Sex and gender differences in pain: past, present, and future

Keogh, Edmund

doi:10.1097/j.pain.0000000000002738

Cited by 29 publications

(17 citation statements)

References 200 publications

(303 reference statements)

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“…Although one of the identified studies indicated that female individuals with MSA may be more prone to complain about pain, 16 our meta‐analysis did not identify any difference in pain prevalence between male and female MSA individuals. Such analysis pooled data from four studies only, highlighting the need for further studies on the effects of sex and gender on pain development, perception, and communication in individuals with MSA 34 …”

Section: Discussionmentioning

confidence: 99%

“…Such analysis pooled data from four studies only, highlighting the need for further studies on the effects of sex and gender on pain development, perception, and communication in individuals with MSA. 34 To date, there are no disease-specific validated questionnaires to screen for pain in individuals with MSA, and different generic tools have been used in the analyzed studies (summarized in Table S2). For PD, both a physician-administered pain rating scale, the King's PD pain scale, 35 and a patient-reported pain questionnaire, the King's PD pain questionnaire, 36 have been validated.…”

Section: Discussionmentioning

confidence: 99%

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Pain in Multiple System Atrophy a Systematic Review and Meta‐Analysis

Campese,

Caliò,

Leys

et al. 2023

Movement Disord Clin Pract

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BackgroundIndividuals with multiple system atrophy (MSA) often complain about pain, nonetheless this remains a poorly investigated non‐motor feature of MSA.ObjectivesHere we aimed at assessing the prevalence, characteristics and risk factors for pain in individuals with MSA.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, we systematically screened the PubMED, Cochrane and Web of Science databases for papers published in English until September 30th, 2022, combining the following keywords: “pain”, “multiple system atrophy”, “MSA”, “olivopontocerebellar atrophy”, “OPCA”, “striatonigral degeneration”, “SND”, “Shy Drager”, “atypical parkinsonism”.ResultsThe search identified 700 records. Sixteen studies provided information on pain prevalence in cohorts of MSA individuals and were included in a qualitative assessment based on the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Thirteen studies (11 cross‐sectional, 2 longitudinal) scored ≥14 points on QUADAS assessment and were included in a quantitative analysis, pooling data from 1236 MSA individuals. The resulting pooled prevalence of pain in MSA was 67% [95% confidence intervals (CI): 57‐75%], and significantly higher in individuals with MSA of parkinsonian rather than cerebellar type [76% (95% CI: 63‐87%) versus 45% (95% CI: 33‐57%), p=0.001]. Pain assessment tools and collected information were highly heterogeneous across studies. Two studies reported pain treatment strategies and found that only every second person with MSA complaining about pain had received targeted treatment.ConclusionsWe found that pain is a frequent, but still under‐recognized and undertreated feature of MSA. Further research is needed to improve pain detection and treatment in MSA.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pain in Multiple System Atrophy a Systematic Review and Meta‐Analysis

Campese,

Caliò,

Leys

et al. 2023

Movement Disord Clin Pract

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“…For instance, in human patients, women have scored higher pain than men when using a visual analogue scale in adults and children [47][48][49][50][51] . Gender has also been shown to impact human perception towards animal pain.…”

Section: Introductionmentioning

confidence: 99%

Effect of the observer’s gender bias monitoring acute pain using a validated behavior scale in castrated piglets

Trindade,

Lopez-Soriano,

Merenda

et al. 2023

Preprint

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We aimed to investigate the observer’s gender bias on acute pain assessment using the Unesp-Botucatu Pig Composite Acute Pain Scale (UPAPS) in piglets before and after castration. Twenty-nine piglets were filmed at 1h pre-castration, 0h and 3h post-castration. Two observers self-identified as women and two as men, and all four observers assessed all films using the UPAPS. Intraclass correlation coefficient (ICC), Lin's concordance correlation coefficient (CCC), and Bland-Altman were used to estimate the agreement, and modeling was conducted to compare genders. The ICC of the UPAPS total sum was ‘very good’ (0.84) when considering both genders and ‘good’ when considering each gender separately. Furthermore, women had a higher level of agreement (0.74) than men (0.65). The agreement of the UPAPS total sum assessed by women and men demonstrated minimal bias (-0.04), no proportion bias, and 55% of the assessments were identical. The UPAPS total sum was statistically equivalent between genders (P = 0.66). In conclusion, we found no evidence supporting gender bias in applying UPAPS in piglets before and after castration. Our findings permit the assessment of piglets' acute pain regardless of the observers’ gender, which might benefit the swine industry and researchers monitoring pain in piglets.

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“…In this study, we evaluated the modulation of attentional and affective responses to emotional facial expressions by using an experimental paradigm of prolonged pain already shown to induce suffering. [4][5][6][7] Considering the well-known gender differences in pain perception, 23 potential gender-related differences were also examined. Additionally, participants were asked to perform an emotional facial recognition task while receiving a series of tonic noxious mechanical stimuli covering a duration of 53 min.…”

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confidence: 99%

Pain and related suffering reduce attention toward others

et al. 2023

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BackgroundIt has been proposed that the expression of pain‐related suffering may lead to an enhanced focus on oneself and reduced attention toward the external world. This study aimed at investigating whether experimentally induced painrelated suffering may lead persons to withdraw into themselves, causing a reduced focus on external stimuli as reflected by impaired performance in a facial recognition task and heightened perception of internal stimuli measured by interoceptive awareness.MethodsThirty‐two participants had to recognize different emotional facial expressions (neutral, sad, angry, happy), or neutral geometrical figures under conditions of no pain, low, and high prolonged pain intensities. Interoceptive accuracy was measured using a heartbeat‐detection task prior to and following the pain protocol.ResultsMales but not females were slower to recognize facial expressions under the condition of high painful stimulation compared to the condition of no pain. In both, male and female participants, the difficulty in recognizing another person's emotions from a facial expression was directly related to the level of suffering and unpleasantness experienced during pain. Interoceptive accuracy was higher after the pain experiment. However, neither the initial interoceptive accuracy nor the change were significantly related to the pain ratings.ConclusionsOur results suggest that long‐lasting and intense painful stimuli, which induce suffering, lead to attentional shifts leading to withdrawal from others. These findings contribute to a better understanding of the social dynamics of pain and pain‐related suffering.

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Sex and gender differences in pain: past, present, and future

Cited by 29 publications

References 200 publications

Pain in Multiple System Atrophy a Systematic Review and Meta‐Analysis

Pain in Multiple System Atrophy a Systematic Review and Meta‐Analysis

Effect of the observer’s gender bias monitoring acute pain using a validated behavior scale in castrated piglets

Pain and related suffering reduce attention toward others

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