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- We have previously suggested that sex differences in nociceptive processing, which would be manifested in responses to experimentally induced pain, represent one potentially important contributing factor.
- Thus, even in the absence of quantitative sex differences, researchers should conduct analyses to uncover potential qualitative sex differences, which simply involves including sex as a moderator in the statistical model.
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Differences in cerebral activation between males and females have been evaluated in a number of studies. Studies have examined brain activity through a number of methods including positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) in response to different pain modalities. Given the reported sex differences in experimental pain perception, the use of neuroimaging is a promising tool that may reveal sex differences in central representations of pain. Table 9 lists several studies that have compared the central processing of pain between males and females. These studies have revealed a number of common cortical and subcortical areas activated by pain, but they have also observed sex-specific areas of activation.
Overall, each study reported sex differences in at least one pain outcome, but, similar to heat pain, discrepancies among pain outcomes occur between indices of cold pain within studies. For example, Jones et al205 observed sex-related differences for cold pain tolerance but not threshold. Based on the present set of studies, it appears that sex differences in cold pain are consistent, particularly for suprathreshold measures such as tolerance and pain ratings.
Next, we will review recent findings regarding sex differences in experimental pain sensitivity. Many studies have investigated the prevalence of musculoskeletal pain in men and women, with some assessing chronic musculoskeletal pain irrespective of the site, whereas others have been site specific. In a previous review, Rollman and Lautenbacher341 concluded that women have greater frequency of musculoskeletal pain than men.
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