Sex, gender, coping, and self‐efficacy: Mediation of sex differences in pain perception in children and adolescents

Abstract

Sex differences in pain perception have been reported in an expanding literature based on adult samples in epidemiological as well as laboratory studies. Especially with respect to the latter, studies with children and adolescents do not consistently show that females report higher pain ratings and display lower pain tolerance than males. The first aim of the presented studies is to comparably examine sex differences in children and adolescents based on experimental and questionnaire approach indices of pain perception. The second aim is to examine the contribution of three prominent psychosocial factors (gender-role expectations, coping with pain, and pain self-efficacy) to these sex differences. In Study 1, a total of 118 children and adolescents from grades 5 to 9 were tested with the Cold Pressor Task (CPT) and a Pain Perception Questionnaire. In Study 2, 148 participants additionally reported on their gender-role expectations, coping with pain, and pain self-efficacy. Although the results reveal only medium-sized correlations between the CPT and the questionnaire measures, both measures indicate substantial sex differences in pain perception in both studies. In Study 2, sex differences are also present for masculinity, femininity, catastrophizing as well as pain self-efficacy. However, while the relation between sex and the CPT rating is partially mediated by pain self-efficacy, catastrophizing partially mediates the relation between sex and the questionnaire based pain ratings. The results of both studies are discussed with respect to the difference between experimental assessments of pain perception and assessments by questionnaire in children and adolescents.

Sex differences in experimental pain among healthy children: A systematic review and meta-analysis

“…Similar results were seen in the meta-analysis of studies in which participant mean age was greater than 12 years, in which four studies (from three published articles) were included, with a total of 262 girls and 258 boys [78,94,109]. This analysis revealed a SMD of 0.00 [-0.17, 0.18], an I 2 of 0%, and no signficant differences between boys and girls on pain tolerance during the cold pressor task (Z= 0.03, p = .98).…”

“…Pain intensity. Data from 19 studies (published in 18 separate articles) were entered into the meta-analysis, which compared self-reported pain intensityduring the cold pressor taskin a total of 628 girls and 633 boys [16,26,39,40,54,75,76,78,82,84,85,93,94,96,99,105,106,109].…”

“…Data from 18 studies (published in 17 separate articles) were entered into the meta-analysis, which compared pain tolerance in a total of 628 girls and 600 boys [16,[23][24][25][26]54,60,76,78,84,85,93,94,96,99,109,113]. This analysis revealed a SMD of 0.04 [-0.07, 0.16] and an I 2 of 0%, indicating no observed heterogeneity.…”

“…Pain intensity. Data from 19 studies (published in 18 separate articles) were entered into the meta-analysis, which compared self-reported pain intensityduring the cold pressor taskin a total of 628 girls and 633 boys [16,26,39,40,54,75,76,78,82,84,85,93,94,96,99,105,106,109].Pain intensity was measured using a variety of self-report tools, including the Faces Pain Scale The meta-analysis was repeated to separately examine studies for which the mean age of participants was greater/equal to or less than 12 years of age. For studies with a mean age of less than 12 years, data from 12 studies were entered into the meta-analysis, with a total of 302 girls and 303 boys [16,26,39,54,75,76,82,84,85,93,96,99].…”

CAD-R. Cuestionario de afrontamiento al dolor crónico: análisis factorial confirmatorio. ¿Hay diferencias individuales en sexo, edad y tipo de dolor?

“…Aunque puedan parecer resultados contradictorios se trata de diferencias culturales en los que, muy probablemente, ciertas variables mediadoras se encuentren a la base de la explicación de las aparentes contradicciones. Una posible explicación es que el resultado pueda deberse al número de personas de la muestra con edades avanzadas frente al de personas más jóvenes ya que estudios más centrados en la adolescencia y más centrados en las diferencias de género (que no en el sexo), encuentran resultados algo diferentes (38). En nuestro caso no hemos trabajado este intervalo de edad.…”