Is it All about Sex? Acupuncture for the Treatment of Pain from a Biological and Gender Perspective

Abstract

Pain is a unique personal experience showing variability where gender and sex related effects might contribute. The mechanisms underlying the differences between women and men are currently unknown but are likely to be complex and involving interactions between biological, sociocultural and psychological aspects. In women, painful experimental stimuli are generally reported to produce a greater intensity of pain than in men. Clinical pain is often reported with higher severity and frequency, longer duration, and present in a greater number of body regions in women than in men. Women are also more likely to experience a number of painful conditions such as fibromyalgia, temporomandibular dysfunction, migraine, rheumatoid arthritis and irritable bowel syndrome. With regard to biological factors, quantitative as well as qualitative differences in the endogenous pain inhibitory systems have been implicated, as well as an influence of gonadal hormones. Psychosocial factors like sex role beliefs, pain coping strategies, and pain related expectancies may also contribute to the differences. Being exposed to repeated painful visceral events (eg menses, labour) during life may contribute to an increased sensitivity to, and greater prevalence of, pain among women. When assessing the outcome of pharmacological and non-pharmacological therapies in pain treatment, the factors of gender and sex should be taken into account as the response to an intervention may differ. Preferably, treatment recommendations should be based on studies using both women and men as the norm. Due to variability in results, findings from animal studies and experiments in healthy subjects should be interpreted with care.

Irritable Bowel Syndrome and Migraine: Bystanders or Partners?

“…Since both disorders are female predominant, it is observed that menstrual cycle does enhance their pain severity 22,65. Consequently, sex steroids likely play a role to modulate the nociception leading to an enhanced symptoms among the females particularly occurring in their cycles, while their psychosocial factors may additionally modify the finally perceived pain sensation 22,66…”

“…Besides, the visceral sensitivity is usually gender determined since sexual steroids may enhance its perception among the female IBS subjects 65,66,81. On the other hand, migraine, a primary brain dysfunction, is an interictal hypersensitivity to some sensory stimuli leading to the episodic activation and sensitization of trigemino-vascular pain pathway and the following headache consequences 61,62.…”

Effect of Self-Management Intervention on Cortisol and Daily Stress Levels in Irritable Bowel Syndrome

“…It has been suggested that gender differences in coping styles and resources may explain the higher occurrence of IBS symptoms and prevalence of this syndrome in women as compared to men (Adeyemo, Spiegel, & Chang, 2010; Lund & Lundeberg, 2008; Rao, 2009). How sex (e.g., ovarian hormones) and/or gender (e.g., social role) contribute to the female predominance in IBS remains to be determined.…”

Women Demonstrate More Pain and Worse Function Before THA but Comparable Results 12 Months After Surgery

“…Women typically have a lower pain threshold (that is, a greater sensitivity to experimentally induced pain) than men [14]. This may be mediated by sociocultural factors (including age, family history, and gender roles), psychological factors (such as anxiety, depression, cognition, behavior), or biological factors (like genetics, sex hormones, endogenous pain inhibition), all of which can also interact with each another in complex ways [27].…”