Gender Differences in Response to Experimental Pain among Medical Students from a Western State of India
DOI:
https://doi.org/10.5195/ijms.2014.69Keywords:
Sex, Pain, Pain threshold, Pulse, Blood pressureAbstract
Background: Pain is one of the most common reasons for patients to seek medical attention and it causes considerable human suffering. Pain is a complex perception that differs enormously among individual patients. Gender plays an important role in how pain is experienced, coped with and treated. Even young healthy individuals often differ in how they perceive and cope with pain. This study was done to investigate gender differences in response to experimental pain among medical students from a western state in India.
Methods: A total of 150 medical students (86 males and 64 females) participated in this interventional study. The Cold Pressor Test was used to exert experimental pain. To study the response, cardiovascular measures (radial pulse, systolic blood pressure and diastolic blood pressure) and pain sensitivity parameters (pain threshold, pain tolerance and pain rating) were assessed.
Results: No significant difference was found in cardiovascular response to experimental pain between both the genders (p>0.05). Pain threshold and pain tolerance were found to be significantly higher in males whereas pain rating was found to be significantly higher in females (p<0.01). Pulse reactivity showed a negative relationship with pain threshold and pain tolerance whereas a positive relationship with pain rating, however no statistically significant relation was found between these measures.
Conclusion: Females display greater pain sensitivity than males. Different pain perception might account for gender difference in pulse reactivity.
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References
1. IASP Sub-committee on Taxonomy. Pain terms: a list with definitions and notes on usage. Pain 1980;8:249-52.
2. Hoffmann DE, Tarzian AJ. The girl who cried pain: a bias against women in the treatment of pain. J Law Med Ethics. 2001;29(1):13-27.
3. International Association for the Study of Pain. Fact Sheet: Children with Chronic Pain-Sex and Gender Differences. 2007.
4. Lowery D, Fillingim RB, Wright RA. Wright. Sex differences and incentive effects on perceptual and cardiovascular responses to cold pressor pain. Psychosom Med. 2003;65(2):284-91.
5. Wiesenfeld-Hallin Z. Sex differences in pain perception. Gend Med. 2005;2(3):137-45.
6. International Association for the Study of Pain. Fact Sheet: Differences in Pain Between Women and Men. 2007.
7. International Association for the Study of Pain. Fact Sheet: Epidemiology of Pain in Women. 2007.
8. Unruh AM. Gender variations in clinical pain experience. Pain. 1996;65(23):123-67.
9. Pud D, Golan Y, Pesta R. Hand dominancy-a feature affecting sensitivity to pain. Neurosci Lett. 2009;467(3):237-40.
10. Joseph L. Riley, Michael E. Robinson, Emily A. Wise, Donald Price. A meta-analytic review of pain perception across the menstrual cycle. Pain. 1999;81(3):225-235.
11. Schulz KF, Altman DG, Moher D, for the CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Ann Int Med. 2010;152.
12. Garrow JS, Webster J. Quetelet's index (W/H2) as a measure of fatness. Int J Obes. 1985;9(2):147–53.
13. Mitchell LA, MacDonald RA, Brodie EE: Temperature and the cold pressor test. J Pain. 2004;5(4):233-7.
14. Joshi M. Evaluation of pain. Indian J. Anaesth. 2006;50(5):335-9.
15. Fillingim RB, Maixner W. Gender differences in the responses to noxious stimuli. Pain Forum. 1995;4(4):209-1.
16. Riley JL 3rd, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: A meta-analysis. Pain. 1998;74(2-3):181-7.
17. Nie H, Arendt-Nielsen L, Andersen H, Graven-Nielsen T. Temporal summation of pain evoked by mechanical stimulation in deep and superficial tissue. J Pain. 2005;6(6):348-5.
18. Myers CD, Robinson ME, Riley JL 3rd, Sheffield D. Sex, gender, and blood pressure: contributions to experimental pain report. Psychosom Med. 2001;63(4):545-50.
19. Berkley KJ. Sex differences in pain. Behav Brain Sci. 1997;20(3):371-80.
20. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. Sex, Gender, and pain: A review of recent clinical and experimental findings. J Pain. 2009;10(5):447-85.
21. Fillingim RB et al. Ischemic but not thermal pain sensitivity varies across the menstrual cycle. Psychosom Med. 1997;59:512-520.
22. Yannick Tousignant-Laflamme, Serge Marchand. Excitatory and inhibitory pain mechanisms during the menstrual cycle in healthy women. Pain. 2009;146:47–55.
23. M. Teepker, M. Peters, H. Vedder, K. Schepelmann, S. Lautenbacher. Menstrual Variation in Experimental Pain: Correlation with Gonadal Hormones. Neuropsychobiology. 2010;61:131–40.
24. Myers CD, Robinson ME, Riley JL 3rd, Sheffield D. Sex, gender, and blood pressure: contributions to experimental pain report. Psychosom Med. 2001;63(4):545-50.
25. Otto MW, Dougher MJ. Sex differences and personality factors in respon- sivity to pain. Percept Mot Skills. 1985;61(2):383-90.
26. Schobel HP, Ringkamp M, Behrmann A, Forster C, Schmieder RE, Handwer- ker HO. Hemodynamic and sympathetic responses to painful stimuli in nor- motensive and borderline hypertensive subjects. Pain. 1966;66(2-3):117-24.
27. Peckerman A, Saab PG, McCabe PM, Skyler JS, Winters RW, Llabre MM et al. Blood pressure reactivity and perception of pain during the forehead cold pressor test. Psychophysiology. 1991;28(5):485-95.
28. Bruehl S, Carlson CR, McCubbin JA. The relationship between pain sensiti- vity and blood pressure in normotensives. Pain. 1992;48(3):463-7.
29. Maixner W, Humphrey C. Gender differences in pain and cardiovascular responses to forearm ischemia. Clin J Pain. 1993;9(1):16-25.
30. France CR, Stewart KM. Parental history of hypertension and enhanced cardiovascular reactivity are associated with decreased pain ratings. Psy- chophysiology. 1995;32(6):571-8.
31. Rosa C, Ghione S, Mezzasalma L, Pellegrini M, Basile Fasolo C, Giaconi S, et al. Relationship between pain sensitivity, cardiovascular reactivity to cold pressor test, and indexes of activity of the adrenergic and opioid system. Clin Exp Hypertens A. 1988;10 Suppl 1:383-90.
32. Bruehl S, Chung OY. Interactions between the cardiovascular and pain regulatory systems: an updated review of mechanisms and possible altera- tions in chronic pain. Neurosci Biobehav Rev. 2004;28:395–414.
33. Bruehl S et al. Hypoalgesia associated with elevated resting blood pressu- re: evidence for endogenous opioid involvement. J Behav Med. 2010;33:168– 176.
34. Swaab DF, Fliers E. A sexually dimorphic nucleus in the human brain. Science. 1985;228(4703):1112-5.
35. Allen LS, Gorski RA. Sex difference in the bed nucleus of the stria termi- nalis of the human brain J Comp Neurol. 1990;302(4):697-706. 36. Allen LS, Gorski RA. Sexual dimorphism of the anterior commissure and massa intermedia of the human brain. J Comp Neurol. 1991;312(1):97-104.
37. Kulynych JJ, Vladar K, Jones DW, Weinberger DR. Gender differences in the normal lateralization of the supratemporal cortex: MRI surface-rende- ring morphology of Heschl’s gyrus and planum temporale. Cereb Cortex. 1994;4(2):107-18.
38. Gur RC, Mozley LH, Mozley PD, Resnick SM, Karp JS, Alavi A, et al. Sex differences in regional cerebral glucose metabolism during a resting state. Science. 1995;267(5197):528-31.
39. Andreason PJ, Zametkin AJ, Gus AC, Baldwin P, Cohen RM. Gender-related differences in regional cerebral glucose metabolism in normal volunteers. Psychiatry Res. 1994;51(2):175-83. 40. Gender differences in pain perception and patterns of cerebral activation during noxious heat stimulus in humans. Pain. 1998;76(1-2):223-9.
41. McRoberts JA, Li J, Ennes HS, Mayer EA. Sex-dependent differences in the activity and modulation of N-methyl-d-aspartic acid receptors in rat dorsal root ganglia neurons. Neuroscience. 2007;21(148):1015–20.
2. Hoffmann DE, Tarzian AJ. The girl who cried pain: a bias against women in the treatment of pain. J Law Med Ethics. 2001;29(1):13-27.
3. International Association for the Study of Pain. Fact Sheet: Children with Chronic Pain-Sex and Gender Differences. 2007.
4. Lowery D, Fillingim RB, Wright RA. Wright. Sex differences and incentive effects on perceptual and cardiovascular responses to cold pressor pain. Psychosom Med. 2003;65(2):284-91.
5. Wiesenfeld-Hallin Z. Sex differences in pain perception. Gend Med. 2005;2(3):137-45.
6. International Association for the Study of Pain. Fact Sheet: Differences in Pain Between Women and Men. 2007.
7. International Association for the Study of Pain. Fact Sheet: Epidemiology of Pain in Women. 2007.
8. Unruh AM. Gender variations in clinical pain experience. Pain. 1996;65(23):123-67.
9. Pud D, Golan Y, Pesta R. Hand dominancy-a feature affecting sensitivity to pain. Neurosci Lett. 2009;467(3):237-40.
10. Joseph L. Riley, Michael E. Robinson, Emily A. Wise, Donald Price. A meta-analytic review of pain perception across the menstrual cycle. Pain. 1999;81(3):225-235.
11. Schulz KF, Altman DG, Moher D, for the CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. Ann Int Med. 2010;152.
12. Garrow JS, Webster J. Quetelet's index (W/H2) as a measure of fatness. Int J Obes. 1985;9(2):147–53.
13. Mitchell LA, MacDonald RA, Brodie EE: Temperature and the cold pressor test. J Pain. 2004;5(4):233-7.
14. Joshi M. Evaluation of pain. Indian J. Anaesth. 2006;50(5):335-9.
15. Fillingim RB, Maixner W. Gender differences in the responses to noxious stimuli. Pain Forum. 1995;4(4):209-1.
16. Riley JL 3rd, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: A meta-analysis. Pain. 1998;74(2-3):181-7.
17. Nie H, Arendt-Nielsen L, Andersen H, Graven-Nielsen T. Temporal summation of pain evoked by mechanical stimulation in deep and superficial tissue. J Pain. 2005;6(6):348-5.
18. Myers CD, Robinson ME, Riley JL 3rd, Sheffield D. Sex, gender, and blood pressure: contributions to experimental pain report. Psychosom Med. 2001;63(4):545-50.
19. Berkley KJ. Sex differences in pain. Behav Brain Sci. 1997;20(3):371-80.
20. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. Sex, Gender, and pain: A review of recent clinical and experimental findings. J Pain. 2009;10(5):447-85.
21. Fillingim RB et al. Ischemic but not thermal pain sensitivity varies across the menstrual cycle. Psychosom Med. 1997;59:512-520.
22. Yannick Tousignant-Laflamme, Serge Marchand. Excitatory and inhibitory pain mechanisms during the menstrual cycle in healthy women. Pain. 2009;146:47–55.
23. M. Teepker, M. Peters, H. Vedder, K. Schepelmann, S. Lautenbacher. Menstrual Variation in Experimental Pain: Correlation with Gonadal Hormones. Neuropsychobiology. 2010;61:131–40.
24. Myers CD, Robinson ME, Riley JL 3rd, Sheffield D. Sex, gender, and blood pressure: contributions to experimental pain report. Psychosom Med. 2001;63(4):545-50.
25. Otto MW, Dougher MJ. Sex differences and personality factors in respon- sivity to pain. Percept Mot Skills. 1985;61(2):383-90.
26. Schobel HP, Ringkamp M, Behrmann A, Forster C, Schmieder RE, Handwer- ker HO. Hemodynamic and sympathetic responses to painful stimuli in nor- motensive and borderline hypertensive subjects. Pain. 1966;66(2-3):117-24.
27. Peckerman A, Saab PG, McCabe PM, Skyler JS, Winters RW, Llabre MM et al. Blood pressure reactivity and perception of pain during the forehead cold pressor test. Psychophysiology. 1991;28(5):485-95.
28. Bruehl S, Carlson CR, McCubbin JA. The relationship between pain sensiti- vity and blood pressure in normotensives. Pain. 1992;48(3):463-7.
29. Maixner W, Humphrey C. Gender differences in pain and cardiovascular responses to forearm ischemia. Clin J Pain. 1993;9(1):16-25.
30. France CR, Stewart KM. Parental history of hypertension and enhanced cardiovascular reactivity are associated with decreased pain ratings. Psy- chophysiology. 1995;32(6):571-8.
31. Rosa C, Ghione S, Mezzasalma L, Pellegrini M, Basile Fasolo C, Giaconi S, et al. Relationship between pain sensitivity, cardiovascular reactivity to cold pressor test, and indexes of activity of the adrenergic and opioid system. Clin Exp Hypertens A. 1988;10 Suppl 1:383-90.
32. Bruehl S, Chung OY. Interactions between the cardiovascular and pain regulatory systems: an updated review of mechanisms and possible altera- tions in chronic pain. Neurosci Biobehav Rev. 2004;28:395–414.
33. Bruehl S et al. Hypoalgesia associated with elevated resting blood pressu- re: evidence for endogenous opioid involvement. J Behav Med. 2010;33:168– 176.
34. Swaab DF, Fliers E. A sexually dimorphic nucleus in the human brain. Science. 1985;228(4703):1112-5.
35. Allen LS, Gorski RA. Sex difference in the bed nucleus of the stria termi- nalis of the human brain J Comp Neurol. 1990;302(4):697-706. 36. Allen LS, Gorski RA. Sexual dimorphism of the anterior commissure and massa intermedia of the human brain. J Comp Neurol. 1991;312(1):97-104.
37. Kulynych JJ, Vladar K, Jones DW, Weinberger DR. Gender differences in the normal lateralization of the supratemporal cortex: MRI surface-rende- ring morphology of Heschl’s gyrus and planum temporale. Cereb Cortex. 1994;4(2):107-18.
38. Gur RC, Mozley LH, Mozley PD, Resnick SM, Karp JS, Alavi A, et al. Sex differences in regional cerebral glucose metabolism during a resting state. Science. 1995;267(5197):528-31.
39. Andreason PJ, Zametkin AJ, Gus AC, Baldwin P, Cohen RM. Gender-related differences in regional cerebral glucose metabolism in normal volunteers. Psychiatry Res. 1994;51(2):175-83. 40. Gender differences in pain perception and patterns of cerebral activation during noxious heat stimulus in humans. Pain. 1998;76(1-2):223-9.
41. McRoberts JA, Li J, Ennes HS, Mayer EA. Sex-dependent differences in the activity and modulation of N-methyl-d-aspartic acid receptors in rat dorsal root ganglia neurons. Neuroscience. 2007;21(148):1015–20.
Published
2014-01-27
How to Cite
Akhani, P., Mendpara, S., Palan, B., & Harsoda, J. (2014). Gender Differences in Response to Experimental Pain among Medical Students from a Western State of India. International Journal of Medical Students, 2(1), 13–17. https://doi.org/10.5195/ijms.2014.69
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