Division of Systems Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
J Pain. 2012 Mar;13(3):228-34. doi: 10.1016/j.jpain.2011.11.002. Epub 2012 Jan 13.
Clinically recorded pain scores are abundant in patient health records but are rarely used in research. The use of this information could help improve clinical outcomes. For example, a recent report by the Institute of Medicine stated that ineffective use of clinical information contributes to undertreatment of patient subpopulations--especially women. This study used diagnosis-associated pain scores from a large hospital database to document sex differences in reported pain. We used de-identified electronic medical records from Stanford Hospital and Clinics for more than 72,000 patients. Each record contained at least 1 disease-associated pain score. We found over 160,000 pain scores in more than 250 primary diagnoses, and analyzed differences in disease-specific pain reported by men and women. After filtering for diagnoses with minimum encounter numbers, we found diagnosis-specific sex differences in reported pain. The most significant differences occurred in patients with disorders of the musculoskeletal, circulatory, respiratory and digestive systems, followed by infectious diseases, and injury and poisoning. We also discovered sex-specific differences in pain intensity in previously unreported diseases, including disorders of the cervical region, and acute sinusitis (P = .01, .017, respectively). Pain scores were collected during hospital encounters. No information about the use of pre-encounter over-the-counter medications was available. To our knowledge, this is the largest data-driven study documenting sex differences of disease-associated pain. It highlights the utility of electronic medical record data to corroborate and expand on results of smaller clinical studies. Our findings emphasize the need for future research examining the mechanisms underlying differences in pain.
This article highlights the potential of electronic medical records to conduct large-scale pain studies. Our results are consistent with previous studies reporting pain differences between sexes and also suggest that clinicians should pay increased attention to this idea.
临床上记录的疼痛评分在患者健康记录中很常见，但在研究中很少使用。这种信息的使用可以帮助改善临床结果。例如，医学研究所最近的一份报告指出，临床信息使用不当导致对患者亚人群的治疗不足，尤其是女性。本研究使用大型医院数据库中的诊断相关疼痛评分来记录报告疼痛的性别差异。我们使用斯坦福医院和诊所的匿名电子病历对超过 72000 名患者进行了研究。每个记录都包含至少 1 个疾病相关的疼痛评分。我们在 250 多个主要诊断中发现了超过 160000 个疼痛评分，并分析了男性和女性报告的特定疾病疼痛差异。在对诊断的最低就诊次数进行过滤后，我们发现报告的疼痛存在与性别相关的特定诊断差异。最显著的差异发生在患有肌肉骨骼、循环、呼吸和消化系统疾病的患者中，其次是传染病、损伤和中毒。我们还发现了以前未报告的疾病中疼痛强度的性别差异，包括颈椎区和急性鼻窦炎（分别为 P =.01，.017）。疼痛评分是在医院就诊期间收集的。没有关于就诊前使用非处方药物的信息。据我们所知，这是最大的数据驱动研究，记录了与疾病相关的疼痛的性别差异。它突出了电子病历数据的实用性，可以证实和扩展较小的临床研究结果。我们的研究结果强调了未来研究需要检查疼痛差异背后的机制。
本文强调了电子病历进行大规模疼痛研究的潜力。我们的结果与先前报告男女之间疼痛差异的研究一致，也表明临床医生应该更加关注这一观点。
