PurposeThe aim of this study is to explore differences between male and female patients entering a rehabilitation program at a pain clinic in order to gain a greater understanding of different approaches to be used in rehabilitation.Method1371 patients referred to a specialty pain rehabilitation clinic, completed sociodemographic and pain related questionnaires. They rated their pain acceptance (CPAQ-8), their kinesiophobia (TSK), the impact of pain in their life (MPI), anxiety and depression levels (HAD) and quality of life scales: the SF-36, LiSat-11, and the EQ-5D. Because of the large sample size of the study, the significance level was set at the p ≤.01.ResultsAnalysis by t-test showed that when both sexes experience the same pain severity, women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia, mood disturbances and lower activity level.ConclusionPain acceptance (CPAQ-8) and kinesiophobia (TSK) showed the clearest differences between men and women. Pain acceptance and kinesiophobia are behaviorally defined and have the potential to be changed.

Chronic widespread pain has limited treatment options and is associated with pronounced negative individual and socioeconomic consequences. Patients with local or regional pain may be at a risk for developing chronic widespread pain. Knowledge of such risk factors can help prevent chronic widespread pain. This study systematically reviews the literature that examines risk factors associated with developing chronic widespread after developing chronic regional pain. We conducted a three-step database search in Medline. Four articles from the authors' files formed a core set of articles that were used to validate the search strategy. We conducted a systematic quality assessment of the included studies. Based on risk estimations reported in six prospective population-based studies and one retrospective study on pain, this study identified five risk factors: female sex, higher age, family history of pain, depressed mode and pain sites at baseline. As only a few studies were recovered, the impact of these factors is unclear. Spreading of pain from local or regional pain to widespread pain occurs in a large proportion of the general population. Few studies have addressed similar risk factors and the few risk factors associated with the transition from chronic regional pain to chronic widespread pain are inconsistent. Studies that focus on this transition have included few subjects and few possible risk factors. Future studies should explore more possible risk factors.

Whiplash-associated disorders (WAD) have been associated with sensory disturbances such as hypersensitivity or hypoesthesia. Different psychological factors seem to be important for prognosis and symptom presentation in WAD. Multivariate correlations between pain thresholds for pressure (PPT), cold and heat (CPT, HPT), detection thresholds for cold and warmth, pain intensity variables, and psychological aspects in women with chronic WAD (n=28) and in healthy pain-free controls (n=29) were investigated. Quantitative Sensory Testing (QST) for thermal thresholds and algometry for PPT at various sites in the body were used. Psychological aspects, including catastrophizing, anxiety, and depression were registered using a questionnaire. WAD showed generalized decreased PPT and CPT, altered HPT and cold detection thresholds in the upper part of the body, and a worse psychological situation. Multivariate correlations were found between QST and PPT variables, habitual pain, and psychological factors in WAD. Different psychological variables were generally stronger predictors of CPT and HPT than pain intensity in WAD. Pain intensity aspects were generally the strongest predictors of PPT in WAD. In contrast, no correlations existed between QST and PPT variables and psychological variables in controls. These results indicate the need to consider that a blend of factors influences the pain thresholds in chronic WAD and emphasize the need for a biopsychosocial model when interpreting QST and PPT variables.