Gender differences in pain: Epidemiologic perspectives

Abstract

I n their Focus article, Drs. Fillingim and Maixner have reviewed data on gender differences in responsiveness to experimental noxious stimuli, interpreted those data as indicating that women are more sensitive to noxious stimuli than men, and proposed a model of how a range of biological and psychological factors might contribute to these gender-associated differences in pain sensitivity. The model is intriguing and is well grounded in the animal literature on sex differences in pain transmission and pain modulation systems. However, because the authors' stated motivation for assessing gender-related differences in pain responsiveness is that certain pain conditions (e.g., migraine headache, fibromyalgia, temporomandibular disorder pain) are more prevalent in women than in men, and that persons with these predominantly female pain conditions exhibit enhanced sensitivity to laboratory pain procedures, additional perspectives from clinical and epidemiologic pain research may be relevant. Specifically, this commentary will introduce an epidemiologic approach to the issue of gender differences in pain that may be useful for exploring alternative interpretations of the data presented and identifying strengths and weaknesses of the model proposed. Epidemiology is the study of the distribution and determinants of diseases or conditions in populations. '° The science of epidemiology is grounded in three important perspectives: the population perspective, the ecological perspective, and the developmental perspective. Elsewhere, we have presented an extensive discussion of the application of these perspectives to the study of pain: This article focuses 'more specifically on what these three perspectives have to offer in terms of