Gender Differences in the Affective Processing of Pain: Brain Neuroscience and Training in “Biopsychosocial” Pain Medicine

Abstract

Wasan and colleagues [1], in their article in this issue “Differences in Pain, Psychological Symptoms, and Gender Distribution Among Patients with Left vs Right-Sided Chronic Spinal Pain”, present data suggesting that left-sided spinal pain may increase the risk of affective distress and interference in male patients complaining of chronic spinal pain. They posit that the differences between men and women in this respect are consistent with experimental neuroscience research demonstrating that: 1) painful stimuli activate men's, more than women's, right hemisphere; 2) that the right hemisphere is more involved in the attentional aspects of pain; and 3) that negative emotions in men are preferentially processed in the right hemisphere. In the language of pain medicine and neuroscience, their article carefully addresses the existing evidence for and against alternative hypotheses that might explain their data. Their work and others herald the promise of the future of pain medicine, in which pain medicine specialists trained in pain evaluation and phenomenology and in clinical neuroscience and psychopathology train their measurement skills to fully realize the promise of a true biopsychosocial pain medicine. This trend will render common terms such as “holistic” and “whole person” medicine, which capture a concept but are unable to be measured scientifically, as lay expressions signifying a level of science consistent with the era prior to the decade …