Women report higher pain scores than men across age groups, geographical regions, and disease populations, according to the results of a systematic review and meta-analysis published in Pain.
Investigators from the University of New South Wales in Australia searched publication databases between January 2000 and January 2020 for randomized controlled trials in the setting of noncommunicable diseases (NCDs). Trials met inclusion criteria if pain was defined using the EuroQoL-5 dimension-5 level (EQ-5D-5L). Of 79 trials identified, 10 trials that comprised 33,957 participants were included.
The patients who reported pain were more likely to be older, women, and nonsmokers. In addition, patients with higher pain scores were more likely to have diabetes, hypercholesterolemia, hypertension, acute coronary syndrome, and atrial fibrillation compared with patients without pain.
Overall, 47% of women reported pain compared with 37% of men (P <.001) and 12% of women reported extreme pain compared with 10% of men (P =.004).
Stratified by study, all but 1 found that women reported higher pain scores than men (odds ratio [OR] range, 1.14-2.11). The study that did not report a significant gender effect (OR, 1.48; 95% CI, 0.79-2.78) was conducted in 4 countries among patients with end-stage kidney disease.
In the fully adjusted model, women reported higher pain scores than men (adjusted odds ratio [aOR], 1.47; 95% CI, 1.26-1.71; P <.001).
Similarly, in the subgroup analyses, women reported higher pain scores among all age groups (OR range, 1.34-1.48) in Australia (OR, 1.24), Asia (OR, 1.51), and America (OR, 1.66) but not in Europe (OR, 1.49; 95% CI, 0.94-2.36); and in all disease groups (OR range, 1.17-2.11) except kidney failure (OR, 1.48; 95% CI, 0.79-2.78). Significant subgroup heterogeneity was observed for disease states (P <.001) but not regions (P =.077).
The limitations of this analysis included the lack of generalizability of study findings based on the mean age of study participants, and potential for incomplete adjustment for confounders. Moreover, the researchers noted that there was a large amount of missing data such as socioeconomic data and components of patients’ medical history.
The study authors noted, “Sex differences in central pain processing mechanisms that increase the risk of females experiencing pain may contribute to this finding.” They concluded, “Research in pain, disease, and treatment must therefore report sex disaggregated results to determine both similarities and differences between females and males.”
Li JXL, Wang X, Henry A, et al. Sex differences in pain expressed by patients across diverse disease states: individual patient data meta-analysis of 33,957 participants in 10 randomized controlled trials. Pain. Published online March 24, 2023. doi:10.1097/j.pain.0000000000002884