Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada.
Int Rev Neurobiol. 2022;164:277-307. doi: 10.1016/bs.irn.2022.06.013. Epub 2022 Jul 30.
Chronic pain affects 20% of adults and is one of the leading causes of disability worldwide. Women and girls are disproportionally affected by chronic pain. About half of chronic pain conditions are more common in women, with only 20% having a higher prevalence in men. There are also sex and gender differences in acute pain sensitivity. Pain is a subjective experience made up of sensory, cognitive, and emotional components. Consequently, there are multiple dimensions through which sex and gender can influence the pain experience. Historically, most preclinical pain research was conducted exclusively in male animals. However, recent studies that included females have revealed significant sex differences in the physiological mechanisms underlying pain, including sex specific involvement of different genes and proteins as well as distinct interactions between hormones and the immune system that influence the transmission of pain signals. Human neuroimaging has revealed sex and gender differences in the neural circuitry associated with pain, including sex specific brain alterations in chronic pain conditions. Clinical pain research suggests that gender can affect how an individual contextualizes and copes with pain. Gender may also influence the susceptibility to develop chronic pain. Sex and gender biases can impact how pain is perceived and treated clinically. Furthermore, the efficacy and side effects associated with different pain treatments can vary according to sex and gender. Therefore, preclinical and clinical research must include sex and gender analyses to understand basic mechanisms of pain and its relief, and to develop personalized pain treatment.
慢性疼痛影响全球 20%的成年人，是全球主要致残原因之一。女性和女孩受到慢性疼痛的影响不成比例。大约一半的慢性疼痛疾病在女性中更为常见，而男性中只有 20%的患病率更高。急性疼痛敏感性也存在性别差异。疼痛是一种由感觉、认知和情感成分组成的主观体验。因此，性别可以通过多个维度影响疼痛体验。从历史上看，大多数临床前疼痛研究都是在雄性动物中进行的。然而，最近包括女性在内的研究表明，疼痛的生理机制存在显著的性别差异，包括不同基因和蛋白质的特定性别参与，以及激素和免疫系统之间的独特相互作用，这些相互作用会影响疼痛信号的传递。人类神经影像学揭示了与疼痛相关的神经回路中的性别和性别差异，包括慢性疼痛情况下特定于性别的大脑改变。临床疼痛研究表明，性别可能会影响个体如何理解和应对疼痛。性别也可能影响患慢性疼痛的易感性。性别偏见会影响疼痛的临床感知和治疗方式。此外，不同疼痛治疗方法的疗效和副作用可能因性别而异。因此，临床前和临床研究必须包括性别分析，以了解疼痛及其缓解的基本机制，并制定个性化的疼痛治疗方案。
