Gender role expectations of pain: relationship to experimental pain perception

The primary purpose of this study was to investigate the influence of an individual's Gender Role Expectations of Pain (GREP) on experimental pain report. One hundred and forty-eight subjects (87 females and 61 males) subjects underwent thermal testing and were asked to report pain threshold, pain tolerance, VAS ratings of pain intensity and unpleasantness, and a computerized visual analogue scales (VAS) rating of pain intensity during the procedure. Subjects completed the GREP questionnaire to assess sex-related stereotypic attributions of pain sensitivity, pain endurance, and willingness to report pain. Consistent with previous research, significant sex differences emerged for measures of pain threshold, pain tolerance, and pain unpleasantness. After statistically controlling for age, GREP scores were significant predictors of threshold, tolerance, and pain unpleasantness, accounting for an additional 7, 11, and 21% of the variance, respectively. Sex remained a significant predictor of pain tolerance in hierarchical regression analyses after controlling for GREP scores. Results provide support for two competing but not mutually exclusive hypotheses related to the sex differences in experimental pain. Both psychosocial factors and first-order, biological sex differences remain as viable explanations for differences in experimental pain report between the sexes. It appears that GREP do play a part in determining an individual's pain report and may be contributing to the sex differences in the laboratory setting.     

Gender bias in cardiovascular advertisements

RATIONALE: Women with cardiovascular disease are treated less aggressively than men. The reasons for this disparity are unclear. Pharmaceutical advertisements may influence physician practices and patient care. AIMS AND OBJECTIVE: To determine if female and male patients are equally likely to be featured in cardiovascular advertisements. METHODS: We examined all cardiovascular advertisements from US editions of general medical and cardiovascular journals published between 1 January 1996 and 30 June 1998. For each unique advertisement, we recorded the total number of journal appearances and the number of appearances in journals' premium positions. We noted the gender, age, race and role of both the primary figure and the majority of people featured in the advertisement. RESULTS: Nine hundred and nineteen unique cardiovascular advertisements were identified of which 254 depicted a patient as the primary figure. A total of 20%[95% confidence interval (CI) 15.3-25.5%] of these advertisements portrayed a female patient, while 80% (95% CI 74.5-84.7%) depicted a male patient, P <0.0001. Female patient advertisements appeared 249 times (13.3%; 95% CI 8.6-18.9%) while male patient advertisements appeared 1618 times (86.7%; 95% CI 81.1-91.4%), P <0.0001. Female patient advertisements also had significantly fewer mean appearances than male patient advertisements in journals' premium positions (0.82 vs. 1.99, P=0.02). Similar results were seen when the advertisements were analysed according to predominant gender. CONCLUSIONS: Despite increasing emphasis on cardiovascular disease in women, significant under-representation of female patients exists in cardiovascular advertisements. Physicians should be cognizant of this gender bias.     

Prior pain experience: influence on the observation of experimental pain in men and women.

Research examining perceptions of subjects participating in an experimental pain task has not been widely studied. The primary purpose of this study was to examine the influence of prior experience with the cold pressor on subsequent perceptions of others experiencing this same pain task. Furthermore, to replicate our previous work, we examined how individuals observe experimentally induced pain in male and female participants. Possible interactions between order of cold pressor experience, sex of the viewer, sex of the individual being observed, and characteristics attributed to the individuals in the videos were also analyzed. The sample was composed of 57 participants. They were each randomized to 1 of 2 conditions: (1) participate in cold pressor task before viewing a presentation of 10 video clips (of subjects in cold pressor task), rate videos, and complete battery of questionnaires or (2) cold pressor participation after completion of the same questionnaires, and viewing/rating videos. Participants viewing the videos provided ratings including observed pain and emotional characteristics they attributed to the individuals. These results replicated and extended our previous work by demonstrating a gender bias (ie, a stereotypical belief about an individual on the basis of their sex) in the observation of pain, such that participants rated female subjects as experiencing greater pain intensity when undergoing a cold pressor task compared to male subjects. Furthermore, experiencing the cold pressor before watching the videos increased a participant's pain ratings of observed pain. There were also several significant interactions between cold pressor condition, sex of video participant, sex of viewer, and emotional/behavioral characteristics attributed to the video participant. PERSPECTIVE: Results of this study demonstrate that prior experience with pain increases accuracy of estimating others' pain. Gender role expectations also influence observer's ratings of pain, and prior experience of pain influences men and women differently.     

Gender bias in an occupational therapy text

Willard and Spackman's Occupational Therapy does not create an awareness and understanding of the role of women in the field of occupational therapy. Nor does the text include general policy statements or reflections on how gender bias affects our work. What is our true consciousness as women therapists? Maria Mies (1983) wrote that women consent to their own oppression or subordination through silence. "Only when there is a rupture in the 'normal' life of a woman, a divorce, an end of a relationship, is there a chance for her to become conscious of her true condition which had been unconsciously submerged in a patriarchal system" (p. 125). True consciousness occurs in occupational therapy when practitioners avoid the use of activities or occupation in therapy. This is our "rupture". I believe the profession needs to develop a policy statement discussing gender concerns in our theory and practice linked to the progress made by women scientists in anthropology, psychology, sociology, history, and literature. It is critical to good treatment that the gender role factor be included in our research on the generic impact of activity on the individual and small group. As female occupational therapists we have the opportunity to make a significant imprint on a gender-based understanding of the health value of activities in our daily lives.     

The effect of cognitive bias modification for interpretation on avoidance of pain during an acute experimental pain task

Research confirms that patients with chronic pain show a tendency to interpret ambiguous stimuli as pain related. However, whether modifying these interpretive pain biases impacts pain outcomes is unknown. This study aimed to demonstrate that interpretation biases towards pain can be modified, and that changing these biases influences pain outcomes in the cold pressor task. One hundred and six undergraduate students were randomly allocated to receive either threatening or reassuring information regarding the cold pressor. They also were randomly allocated to 1 of 2 conditions in the Ambiguous Scenarios Task, in which they were trained to have either a threatening interpretation of pain (pain bias condition) or a nonthreatening interpretation of pain (no pain bias condition). Therefore, the study had a 2 (threat/reassuring) × 2 (pain bias/no pain bias) design. Analyses showed that a bias was induced contingent on condition, and that the threat manipulation was effective. Participants in the pain bias condition hesitated more before doing the cold pressor task than those in the no pain bias condition, as did those in the threat compared with the reassurance condition. The major finding was that interpretive bias mediated the relationship between bias condition and hesitance time, supporting the causal role of interpretive biases for avoidance behaviors in current chronic pain models. No differences were found on other pain outcomes regarding bias or threat, and the efficacy of the bias modification was not impacted by different levels of threat. These results suggest that cognitive bias modification should be further explored as a potential intervention in pain.     

Gender, interpersonal transactions, and the perception of pain: an experimental analysis.

Two experiments assessed how interpersonal transactions influence responses to cold pressor pain in women versus men. In Experiment 1, 91 young adults (57 women, 34 men) were randomly assigned to either a no transaction (NT) condition in which they coped alone with the cold pressor test or a transaction opportunity (TO) condition in which they also had the option of interacting with an empathetic, reflecting experimenter. Compared to men, women had lower pain tolerance and reported more pain and catastrophizing, although there were no gender differences in support seeking or other ways of coping. Within the TO condition, women were no more likely than men to initiate a transaction, but female speakers were more pain-focused than male speakers, and speaking with the empathetic interaction partner had generally negative effects on pain perception and coping. In Experiment 2, 126 young adults (76 women, 50 men) were randomly assigned to NT, TO, or experimenter-directed (1) Distraction (DT), (2) Reinterpretation (RT), or (3) Encouragement (ET) conditions. Although men had similar levels of pain tolerance across the 5 transaction conditions, women in NT and TO conditions exhibited reduced tolerance compared with those in the DT, RT, and ET conditions. Pain tolerance times among women in DT, RT, and ET conditions were equal to or exceeded those of men in these conditions. Together, findings suggest the nature of interpersonal transactions exerts a greater influence on women's responses to noxious stimulation than those of men. PERSPECTIVE: This study adds to literature indicating that women exhibit reduced tolerance for experimentally induced pain compared with men. These results suggest that the nature of interpersonal transactions also affects women's responses to noxious stimulation, more than those of men.     

Gender differences in the perception of chest pain

This study investigated gender differences in pain perception as characterized by pain symptoms in patients diagnosed with unstable angina pectoris. Twenty-nine women and 32 men were asked to characterize their chest pain using a semi-open questionnaire assessing pain intensity (by numerical rating), pain location, pain characteristics, complaints following chest pain, factors that evoked or reduced chest pain, and whether the chest pain was related to heart disease. Significant gender differences were found. Women scored the intensity of their chest pain significantly higher than men (Chi-square 14.8, P < 0.0001), and related their chest pain less to heart disease (Chi-square 24.6, P < 0.0001). The women described an atypical clinical picture of chest pain that was significantly different from men's. The results are discussed in light of pschological theories regarding gender differences in pain perception. These findings imply the need for special attention to the unique clinical pictures that appear for women and men.     

Gender,coping and the perception of pain

Research consistently indicates that gender differences exist in pain perception, with females typically reporting more negative responses to pain than males. It also seems as if males and females use and benefit from different coping strategies when under stress; females seem to prefer emotion-focused coping, whereas males prefer sensory-focused coping. Unfortunately, experimental research that examines such differences in the context of pain has not yet been adequately investigated. The aim of the current study was, therefore, to determine whether gender differences would be found in the effect that sensory-focused and emotion-focused coping instructions have on cold pressor pain experiences. Participants consisted of 24 male and 26 female healthy adults, all of whom reported no current pain. A consistent pattern of effects was found, over both behavioural and self-report measures of pain. Compared to females, males exhibited less negative pain responses when focusing on the sensory component of pain (i.e. increased threshold, tolerance and lower sensory pain). Furthermore, compared to sensory focusing, emotional focusing was found to increase the affective pain experience of females. Together these results confirm that important differences exist between men and women in the effects pain coping instructions have on the experience of pain. The implications of such findings for research and practice are discussed.     

Gender and the placebo analgesic effect in acute pain

OBJECTIVE: Our objective was to examine the placebo arms from a series of clinical trials in which the post-third molar extraction dental pain model was used to elucidate the time course of the placebo effect and the proportion of the population that are responders, as well as to evaluate whether the placebo analgesic response of female subjects may differ from that of male subjects. METHODS: We performed a meta-analysis of 596 subjects included in the placebo treatment arm of 16 double-blind, post-third molar extraction dental pain (moderate to severe) studies submitted to the Food and Drug Administration electronically. The inclusion and exclusion criteria were practically identical in all studies. Pain relief and pain intensity measurements used the same metrics in all studies. The measurements were recorded just before drug administration and at least at postdose hours 0.5, 1, 1.5, 2, 3, 4, 5, and 6. RESULTS: There were 325 female subjects and 271 male subjects. They were all otherwise healthy, with a mean age of 21.6 years for female subjects and 22.3 years for male subjects. The postoperative baseline pain was greater in female subjects than in male subjects, and this difference was statistically significant. Both pain intensity and pain relief scores demonstrate the well-established placebo effect in 10% of the pooled subjects, as well as in all the individual studies. Over time, however, the mean pain intensity and pain relief scores for the female and male treatment groups were not noticeably different at any time point after medication. Further analysis of the data showed no gender difference in duration of action of the placebo. CONCLUSIONS: The results demonstrated no gender difference in response to placebo. These results were obtained from the post-third molar extraction situation, in which the least possible confounding factors were present. To fully establish the generality of this phenomenon, studies should be carried out in other pain models.     

Gender role expectations of pain: Relationship to sex differences in pain

Empirical research supports the existence of sex differences in pain; yet these differences are poorly understood. Although biological mechanisms have been posited to explain variability, results of pain modeling manipulations suggest social learning may be a stronger influence on pain response. In this report we use the term sex to refer to the biological category of male or female. We use the term gender to refer to the socially acquired aspects of being male or female sometimes referred to as femininity and masculinity. This study investigated a new measure, the Gender Role Expectations of Pain questionnaire (GREP), which was designed to measure sex-related stereotypic attributions of pain sensitivity, endurance, and willingness to report pain. Subjects were 156 male and 235 female undergraduates at a southeastern university. Psychometric investigation of the questionnaire revealed a 5-factor solution that closely mirrored the theoretical construction of the items. Test-retest reliability was also shown for individual items on a separate sample of 28 subjects. Results supported hypotheses about gender role: both men and women rated men as less willing to report pain than women (F_1,389 = 336, P <.001); both men and women rated women more sensitive (F_1,389 = 9.5, P <.05) and less enduring of pain (F_1,389 = 65.7, P <.001) than men; and men rated their own endurance as higher than the typical man (F_1,389 = 65.7, P <.001). Sex accounted for 46% of the variance in willingness to report pain. Results suggest that the GREP distinguished between the socially learned reactions to pain for men and women. It is recommended that the influence of gender-related expectations for pain be assessed in all studies investigating human sex differences in pain. © 2001 by the American Pain Society     

Gender differences in temporal summation of mechanically evoked pain

Several studies indicate that females are more sensitive to experimentally induced pain than males. Moreover, it was recently shown that temporal summation of heat pain is greater in females than males, suggesting that central processing of nociceptive input may be upregulated in women. Temporal summation of pain has been examined principally using thermal or electrical stimuli. The purpose of this study was to investigate the temporal summation to noxious mechanical stimulation, and examine gender differences in temporal summation of mechanically evoked pain. A sharp probe was used to apply brief mechanical stimuli on the fingers of ten healthy females and ten healthy males. Trains of ten repetitive stimuli were applied at an intensity of 1.2-1.3 x the individual subject's pain threshold, at interstimulus intervals (ISIs) ranging from 1 to 6 s. The same or different skin sites were stimulated in any single train of stimuli. The pain ratings for the fifth as well as the tenth stimulus were significantly higher than those for the first stimulus. Also, the pain responses for the tenth stimulus were higher than those for the fifth. There was no overall gender difference in pain ratings, however, there was a significant trial # x gender interaction. Males and females provided comparable magnitude estimates for the first stimulus in the train, but females provided higher pain ratings than males for the fifth as well as the tenth stimulus. Temporal summation occurred across all ISIs, but shorter ISIs (1-3 s) elicited significantly greater temporal summation than longer ISIs (4-6 s). Finally, although higher pain ratings were obtained when the ten consecutive stimuli were applied on the same versus different skin areas, the degree of temporal summation was not significantly different. These findings indicate that temporal summation of mechanically evoked pain is higher in females compared to males, is stimulation frequency dependent and is centrally mediated.