Marchesini Maurizio, Fornasari Diego, Natoli Silvia, Vegni Elena, Cuomo Arturo
Department of Anesthesia, Critical Care and Pain Medicine, Mater Olbia Hospital, 07026 Olbia, Italy.
Department of Medical Biotechnology and Translational Medicine, Università Degli Studi di Milano, 20133 Milan, Italy.
Medicina (Kaunas). 2025 Jun 28;61(7):1172. doi: 10.3390/medicina61071172.
Chronic pain (CP), defined as pain persisting for over 3 months, is a significant cause of global disability and affects more than 20% of individuals in Western countries, including Italy. Substantial evidence indicates a higher prevalence of CP among women, who also experience greater sensitivity, increased frequency, and a longer duration of pain. The impact of CP on quality of life, daily functioning, and employment is profound, particularly for women. However, chronic pain research has insufficiently addressed sex and gender differences, contributing to suboptimal and inequitable care. This neglect limits the development of personalized treatment strategies and, when combined with an aging population and women's longer life expectancy, highlights an increasing societal and economic burden. The authors conducted a narrative review of studies examining biological, psychological, or social determinants of sex-related differences in CP perception or treatment. Each thematic area was reviewed by at least two authors, who critically appraised the literature. Their analyses were refined through iterative group discussions to develop concise, evidence-informed recommendations for personalized and equitable pain management. Sex differences in CP arise from a range of factors, including biological mechanisms such as hormonal and genetic influences, psycho-social factors such as depression and anxiety, and socio-economic determinants, such as income and education levels. These factors also affect sex-specific outcomes of analgesic treatments currently available. Identifying these risk factors and tailoring treatment strategies to sex differences can significantly improve CP management. Such a personalized approach is essential for advancing precision medicine in CP management. Even in the absence of molecular or genomic biomarkers, adopting a biopsychosocial model that considers sex and gender differences, symptoms, physiological indicators, medical history, lifestyle, and psychological aspects may substantially enhance patient outcomes. This review provides a comprehensive analysis of sex differences in CP perception, stressing the importance of individualized, interdisciplinary approaches in pain management. Addressing both the biological and psycho-social contributors to pain in men and women is critical for guiding healthcare professionals in implementing precision pain medicine strategies, ultimately fostering more equitable and effective care.
慢性疼痛（CP）被定义为持续超过3个月的疼痛，是全球残疾的一个重要原因，在西方国家（包括意大利）影响着超过20%的人群。大量证据表明，CP在女性中的患病率更高，她们还表现出更高的疼痛敏感性、更频繁的疼痛发作以及更长的疼痛持续时间。CP对生活质量、日常功能和就业的影响深远，对女性而言尤为如此。然而，慢性疼痛研究对性别差异的关注不足，导致治疗效果欠佳且不公平。这种忽视限制了个性化治疗策略的发展，再加上人口老龄化和女性预期寿命延长，凸显出日益加重的社会和经济负担。作者对研究CP感知或治疗中性别相关差异的生物学、心理学或社会决定因素的研究进行了叙述性综述。每个主题领域至少由两位作者进行综述，他们对文献进行了严格评估。通过反复的小组讨论对他们的分析进行完善，以制定出针对个性化和公平疼痛管理的简洁、基于证据的建议。CP中的性别差异源于一系列因素，包括激素和基因影响等生物学机制、抑郁和焦虑等心理社会因素以及收入和教育水平等社会经济决定因素。这些因素也会影响当前可用镇痛治疗的性别特异性结果。识别这些风险因素并根据性别差异调整治疗策略，可以显著改善CP的管理。这种个性化方法对于推进CP管理中的精准医学至关重要。即使没有分子或基因组生物标志物，采用考虑性别差异、症状、生理指标、病史、生活方式和心理方面的生物心理社会模型，也可能大幅改善患者的治疗效果。本综述对CP感知中的性别差异进行了全面分析，强调了疼痛管理中个性化、跨学科方法的重要性。解决男性和女性疼痛的生物学和心理社会因素，对于指导医疗保健专业人员实施精准疼痛医学策略至关重要，最终促进更公平、有效的护理。
