Lund Iréne, Lundeberg Thomas
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Acupunct Med. 2008 Mar;26(1):33-45. doi: 10.1136/aim.26.1.33.
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.
疼痛是一种独特的个人体验，存在个体差异，其中性别相关影响可能起作用。目前尚不清楚男女之间差异的潜在机制，但可能很复杂，涉及生物、社会文化和心理方面的相互作用。一般来说，与男性相比，女性在疼痛实验刺激下报告的疼痛强度更大。临床疼痛在女性中通常报告为严重程度更高、频率更高、持续时间更长，且涉及的身体部位比男性更多。女性也更有可能经历多种疼痛病症，如纤维肌痛、颞下颌功能障碍、偏头痛、类风湿性关节炎和肠易激综合征。关于生物因素，内源性疼痛抑制系统的数量和质量差异以及性腺激素的影响都被认为与之有关。社会心理因素，如性别角色信念、疼痛应对策略和与疼痛相关的预期，也可能导致这些差异。一生中反复经历痛苦的内脏事件（如月经、分娩）可能导致女性对疼痛的敏感性增加和患病率更高。在评估疼痛治疗中药理学和非药理学疗法的效果时，应考虑性别因素，因为对干预的反应可能不同。最好，治疗建议应基于以男性和女性为样本的研究。由于结果存在差异，动物研究和健康受试者实验的结果应谨慎解读。
