Although the overall pain burden may be comparable in men and women with chronic pain, there may be sex differences regarding pain beliefs and coping styles, according to a study published in Pain Practice.
Investigators examined patients with chronic pain enrolled in a therapeutic program, with the primary aim of assessing pretreatment sex differences in pain intensity, beliefs and catastrophizing, kinesiophobia, activity management patterns, and physical and psychological functioning. The study’s secondary aim was to evaluate gender disparities in treatment response.
A total of 72 men (mean age, 51.0 years; mean pain duration, 11.8 years; 58.3% reporting >3 major pain sites) and 130 women (mean age, 46.9 years; mean pain duration, 9.2 years; 60.8% reporting >3 major sites) were enrolled. Participants were referred for participation in a 4-week interdisciplinary chronic pain treatment program. Self-reported questionnaires were administered before and after treatment to evaluate pain intensity, physical function, and depressive symptoms. During the program, a multidisciplinary team instructed participants on the use of relaxation techniques, cognitive restructuring strategies, and appropriate therapeutic exercises and activities.
The McGill Pain Questionnaire was used to assess pain intensity, physical function was evaluated with the Pain Disability Index, and psychological function was assessed using the Beck Depression Inventory and the 20-item State-Trait Anxiety Inventory-Trait Form. Pain beliefs, pain catastrophizing, kinesiophobia, and pain management activity patterns were evaluated using the Survey of Pain Attitudes, the 13-item Pain Catastrophizing Scale, the 17-item Tampa Scale of Kinesiophobia, and the 30-item Patterns of Activity Measure- Pain questionnaires, respectively.
No between-group sex differences in pain intensity, pain catastrophizing, activity avoidance, pain beliefs, or physical or psychological functioning were established. Compared with women, men were found to view their pain as harmful more often (P =.001), to use activity pacing in performing daily activities to a greater extent (P =.022), and report greater levels of kinesiophobia (P <.001). More women were found to engage in an overdoing activity pattern compared with men (P <.001).
After 4 weeks of treatment, both men and women reported reduced depressive symptoms compared with pretreatment scores (P =.047). Women had greater improvements in pain intensity and physical function after the program compared with men (P <.001 for both). Effect sizes were estimated as small to moderate.
Study limitations include a small sample size, possible nongeneralizability to other chronic pain populations, lack of information concerning potential relevance of unexamined baseline variables, use of self-reported questionnaires, and restriction of the investigation to only biological sex differences.
“These findings indicate that further research to develop sex-specific assessment procedures and tailored pain treatments may be warranted,” noted the authors.
Racine M, Solé E, Sánchez‐Rodríguez E, et al. An evaluation of sex differences in patients with chronic pain undergoing an interdisciplinary pain treatment program [published online August 3, 2019]. Pain Pract. doi:10.1111/papr.12827