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女性的疼痛:对一个值得优先关注的相关临床问题的前瞻性综述

Pain in Women: A Perspective Review on a Relevant Clinical Issue that Deserves Prioritization.

作者信息

Casale Roberto, Atzeni Fabiola, Bazzichi Laura, Beretta Giovanna, Costantini Elisabetta, Sacerdote Paola, Tassorelli Cristina

机构信息

OPUSmedica, PC&R, Persons, Care & Research Network, Piacenza, Italy.

Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.

出版信息

Pain Ther. 2021 Jun;10(1):287-314. doi: 10.1007/s40122-021-00244-1. Epub 2021 Mar 15.

Abstract

INTRODUCTION

Gender equity and gender medicine are opportunities not to be missed, and this Expert Group Opinion Paper on pain in women aims to review the treatment of pain conditions mainly affecting women, as well as the fundamental aspects of the different clinical response to drug treatment between the genders, and what can be done for gender-specific rehabilitation.

METHODS

Perspective review.

RESULTS

Genotypic and phenotypic differences in pain between the sexes are conditioned by anatomical, physiological, neural, hormonal, psychological, social, and cultural factors, such as the response to pharmacological treatment to control pain. The examination of these factors shows that women are affected by pain diseases more frequently and severely than men and that they report pain more frequently and with a lower pain threshold than men. Some forms of pain are inherently related to gender differences, such as pain related to the genitourinary system. However, other forms of chronic pain are seen more frequently in women than men, such as migraine, rheumatological, and musculoskeletal pain, in particular fibromyalgia.

DISCUSSION

Research is needed into the pathophysiological basis for gender differences in the generation of acute pain and maintenance of chronic pain, including the factors that put women at higher risk for developing chronic pain. In addition, different specialties need to collaborate to develop gender-related diagnostic and therapeutic guidelines, and healthcare professionals need to upskill themselves in the appropriate management of pain using existing diagnostic tools and therapeutic options.

摘要

引言

性别平等和性别医学是不容错过的机遇,这份关于女性疼痛的专家小组意见书旨在综述主要影响女性的疼痛病症的治疗方法,以及不同性别对药物治疗的临床反应的基本差异,以及针对特定性别的康复治疗可采取的措施。

方法

前瞻性综述。

结果

男女在疼痛方面的基因型和表型差异受解剖学、生理学、神经学、激素、心理、社会和文化因素制约,比如对控制疼痛的药物治疗的反应。对这些因素的研究表明,女性比男性更频繁、更严重地受到疼痛疾病的影响,并且与男性相比,她们更频繁地报告疼痛,且疼痛阈值更低。有些疼痛形式与性别差异有着内在联系,比如与泌尿生殖系统相关的疼痛。然而,其他形式的慢性疼痛在女性中比在男性中更常见,如偏头痛、风湿性疼痛和肌肉骨骼疼痛,尤其是纤维肌痛。

讨论

有必要对急性疼痛产生和慢性疼痛维持中性别差异的病理生理基础进行研究,包括使女性患慢性疼痛风险更高的因素。此外,不同专业需要合作制定与性别相关的诊断和治疗指南,医护人员需要利用现有的诊断工具和治疗方案提高自身对疼痛的恰当管理技能。

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