Gender Differences in Pain Flashcards
1
Q
Sentinel Questions
A
Referencing Pain:
- Location
- Onset / Duration
- Quality
- Timing
- Severity
- Radiation
- Functional Status
- Associated Symptoms
- Modifying Factors
- Previous Episode / Injury
2
Q
Nociception
A
The neural processing (physiology) of noxious stimuli that results in the perception of pain.
3
Q
Nociceptive
A
- Peripheral nerve receptor (Nociceptors or pain receptors)
- Stimulated by specific types of activity (mechanical, chemical, thermal changes above set points)
- Produce afferent activity from actual tissue damage or potentially tissue-damaging stimuli
- Receptors then send info into to spinal cord and from there to the brain and might result in pain sensation
-
Examples:
- Motorcycle falls on her leg and results in a second-degree burn (thermal)
- Handled a chili pepper and stuck finger into eye (chemical)
- Closed hand in car door (mechanical)
- Diffuse abdominal pain (visceral pain)
- Fracture of toe (deep somatic pain)
- Meaning stimulation of pain receptors by ligaments, bones, blood vessels, fascia, muscles)
4
Q
The Clinical “Wish” of Pain
A
- Logical that the amount of tissue damage should be a barometer of the amount of pain a patient perceives
- Perception is a sensory and emotional experience
- Problems in pain treatment result when doctors think that they know best on amount of medication for pain control
- Accurately using appropriate medications for optimal goal of pain relief is important
5
Q
Women and Pain
A
Women have more pain that is:
- Recurrent
- Severe
- Anatomically Affected
- Diffuse and longer lasting
- Under-diagnosed and under-treated
- More side effects and debility
- Insufficient research and effective targeted treatment
- Lack of access and coverage
6
Q
Having multiple pain conditions is…
A
- Associated with higher levels of disability and psychological distress than having a single pain condition
- A risk factor for onset of new pain conditions
7
Q
Women vs Men
A
-
Pain threshold
- Higher in men
-
Tolerance
- Higher in men
-
Adaptation
- May be higher in women
- Evidence for sex differences in pain is wide ranging
- Includes basic science, epidemiology and clinical research
8
Q
Female Pain Perception
Factors
A
-
Hormones
- Changes in sex hormones have been found to moderate pain (eg, menstrual cycle, pregnancy)
-
Lifespan
- Sex differences in pain can vary across the lifespan
- Many of the observed gender differences in pain prevalence appear to reduce beyond the reproductive years
-
Culture
- Sex differences in pain can vary across different cultures as well
9
Q
Top Pain Areas for Women
A
- Musculoskeletal
- Autoimmune
- Neurologic
- Vascular
- Gastrointestinal
- Genitourinary
- Gyn Only Conditions
10
Q
Musculoskeletal Pain
&
Sex Differences
A
-
More Common in Women
- TMJ disorder
- Occipital neuralgia
- Carpal tunnel syndrome
- Fibromyalgia (7x)
- Slipping rib / 12th rib syndrome
- Piriformis syndrome
- Rheumatoid Arthritis
-
More Common in Men
- Ankylosing Spondylitis
- Reactive Arthritis (formerly Reiter’s Syndrome)
- Hemophilic Arthropathy
11
Q
Neurologic Sex Differences and Pain
A
-
More Common in Women:
- Headaches – Migraine with aura; Chronic tension; Post-dural puncture; Cervicogenic
- Ticdouloureux
- Multiple Sclerosis
- Interstitial cystitis
-
More Common in Men:
- Headaches: Migraine without aura; Cluster; Post-traumatic
- Pancoast tumor
- Lateral femoral cutaneous neuropathy
12
Q
No Sex Prevalence
A
- Acute tension headache
- Cluster tic syndrome
- Secondary trigeminal neuralgia
- Painful ophthalmoplegia
- Maxillary sinusitis
- Burns
13
Q
Gyn Pain Conditions
A
-
Dysmenorrhea
- Extremely common, affecting 40- 90% of women
- Excruciating in about 15%
- Prevalence & severity of primary are highest in late adolescence and the young adult years
-
Low Back Pain with Pregnancy
- 45% lower back/pelvic girdle during pregnancy
- 25% of all women have pain of sufficient severity to require medical attention
-
Postpartum
- 25% experience lower back/pelvic girdle pain
- About 5% of all women experiencing severe pain
-
Labor Pain
- Over 95% of labors
-
Vulvodynia
- Chronic pain in the vulvar area in the absence of known infectious, dermatological, metabolic, autoimmune or neoplastic causes
- In one community study, vulvar pain in over 18% of women
- 12% reporting knifelike pain or pain on contact
- Over 6% reporting persistent itching or burning sensations
-
Chronic (Non-menstrual) Pelvic Pain caused by:
- Gynecological conditions (eg, endometriosis, infection
- Nongynecological conditions (including irritable bowel syndrome or bladder-related pain)
- All cause prevalence 15% among reproductive age women
- 30-50% women with pelvic pain have urinary frequency
- IBS commonly coexists with pelvic pain
14
Q
Sex Hormones and Pain
A
Pain, and in particular chronic pain, shows important sex differences:
- Several reasons for higher reactivity of females vs males to a similar painful stimulation
- Genes, hormonal, and cultural influences
- Pain perception varies according to the menstrual cycle phases in women with chronic pain
- For example, temporomandibular pain is highest in the premenstrual period and during menses
- Androgens and estrogens are vital for the proper development and maintenance of the male and female reproductive systems
- Also play an important physiological role in the activity and wellbeing of males and females
- Androgens are able to affect nociception and pain
- Inverse relationship was found between plasma testosterone and work-related neck and shoulder disorders in female workers
- Low dose transdermal testosterone therapy was found to improve angina threshold in men with chronic stable angina
- Testosterone, administered to both male and female rats, change formalin induced responses and analgesia
15
Q
Unrecognized Factors with Pain
A
History of sexual abuse (disclosed or not)
Incidence of unattended depression
