Other forms of pain inhibition have included stress-induced analgesia (SIA), in which a laboratory stressor is used to reduce experimental pain, and exercise-induced analgesia. Assuming that basal pain sensitivity may reflect the activity of endogenous pain modulatory systems, it would be expected that females and males may also differ in endogenous pain modulation. The results from 7 studies that examined sex differences in experimental ischemic pain are presented in the lower portion of Table 5. Studies used several variations of the submaximal effort tourniquet test to induce ischemic pain. Overall, a majority of the studies reported no sex differences in threshold (6 studies), tolerance (5 studies), or pain ratings (2 studies) to ischemic pain.
- These studies generally support the conclusion that sex differences will be more robust with a painful stimulus that produces a deep, tonic sensation of pain.127 Given the recency of these studies, they were not included in the previous meta-analysis327 but will be reviewed below.
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- The results from 22 studies that examined sex differences in experimental heat pain are presented in the upper portion of Table 6.
- Torrance et al409 estimated the prevalence of pain of predominantly neuropathic origin using a random sample of 6000 adults from family practices in three United Kingdom cities using a 5-item neuropathic pain scale developed by Bennett.28 Females (6%) showed greater prevalence of neuropathic pain (lasting longer than 3 months) compared with males (3%).
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Studies of laboratory pain provide additional evidence of hormonal influences on pain responses. The results from 22 studies that examined sex differences in experimental cold pain are presented in the lower portion of Table 6. Most studies have used some form of the cold pressor test in which subjects immerse their arm or hand in circulating cold water for a defined period of time, and their results support the hypothesis that cold pain sensitivity is more pronounced in females. Sex differences in cold pain were observed in 67% (6/9) of studies reporting cold pain threshold, 93% (14/15) of studies reporting cold pain tolerance, and 81% (13/16) of studies reporting continuous or retrospective subjective pain ratings to cold water immersion.
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Most studies used the cold pressor as the conditioning stimulus, whereas a variety of test stimuli have been used. For example, Weissman-Fogel et al439 found that sex differences in DNIC were no longer significant after controlling for catastrophizing, which suggests a potential mediating role for psychological factors in sex differences in DNIC. Another important issue to consider is the possibility of sex and gender differences in the context of pain treatment. One topic that has received attention is the possibility of gender bias in the provision of pain treatment.
Two studies reported that sex differences in temporal summation to heat156 and mechanical361 stimulation persisted in clinical pain populations with low back pain and temporomandibular disorders, respectively. Thus, on balance, the evidence supports the conclusion that temporal summation is greater among females than males. A recent meta-analysis on sex differences in osteoarthritis using clinical markers as the case definition (not pain) indicated that females are at significantly increased risk for osteoarthritis (OA) in the knee and hand compared with males.382 Several studies have documented sex differences in pain prevalence, ratings, and depression in OA, and we will review selected studies below. NSFW Character AI represents a groundbreaking advancement in traditional AI chat technology, introducing a nsfw chat bot specifically designed for users to explore their NSFW character fantasies without restraint. This advanced platform not only facilitates a liberating space for expression but also comes equipped with sophisticated character creation tools and an intuitive interface, making it an ideal adult AI companion. As a safer and more appropriate option, platforms explicitly designed to host NSFW content should be sought.
