cortical areas and then through a cortico-limbic pathway. The latter integrates nociceptive input with contextual information
and memory to provide cognitive mediation of pain affect. Both direct and cortico-limbic pathways converge on the same anterior
cingulate cortical and subcortical structures whose function may be to establish emotional valence and response priorities.
The aim of this investigation was to evaluate whether the pressure pain threshold (PPT) in masticatory muscles of symptom-free subjects was influenced by fluctuations of the sex hormones. The PPT was measured with an electronic algometer for at least 10 consecutive menstrual cycles in 10 women using oral contraceptives and 10 women not using oral contraceptives, with a regular menstrual cycle (26-31 days). In addition, 10 men were measured in a regular pattern over a period of 1 year. All subjects were symptom-free with an age range between 18 and 39 years. Measurement sessions were held during three different cycle phases (follicular, luteal, perimenstrual) and each session consisted of four consecutive PPT measurements. By means of a linear mixed model (SAS), the PPTs of the masster, temporalis and thumb muscles were compared between: (1) groups, (2) sex-hormonal phases, (3) the four consecutive measurements of each muscle per session and (4) time. The PPTs of the masseter (p = 0.8419) and temporalis muscles (p = 0.2786) did not change significantly over time. There was no significant difference in variance for the masseter (p = 0.6250), temporalis (p = 0.9705) and thumb (p = 0.7446) between the three groups. The PPTs of all muscles were significantly lower during the perimenstrual phases in the two female groups. The present data showed similar patterns of PPTs for the three muscle groups. Moreover, the results have shown a very good consistency of the PPTs over a long time period, both in males and females.
The neurological basis for painful temporomandibular disorders (TMD) and the higher prevalence of TMD pain in women than men is not known. To better define the circuitry and neurochemical mechanisms in the lower brainstem associated with noxious sensory inputs from the temporomandibular joint (TMJ) region a microdialysis method was used to measure the release of amino acid transmitters from the ventral trigeminal subnucleus interpolaris/caudalis transition region (Vi/Vc-vl). The irritant chemical, mustard oil, was injected into the TMJ region (TMJ-MO) under barbiturate anesthesia in males and normal cycling female rats. Males displayed significant increases in glutamate, serine, and glycine within 15 min after TMJ-MO and increases in citrulline occurred after a delay of 15-30 min. TMJ-MO did not enhance amino acid release in diestrus or proestrus females. GABA release was not affected by TMJ-MO in males or females. Pretreatment with morphine (3 mg/kg, i.v.) prevented the increase in amino acid release seen after TMJ-MO in males. Amino acid release at the Vi/Vc-vl transition region evoked by TMJ-MO also was prevented by prior microinjection of the GABA(A) receptor agonist, muscimol, into the most caudal portion of Vc suggesting this region acted as a critical relay for nociceptive inputs from the TMJ region. These results suggest that glutamatergic mechanisms acting at the Vi/Vc-vl transition region contribute to processing of nociceptive signals that arise from the TMJ region. These results also are consistent with the hypothesis that central neural mechanisms that integrate nociceptive inputs from deep craniofacial tissues are different in males and females.
Sex differences in the antinociceptive effects of opioids have been reported in a variety of nociceptive assays, and it has been postulated that these differences are mediated by gonadal hormones.
The present study examined the influence of gonadectomy on opioid antinociception in male and female rats.
In a warm-water, tail-withdrawal procedure, the antinociceptive effects of the high-efficacy micro opioids etorphine and morphine; the low-efficacy micro opioids buprenorphine and dezocine; and the low-efficacy, mixed-action opioids butorphanol and nalbuphine were examined in intact and gonadectomized rats of the F344 and Sprague Dawley (SD) strains.
The opioids examined were generally more potent in producing an antinociceptive effect in intact males than intact females, with larger sex differences observed with the less-effective opioids. In F344 males, gonadectomy produced small decreases in the potency of etorphine and morphine, and large decreases in the potency of buprenorphine, dezocine, butorphanol, and nalbuphine. Similar effects were obtained in SD males, with gonadectomy decreasing the potency of each of the opioids tested. In F344 females, gonadectomy produced small increases in the potency of etorphine and large increases in the potency of buprenorphine, dezocine, butorphanol, and nalbuphine. A similar effect was obtained in SD females, as gonadectomy increased the potency of etorphine, morphine, and buprenorphine. In both sexes, gonadectomy had a greater effect in F344 than SD rats.
These findings suggest that gonadectomy decreases opioid antinociception in male rats and increases opioid antinociception in female rats. Additionally, the influence of gonadectomy on opioid antinociception appears to be determined by the relative effectiveness of the opioid tested and the rodent strain used.
Evidence from both hypertensive and normotensive individuals indicate that elevated blood pressure is associated with decreased pain sensitivity. The current study sought to experimentally raise blood pressure using 250 mg caffeine, and investigate its effects on the cold pressor pain experiences of 25 men and 25 women. In a placebo-controlled repeated-measures experiment, caffeine increased systolic and diastolic blood pressure, as well as producing more clearheaded and energetic feelings. Caffeine produced higher pain threshold and pain tolerance levels compared to placebo, and women had a lower tolerance to pain than men. Finally, a significant association was found between caffeine-related increase in systolic blood pressure and caffeine-related increase in pain tolerance. Furthermore, this association was the strongest in women. These results are discussed in light of future directions for pain and hypertension research.
Previous studies indicate that in antinociceptive procedures employing thermal, chemical and electrical stimuli, opioids are generally more potent in male than female rodents. The purpose of the present study was to examine nociception and opioid antinociception in male and female rats using a mechanical nociceptive stimulus. Results indicated that males had a higher threshold for nociception, and in tests in which a constant pressure was applied to the hindpaw, the paw withdrawal latencies were consistently longer in males. Opioids with activity at the mu receptor, including levorphanol, morphine, dezocine, buprenorphine, butorphanol and nalbuphine, were generally more potent and/or effective in males. In contrast, sex differences were not consistently observed with the kappa-opioid receptor agonists spiradoline, (5,7,8b)-N-methyl-N[2-1(1-pyrrolidinyl),1-oxaspiro[4,5]dec-8-yl benzeneacetamide (U69593), trans-(+/-)-3,4-dichloro-N-methyl-[2-(1-pyrrolidinyl)-cyclohexyl]benzeneacetamide (U50488), enadoline, ethylketocyclazocine, and nalorphine. These findings suggest that males and females differ in their responsiveness to mechanical nociception and that sex differences in sensitivity to kappa-, but not mu-, opioid receptor agonists are specific to certain nociceptive stimulus modalities.
In the United States and other Western cultures, a greater number of women seek health care services for symptoms of functional pain disorders, including irritable bowel syndrome, than men. Recent clinical trials indicate that gender differences in responsiveness to drug therapy also occur. Several lines of inquiry have focused on explaining this gender-related difference due to the higher prevalence of these disorders in women. Evidence of a physiologic component is based on gender differences in gastrointestinal transit time, visceral sensitivity, central nervous system pain processing, and specific effects of estrogen and progesterone on gut function. Additional factors may play a role, including gender-related differences in neuroendocrine, autonomic nervous system, and stress reactivity, which are related to bowel function and pain. However, the link between these measures and gut motility or sensitivity remains to be clarified. Psychological characteristics, including somatization, depression, and anxiety as well as a history of sexual abuse, may also contribute to gender-related differences in the prevalence of irritable bowel syndrome. Although gender differences in the therapeutic benefit of serotonergic agents have been observed, less is known about potential differences in responsiveness to nondrug therapies for irritable bowel syndrome.
Chronic stable angina pectoris, the chest pain associated with reversible myocardial ischemia has detrimental effects on health-related quality of life, particularly in women. The limited research on gender differences in chronic stable angina suggests that angina may be experienced differently in women and that women report greater functional disability related to angina symptoms. No studies have examined gender differences in chronic stable angina from a multidimensional pain perspective or have included reliable and valid measures of pain that would facilitate comparing chronic angina patients with other chronic pain populations. The purpose of this descriptive study was to examine gender differences in characteristics of chronic stable angina using the short-form McGill pain questionnaire (SF-MPQ) and to explore relationships among these pain characteristics and perceived limitation in performing physical activities in patients with coronary artery disease (CAD) (physical limitation subscale of the Seattle angina questionnaire). One hundred and twenty-eight subjects (30.5% women) with stable CAD and angina pectoris documented by a cardiologist completed study questionnaires in an outpatient cardiology clinic. Results of the study suggest that men and women with chronic stable angina had more similarities than differences in chest pain characteristics. No significant gender differences were demonstrated in total sensory or affective intensity scores, the present pain intensity index, or the number of pain words chosen. However, women did report significantly greater pain intensity on the SF-MPQ visual analogue scale. Women were also significantly more likely to describe their chronic angina as 'hot-burning' and 'tender' and to have greater intensity of pain for these two descriptors. Despite the similarities in pain characteristics, women reported greater physical limitation related to anginal pain. The variables of social status and years diagnosed with CAD significantly interacted with gender in predicting physical limitation suggesting that gender-specific models of physical limitation in angina patients need to be explored. To our knowledge, this is one of the first studies that has assessed chronic anginal pain using a reliable and valid generic pain instrument. More research is needed to better understand the nature of gender differences in functional limitation secondary to anginal pain and the physiologic, cognitive-perceptual and psychosocial mechanisms that lead to angina-related functional disability.
A major responsibility of nurse anesthetists caring for patients is the provision of adequate pain relief. A growing body of evidence in the literature suggests that gender of the provider and gender of the patient may affect the clinical management of pain. The different socialization processes of children has been theorized to influence how, as adults, individuals perceive and express pain. The willingness of females to express their discomfort has led to the perception that females are more emotional and expressive than males; this perception has led investigators to note that females may be at a disadvantage in the treatment of pain. Recently recognized disparities between the sexes in their response to antidepressants, certain opioids, and inhalation agents, as well as the identification of gender distributions for certain diseases, has heightened awareness among the scientific community of gender influences and gender differences that were not evident in the past. Awareness among nurse anesthetists of these differences, as well as the possible influence of gender, is critical to individualize anesthetic management and to minimize the potential for gender bias in providing pain management.
To compare lower extremity functioning and leg symptoms between women and men with peripheral arterial disease (PAD).
Cross-sectional.
Three Chicago-area medical centers.
One hundred eighty-seven women and 273 men with PAD identified consecutively in patients in the noninvasive vascular laboratories and a general medicine practice at the three medical centers.
Walking speed, 6-minute walk, accelerometer-measured 7-day physical activity, and a summary performance score. The summary performance score combines data on walking velocity, time for five repeated chair rises, and standing balance to achieve a score on a 0 to 12 scale (12 = best).
Women with PAD were older and had a lower prevalence of prior leg revascularization, a higher prevalence of spinal stenosis, and a lower prevalence of other cardiovascular disease than men with PAD. Mean ankle brachial index (ABI) values +/- standard deviation were similar in women and men with PAD (0.64 +/- 0.15 vs 0.66 +/- 0.14, P =.15). Women with PAD were significantly more likely than men with PAD to have exertional leg pain that sometimes begins at rest (27.8% vs 13.2%, P <.001). Women with PAD had slower walking speed (0.81 vs 0.92 m/s, P <.001), shorter 6-minute walk distance (1,047 vs 1,182 feet, P <.001), and a poorer summary performance score (8.9 vs 9.8, P <.001) than men with PAD, adjusting for age, race, height, comorbid disease, and leg symptoms. After adjusting for leg strength, sex differences in 6-minute walk performance and summary performance score were attenuated modestly (1,089 vs 1,177 feet for 6-minute walk, P =.022 and 9.2 vs 9.8 for summary performance score, P =.027).
Women with PAD had a higher prevalence of leg pain on exertion and rest, poorer functioning, and greater walking impairment from leg symptoms than men with PAD. A higher prevalence of spinal stenosis in women may explain the observed sex differences in leg symptoms. Poorer leg strength in women may contribute to poorer lower extremity functioning in women with PAD than in men with PAD.
Neither the etiology of muscle-related temporomandibular disorders (TMD) nor the reason for the disproportionate number of women suffering from these disorders is well-established. We tested the hypothesis that physiologically relevant exercise (i.e., chewing bubble gum for 6 min) increases masticatory muscle pain in patients, but not in asymptomatic control subjects, and that female patients experience a significantly greater increase than males. Chewing increased pain in both female and male patients and, unexpectedly, also in female control subjects. One hour after chewing, the pain remained above pre-test levels for female patients but not for the other groups. Thus, sex differences in chewing-induced pain were found in control subjects but not as hypothesized in patients. Because chewing-induced masticatory muscle pain was significantly greater in female control subjects than in males, and persisted longer in female patients than in males, these results suggest greater susceptibility in women.
The aim of this prospective cardiological-linguistic study was to assess cause-specific and gender-specific differences in the reported symptoms and description of chest pain.
In patients hospitalized because of chest pain, location, radiation, quality of chest pain, pain precipitating and relieving factors, and additional symptoms were assessed. The cause of chest pain was assessed as either coronary or noncoronary. Patients' pain descriptions were taped for linguistic narrative analysis and transcribed according to ethnomethodological standards.
The cause of chest pain was assessed as coronary in 43 (18 females, 25 males, mean age 63 years) and noncoronary in 49 (30 females, 19 males, mean age 62 years) patients. Only few cause-related differences in the symptoms were found. In patients with a coronary cause, the location of chest pain was more often retrosternal (93% vs. 71%, p = 0.0078), in the right arm (23% vs. 6%, p = 0.0186), and less often in the back (28% vs. 51%, p = 0.0241) than in patients with a noncoronary cause of chest pain. Coronary patients more often had a pressing pain quality (81% vs. 61%, p = 0.034), less often pain precipitated by respiration (16% vs. 45%, p = 0.0032), and vertigo (21% vs. 43%, p = 0.0252) than noncoronary patients. The women were older than the men (mean age 65.6 vs. 59.0 years, p = 0.01). Women with a coronary cause more often had a gradual pain onset (78% vs. 48%, p = 0.0488) and relief by rest (78% vs. 40%, p = 0.0139) than men with a coronary cause. Linguistic analysis revealed that men presented themselves as interested in the cause of the chest pain, observing and describing pain concretely, whereas women presented themselves as prevailingly pain enduring, describing their pain diffusely.
Cause-related and gender-related differences in symptoms are too unspecific to distinguish between coronary and noncoronary causes. The strong gender differences in self-presentation and description of chest pain might be an explanation for underdiagnosis and undertreatment of women with coronary heart disease and should be considered when taking the clinical history of a female patient.
AIMS OF INVESTIGATION: To quantify the magnitude of putative gender differences in experimental pressure pain threshold (PPT), and to establish the relevance of repeated measurements to any such differences.
Two separate studies were undertaken. A pressure algometer was used in both studies to assess PPT in the first dorsal interosseous muscle. Force was increased at a rate of 5 N /s. In study 1, two measurements were taken from 240 healthy volunteers (120 males, 120 females; mean age 25 years) giving a power for statistical analysis of beta=0.80 at alpha=0.01. In study two, 30 subjects (15 males, 15 females mean age 28 years) were randomly selected from study one. Fourteen repeated PPT measurements were recorded at seven, 10 min intervals. Mean PPT data for gender groups, from both studies, were analysed using analysis of covariance with repeated measures, and age as the covariate.
The mean PPT for each of the two measurements in study one showed a difference between gender of 12.2 N (f=30.5 N, m=42.7 N) and 12.8 N (f=29.5 N, m=42.3 N), respectively, representing a difference of 28% with females exhibiting a lower threshold. In study two, the mean difference calculated from 14 PPT repeated measurements over a 1h period was comparable to that in study one at 12.3N (range 10.4-14.4 N) again females exhibited the lower threshold. The differences in mean PPT values between gender were found to be significant in both study one, at (P<0.0005, F=37.8, df=1) and study two (P=0.01, F=7.6, df=1). No significant differences were found in either study with repeated measurement (P=0.892 and P=0.280), or on the interaction of gender and repeated measurement after controlling for age (P=0.36 and P=0.62).
Healthy females exhibited significantly lower mean PPTs in the first dorsal interosseous muscle than males, which was maintained for fourteen repeated measures within a 1 h period. This difference is likely to be above clinically relevant levels of change, and it has clear implications for the use of different gender subjects in laboratory based experimental designs utilising PPT as an outcome measure.
The gender aspect in pharmacokinetics and pharmacodynamics of anesthetics has attracted little attention. Knowledge of previous work is required to decide if gender-based differences in clinical practice is justified, and to determine the need for research.
Basis for this paper was obtained by Medline searches using the key words 'human' and 'gender' or 'sex,' combined with individual drug names. The reference lists of these papers were further checked for other relevant studies.
Females have 20-30% greater sensitivity to the muscle relaxant effects of vecuronium, pancuronium and rocuronium. When rapid onset of or short duration of action is very important, gender-modified dosing may be considered. Males are more sensitive than females to propofol. It may therefore be necessary to decrease the propofol dose by 30-40% in males compared with females in order to achieve similar recovery times. Females are more sensitive than males to opioid receptor agonists, as shown for morphine as well as for a number of kappa (OP2) receptor agonists. On this basis, males will be expected to require 30-40% higher doses of opioid analgesics than females to achieve similar pain relief. On the other hand, females may experience respiratory depression and other adverse effects more easily if they are given the same doses as males.
These examples illustrate that gender should be taken into account as a factor that may be predictive for the dosage of several anesthetic drugs. Moreover, there is an obvious need for more research in this area in order to further optimize drug treatment in anesthesia.
Background:
Numerous experimental studies, conducted primarily over the past 10 years, show that there are sex differences in opioid analgesia. This review summarizes the published literature on sex differences in analgesia produced by acute administration of drugs acting at mu-, kappa-, and delta-opioid receptors, in animals and humans. Additionally, methodological issues in research into opioid sex differences are discussed.
Conclusions:
Procedural variables that may influence the outcome of studies examining sex differences in opioid analgesia include modality and intensity of the noxious stimulus used in the pain test, opioid type (efficacy and selectivity), and experimental design and data analytic techniques. Subject variables that may be important to consider include subject genotype and gonadal steroid hormone state of the subject at the time of analgesia testing. Evidence is provided for multiple mechanisms underlying sex differences in opioid analgesia, including both pharmacokinetic and pharmacodynamic factors. Future research directions are suggested, such as examining sex differences in opioid tolerance development, sex differences in opioid analgesia using models of acute inflammatory pain and chronic pain, and sex differences in effects of opioids other than analgesia, which may limit their therapeutic use.
Background:
Sex differences in the response threshold to painful stimuli and the higher number of chronic pain syndromes in women than in men have prompted a series of studies on lower animals and humans aimed at clarifying the role of gonadal hormones in pain.
Objective:
This article examines the morphologic and functional aspects of gonadal hormone systems and the relations between gonadal hormones and pain circuits, to identify areas deserving of increased attention in elucidating the endocrine mechanisms that contribute to abnormal pain states.
Women have a higher prevalence of irritable bowel syndrome (IBS) and possible differences in response to treatment, suggesting sex-related differences in underlying pathophysiology. The aim of this study was to determine possible sex-related differences in brain responses to a visceral and a psychological stressor in IBS.
Regional cerebral blood flow measurements using H(2)(15)O positron emission tomography were compared across 23 female and 19 male nonconstipated patients with IBS during a visceral stimulus (moderate rectal inflation) and a psychological stimulus (anticipation of a visceral stimulus).
In response to the visceral stimulus, women showed greater activation in the ventromedial prefrontal cortex, right anterior cingulate cortex, and left amygdala, whereas men showed greater activation of the right dorsolateral prefrontal cortex, insula, and dorsal pons/periaqueductal gray. Similar differences were observed during the anticipation condition. Men also reported higher arousal and lower fatigue.
Male and female patients with IBS differ in activation of brain networks concerned with cognitive, autonomic, and antinociceptive responses to delivered and anticipated aversive visceral stimuli.
Irritable bowel syndrome (IBS) is a common functional bowel disorder characterized by abdominal pain and change in defecation pattern. This review addresses the topic of possible sex (genetic, biological) and gender (experiential, perceptual) differences in individuals with and without IBS. Several observations make the topic important. First, there is a predominance of women as compared to men who seek health care services for IBS in the United States and other industrialized societies. Second, menstrual cycle-linked differences are observed in IBS symptom reports. Third, women with IBS tend to report greater problems with constipation and nongastrointestinal complaints associated with IBS. Fourth, serotonin (5-HT3) receptor antagonist and 5-HT4 partial agonist drugs appear to more effectively diminish reports of bowel pattern disruption in women with IBS as compared to men. This review examines sex and gender modulation of gastrointestinal motility and transit, visceral pain sensitivity, autonomic nervous system function, serotonin biochemistry, and differences in health care-seeking behavior for IBS.
Increased anxiety is believed to correlate with increased pain sensitivity in men and women. However, one laboratory-based study and one clinical-based study have offered evidence to suggest that the effect of anxiety in modulating pain sensitivity is specific to men only. The aim of the present study was to examine further whether anxiety differentially effects men and women's report of experimentally induced pain.
One hundred forty-four healthy university students (75 women, 69 men) were exposed to a contact heat pain procedure (ascending method of limits procedure, baseline temperature 30 degrees C, +/- 0.2 degrees C, rate of change 2.0 degrees C/s, cut-off limit 52 degrees C) and a cold pressor pain procedure (constant temperature +1 degrees C; +/-1 degrees C, cut-off limit 240 s).
The results agreed with the previous two studies indicating a sex-specific effect of anxiety on pain report. Male participants scoring above the median on the Trait Anxiety Inventory reported significantly greater pain intensity, unpleasantness and showed lower pain tolerance compared to males scoring below the median on the cold pressor pain procedure, while no such differences in cold pressor pain report were found between high and low anxious women. No effect of anxiety was found on measures taken from the contact heat pain procedure, indicating that the sex-specific effect of anxiety on laboratory induced pain is dependent upon the method of stimulation used.
Anxiety is an important factor when considering gender differences in pain perception and warrants further investigation.
Several studies suggest that females exhibit greater sensitivity to experimentally induced thermal pain than males. These investigations have focused mainly on the sensory-discriminative rather than the affective aspect of pain. Moreover, potential gender differences for the affective components of innocuous thermal sensations have yet to be examined. The primary aim of the present study was to evaluate gender differences in the sensory and the affective dimensions of the entire thermosensory system, including warmth, coolness, heat pain and cold pain. The secondary aim was to evaluate laterality differences in these same perceptual dimensions and ranges. Twenty healthy females and 20 healthy males immersed their hands in water baths maintained at temperatures ranging from 10 to 47 degrees C, and rated their perceived thermal intensity, (un)pleasantness, and pain intensity. There was a progressive growth in the thermal intensity ratings as bath temperatures either increased or decreased from the adapting temperature of 33 degrees C. No gender differences emerged for these thermal intensity ratings. However, a significant sex effect emerged for the pain intensity ratings (P<0.01), and a significant sex x temperature interaction for the affective ratings (P<0.01). Females provided higher unpleasantness and pain intensity ratings for the more extreme temperatures (10, 15 and 47 degrees C), compared to males. Moreover, women perceived the milder temperature baths as more pleasant than men did. For a given painful temperature, unpleasantness ratings were higher than pain intensity ratings. This relationship between unpleasantness ratings and pain ratings was not significantly different between the sexes. No laterality differences emerged for the thermal intensity ratings. However, perceived pain intensity was significantly higher for the left as compared to the right hand (P<0.01). Ratings of unpleasantness also tended to be higher for the left vs. right hand, but this difference fell just short of statistical significance (P=0.06). These findings indicate that sex differences in thermosensory perception are not general, but occur only for the painful and affective components. Of particular note is the sex difference for affective but not intensive ratings of innocuous temperatures, revealing sex differences in thermal perception outside the nociceptive system.
Diffuse noxious inhibitory control (DNIC) is part of a central pain modulatory system that relies on spinal and supraspinal mechanisms. Previous studies have shown that fibromyalgia (FMS) patients are lacking DNIC effects on experimental pain, compared to normal control (NC) subjects. Because DNIC has a greater effect on second pain than on first pain, we hypothesized that wind-up (WU) of second pain should be attenuated by a strong conditioning stimulus. Thus, we compared DNIC's effect on WU in three groups of subjects: 11 NC males, 22 NC females, and 11 FMS females. To separately assess the contributions of distraction related mechanisms to inhibition of second pain, we designed the experiment in such a way that directed the subjects' attention to either the test or conditioning stimulus. Repeated heat taps to the thenar surface of the right hand were used as test stimuli to generate WU of second pain. Immersion of the left hand into a hot water bath was the conditioning stimulus. As previous experiments have shown, DNIC requires a strong conditioning stimulus for pain attenuation, which may be at least partly dependent on a distraction effect. DNIC significantly inhibited thermal WU pain in normal male subjects, but adding distraction to the DNIC effect did not increase the extent of this inhibition. In contrast, neither DNIC nor DNIC plus distraction attenuated thermal WU pain in female NCs. DNIC plus distraction but not DNIC alone produced significant inhibition of thermal WU pain in female FMS patients. Our results indicate that DNIC effects on experimental WU of second pain are gender specific, with women generally lacking this pain-inhibitory mechanism.
Human Nature: Historical, Scientific, and Religious Issues In Whatever Happened to the Soul? Scientific and Theological Portraits of Human Nature
- Murphy
- Nancey
Murphy, Nancey. 1998. " Human Nature: Historical, Scientific, and Religious Issues. " In Whatever Happened to the Soul? Scientific and Theological Portraits of Human Nature, ed. Warren Brown, Nancey Murphy, and Newton Malony, 1–29.
Classification of Chronic Pain Seattle: IASP Task Force on Taxonomy. http://www.iasp-pain.org/terms-p.html Contribution of GIRK2-mediated Postsynaptic Signaling to Opi-ate and Alpha 2-adrenergic Analgesia and Analgesic Sex Differences
- Merskey
- Nikolai Harold
- Bogduk
Merskey, Harold and Nikolai Bogduk. 1994. Classification of Chronic Pain. 2d ed. Seattle: IASP Task Force on Taxonomy. http://www.iasp-pain.org/terms-p.html. Mitrovic, Igor, Marta Margeta-Mitrovic, Semon Bader, Markus Stoffel, Lily Jan, and Allan Basbaum. 2003. " Contribution of GIRK2-mediated Postsynaptic Signaling to Opi-ate and Alpha 2-adrenergic Analgesia and Analgesic Sex Differences. " Proceedings of the National Academy of Sciences of the United States of America 100 (January): 271–76.
Minding God: Theology and the Cognitive Sciences Gender Difference in Drug Ef-fects: Implications for Anesthesiologists
- Gregory H Peterson
- O Spigset
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