Gender Differences in Acute and Chronic Pain in the Emergency Department: Results of the 2014Academic Emergency MedicineConsensus Conference Pain Section

Abstract

Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas in May of 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacologic and non-pharmacologic interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the lifespan; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biologic mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biologic mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender differences in the assessment and treatment of pain conditions in emergency care settings.

Sex Associated Differential Expressions of the Alternatively Spliced Variants mRNA of OPRM1 in Brain Regions of C57BL/6 Mouse

“…demonstrated that sex differences actually existed, consisting with previous studies [6,7,22,26,45,46], and the mRNA expressions of these variants were region-specific and also genderspecific, in accordance with our previous study partially [33]. Our results indicated that pain threshold of male mice against thermal stimulus and morphine-induced analgesic potency was higher in male mice compared with female mice and female mice was more easily to generate morphine tolerance.…”

A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures

“…Variables that could impact the outcome measure, based on construct validity or existing evidence in literature, was included in adjusted analysis. These covariates included race [19], age [7], gender [20], Charlson comorbidity index, triage acuity, the first recorded pain score, and the type of long or shorter bone fracture. Adjusted analysis were completed using generalized estimating equations clustered by study site, using linear models for continuous outcomes, logistic models for categorical outcomes, and gamma with log link function for time-based outcomes (which had a non-normal, gamma distribution); 95% confidence intervals were calculated using Wald analysis.…”

Future Directions in Sex- and Gender-specific Emergency Medicine

“…Another conceptual thread that may deserve further exploration is the complex interaction between the sex and gender of the patient and that of the clinical provider. A subtopic brought forth by the pain, 8 cardiac, 9 and trauma resuscitation workgroups, 10 this area likely plays a role in all areas of clinical care and may have merited more detailed discussion and exploration of its relevance in the other breakout groups at the conference. As our specialty matures in the area of sex and gender research, we will gradually be able to deepen our research agenda and expand our work to the many important questions that did not emerge in the forefront in this initial effort.…”