Walker J S, Carmody J J
School of Physiology and Pharmacology, University of New South Wales, Sydney, Australia.
Anesth Analg. 1998 Jun;86(6):1257-62. doi: 10.1097/00000539-199806000-00023.
We used electrically induced pain in healthy young subjects to study gender differences in nociception and the analgesic efficacy of ibuprofen. Cutaneous stimulation of the earlobe allowed measurement of pain detection thresholds and maximal pain tolerance. Drug and placebo were each administered twice using a double-blind, randomized, multiple cross-over design. Male subjects had greater stimulus thresholds (lower nociception) compared with female subjects (18 +/- 0.3 vs 15 +/- 0.3 volts, mean +/- SEM; n = 10 in each group) and a greater pain tolerance (24 +/- 0.4 vs 21 +/- 0.4 volts). Response variability was also greater in the male subjects, yet only the men exhibited a statistically significant analgesic response to ibuprofen (deltavolts; ibuprofen versus placebo: 2.80 +/- 0.33 vs -0.18 +/- 0.34; P < 0.05, n = 10). None of these results could be attributed to pharmacokinetic differences. The finding that ibuprofen was less effective in women than in men has potential clinical significance, especially as a factor in the response variability to nonsteroidal antiinflammatory drugs.
In this study, we examined ibuprofen, a widely used nonsteroidal antiinflammatory drug, for its ability to reduce experimental pain. We found that it had such properties in healthy young male subjects but not in young female subjects. This is a paradox because many of the painful conditions for which nonsteroidal antiinflammatory drugs are used (e.g., rheumatoid arthritis) occur more often in women.
我们利用电诱导疼痛对健康年轻受试者进行研究，以探讨伤害感受中的性别差异以及布洛芬的镇痛效果。对耳垂进行皮肤刺激可测量疼痛检测阈值和最大疼痛耐受性。采用双盲、随机、多次交叉设计，药物和安慰剂各给药两次。与女性受试者相比，男性受试者的刺激阈值更高（伤害感受更低）（分别为18±0.3伏和15±0.3伏，均值±标准误；每组n = 10），且疼痛耐受性更高（分别为24±0.4伏和21±0.4伏）。男性受试者的反应变异性也更大，但只有男性对布洛芬表现出具有统计学意义的镇痛反应（电压差值；布洛芬与安慰剂相比：2.80±0.33对 -0.18±0.34；P < 0.05，n = 10）。这些结果均不能归因于药代动力学差异。布洛芬在女性中比在男性中效果更差这一发现具有潜在的临床意义，尤其是作为对非甾体抗炎药反应变异性的一个因素。
在本研究中，我们研究了广泛使用的非甾体抗炎药布洛芬减轻实验性疼痛的能力。我们发现它在健康年轻男性受试者中有此作用，但在年轻女性受试者中则不然。这是一个矛盾之处，因为使用非甾体抗炎药治疗的许多疼痛病症（例如类风湿性关节炎）在女性中更为常见。
