Combining the data from Table 11 with the studies reviewed by Miaskowski and Levine,277 there is some suggestion that when using PCA women consume lower doses of morphine. Interestingly, the two studies showing lower morphine requirements for men involved provider administered morphine.16,62 It is tempting to speculate that men may be less willing to report pain or request analgesics from a provider, which would explain their lower opioid consumption in the provider-administered settings. Alternatively, one could argue that women benefit more from the increased sense of control that accompanies self-administration of opioids. Additional research will be required to confirm or refute these possibilities.
- Ritter et al329 followed a large sample of patients that received a total knee arthroplasty for 5 years.
- The impact of sex hormones on pain responses can be broadly dichotomized into peripheral versus central nervous system effects, which are discussed below.
- Fillingim et al119 provided instructions designed to manipulate females’ and males’ perceived ability to tolerate ischemic pain, hypothesizing that enhancing perceived ability would produce greater effects in females, because males report higher perceived ability to tolerate pain at baseline.
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The SRY gene plays a critical role in the initiation of testicular differentiation in males18). In XY embryos, SRY, which is normally located on the Y chromosome, induces the gonadal primordia to develop into testes. If a fetus is conceived from a sperm with an SRY-bearing X chromosome, it will develop as a male despite not having a Y chromosome.
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There were no significant differences between girls and boys regarding type of headache; however, they did find that girls experience recurrent headaches more than boys. Other studies, however, find the prevalence of tension-type headaches to be higher in girls. For example, in a sample of children from Sweden, Laurell et al236 reported the 1-year prevalence of tension-type headache among girls as 12% and 8% for boys.
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- Although research regarding sex, gender, and pain has continued to expand and generate novel findings, to date there has been limited clinical impact of this new knowledge.
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To complete the translational continuum, it is important to determine whether sex-related genetic associations such as these discovered in the laboratory setting will extend to clinical populations. Human brain imaging represents another methodology that holds promise for facilitating mechanistic and translational advancements, and increased application of imaging to enhance understanding of sex differences in pain and analgesia is strongly recommended. Since our two previous reviews127,327 a large number of studies using widely varying methodologies have investigated sex differences in experimental pain sensitivity. Based on the overall findings, it can be concluded that females are more sensitive to painful stimulation as assessed in the laboratory. From the pattern of results, it is difficult to pinpoint any specific mechanism(s), because the sex differences appear relatively consistently across multiple stimulus modalities. However, the recently developed literature on pain in response to intramuscular injections of algesic substances reveals robust and unanimous differences, suggesting that deep, tonic stimuli that mimic clinical musculoskeletal pain may be particularly sensitive to sex differences.
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