Zacharoff Kevin L
Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
Anesthetic and Analgesic Drug Products Advisory Committee to the U.S. Food and Drug Administration, Silver Spring, MD, USA.
Handb Exp Pharmacol. 2023;282:107-125. doi: 10.1007/164_2023_686.
Pain is a highly personal experience. Pain is often considered to be a purely neurologic phenomenon, but in actuality, it is a combination of both sensory and emotional experiences. This has sometimes been translated clinically toward a more mechanistic approach to the assessment and treatment of pain instead of one that does not discount pain mechanisms, but also is more inclusive of the need for humanism - considering the individual. In today's medical environment, more than ever before there is a significant amount of attention being paid to educating clinicians to better understand that several physiological, neurophysiological, and psychosocial factors can significantly impact responses to pain. The composition of these factors will be unique to that individual's life narrative, context, sex, and prior life experiences. Thus, the concept that a templated approach to pain assessment and pharmacotherapeutic treatment planning should not be expected to provide optimal patient satisfaction and treatment outcomes in the majority. The hypotheses that there may be sex-based differences in the pain experience in a variety of ways including pain sensitivity, tolerance to pain, threshold at which something becomes painful, and the effectiveness of endogenous pain modulation systems are not new and have been well represented in the literature. This chapter reviews important key findings in the scientific literature with respect to sex-based differences in pain and pain responses to experimentally induced painful stimuli, pain experienced in commonly occurring painful medical conditions, and variations in responses to pain treatments. Possible explanations to account for observed differences or similarities will also be discussed.
疼痛是一种高度个体化的体验。疼痛通常被认为是一种纯粹的神经现象，但实际上，它是感觉和情感体验的结合。这有时在临床上被转化为一种更机械的疼痛评估和治疗方法，而不是一种既不忽视疼痛机制，又更能包容人文关怀需求——考虑个体差异的方法。在当今的医疗环境中，临床医生接受教育以更好地理解多种生理、神经生理和社会心理因素会显著影响对疼痛的反应，这一点比以往任何时候都受到更多关注。这些因素的构成对于个体的生活经历、背景、性别和既往生活经验而言是独一无二的。因此，不应期望采用模板化的疼痛评估和药物治疗规划方法能在大多数情况下提供最佳的患者满意度和治疗效果。关于疼痛体验可能存在基于性别的差异这一假设，包括疼痛敏感性、对疼痛的耐受性、疼痛阈值以及内源性疼痛调节系统的有效性等多种方式，并非新鲜事，且在文献中已有充分体现。本章回顾了科学文献中关于疼痛的性别差异以及对实验性诱发疼痛刺激的疼痛反应、常见疼痛性疾病中所经历的疼痛，还有对疼痛治疗反应差异等方面的重要关键发现。还将讨论对观察到的差异或相似性的可能解释。
