Pain Research and Intervention Center of Excellence, University of Florida, 1395 Center Drive, Room D2-148, PO Box 100404, Gainesville, FL 32610, USA.
Br J Anaesth. 2013 Jul;111(1):52-8. doi: 10.1093/bja/aet127.
Recent years have witnessed substantially increased research regarding sex differences in pain. The expansive body of literature in this area clearly suggests that men and women differ in their responses to pain, with increased pain sensitivity and risk for clinical pain commonly being observed among women. Also, differences in responsivity to pharmacological and non-pharmacological pain interventions have been observed; however, these effects are not always consistent and appear dependent on treatment type and characteristics of both the pain and the provider. Although the specific aetiological basis underlying these sex differences is unknown, it seems inevitable that multiple biological and psychosocial processes are contributing factors. For instance, emerging evidence suggests that genotype and endogenous opioid functioning play a causal role in these disparities, and considerable literature implicates sex hormones as factors influencing pain sensitivity. However, the specific modulatory effect of sex hormones on pain among men and women requires further exploration. Psychosocial processes such as pain coping and early-life exposure to stress may also explain sex differences in pain, in addition to stereotypical gender roles that may contribute to differences in pain expression. Therefore, this review will provide a brief overview of the extant literature examining sex-related differences in clinical and experimental pain, and highlights several biopsychosocial mechanisms implicated in these male-female differences. The future directions of this field of research are discussed with an emphasis aimed towards further elucidation of mechanisms which may inform future efforts to develop sex-specific treatments.
近年来，关于疼痛的性别差异的研究显著增加。这一领域广泛的文献清楚地表明，男性和女性对疼痛的反应不同，女性通常对疼痛更敏感，患临床疼痛的风险更高。此外，还观察到对药理学和非药理学疼痛干预措施的反应性存在差异；然而，这些影响并不总是一致的，似乎取决于治疗类型以及疼痛和提供者的特征。尽管这些性别差异的具体病因基础尚不清楚，但似乎有多种生物和心理社会过程是促成因素。例如，新出现的证据表明，基因型和内源性阿片类物质功能在这些差异中起着因果作用，大量文献表明性激素是影响疼痛敏感性的因素。然而，性激素对男性和女性疼痛的具体调节作用需要进一步探索。心理社会过程，如疼痛应对和早期生活中压力的暴露，也可能解释疼痛的性别差异，除了可能导致疼痛表达差异的刻板性别角色之外。因此，本综述将简要概述检查临床和实验疼痛中与性别相关的差异的现有文献，并强调几个涉及这些男女差异的生物心理社会机制。讨论了该研究领域的未来方向，重点是进一步阐明可能为未来开发针对特定性别的治疗方法提供信息的机制。
