Several studies have addressed whether physical or psychological interventions differentially influence pain responses in men versus women, and these studies are summarized in the lower portion of Table 10. The majority of these studies (5/6, 81%) indicate that females exhibit more efficient pain inhibitory responses compared with males. For example, using an isometric handgrip exercise, pressure pain threshold was elevated in females but not males, suggesting that exercise-induced analgesia was greater in females.226 However, sex-related differences in pain modulation may be dependent on the type of stressor and pain modality. For example, in response to a laboratory public-speaking stressor, males exhibited a greater stress-related reduction in heat pain, whereas females showed a greater reduction with ischemic pain.45 Sternberg et al387 reported that cold pain was reduced in males during video game competition, whereas pain was more substantially reduced by physical exercise in females.
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- For example, in response to a laboratory public-speaking stressor, males exhibited a greater stress-related reduction in heat pain, whereas females showed a greater reduction with ischemic pain.45 Sternberg et al387 reported that cold pain was reduced in males during video game competition, whereas pain was more substantially reduced by physical exercise in females.
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Two studies reported that males displayed higher pain threshold and tolerance.128,161 Despite large sample sizes for several studies,107,124,132,133,161 sex differences in ischemic pain have not been statistically significance due to their small effect sizes. Epidemiologic studies of pain typically report point prevalence (currently in pain), period prevalence (ie, experiencing pain during the past month or year), or lifetime prevalence. Some of the studies reviewed have measured pain intensity or severity ratings and depression, a common impact of chronic pain, and when sex differences were tested, we will report the findings. One issue worth mentioning is over interpretation of positive findings for sex differences in pain due to publication biases. It seems plausible that in some cases sex differences were tested, found to be nonsignificant, and then not reported in a manuscript.93 This may be particularly true for population-based studies of prevalence in which pain intensity or severity is of secondary interest.