The impact of sex differences on perceived pain intensity in pain protocol standardization, 2024, Wragan et al

Preprint
Abstract
Background: Sex differences have been widely demonstrated in both acute and chronic pain. Sex differences may have wider impact on research design and analysis than already established. This study addresses an important methodological aspect with regards to how sex differences could influence the design of standardized experimental pain protocols used to characterize an individuals pain response.

Methods: This study addresses sex differences of perceived pain at tonic heat pain threshold (HPT). Participants used a computerized visual analogue scale (CoVAS) to continually rated subjective pain intensity during tonic HPT. Metrics (Mean, Standard Deviation, Maximum) were extracted from the CoVAS to characterize perceived pain.

Results: Female participants rated pain intensity at HPT significantly lower than male participants across all extracted metrics used to characterize the coVAS rating. The effect of sex on the mean and standard deviation of pain intensity ratings at HPT was medium, while the effect size of sex on the maximum pain intensity rating at HPT was large.

Conclusion: The significant sex differences in perceived pain intensity at HPT indicates that methods of standardization to a specific pain intensity merit sex-specific consideration. Additionally, these observed sex differences underscore the necessity for sex specific design across both pre-clinical and clinical studies of pain.


https://www.biorxiv.org/content/10.1101/2024.12.09.626634v1?med=mas

 

But it was the women who rated the pain lower?

 

Saw it on Mastodon https://biologists.social/@biorxiv_neursci/113628238034821270 and it sparked half a memory of someone commenting on here about the need to take sex into account in studies (sorry, can't remember who that was).

Happy for the thread to be deleted if you think it's not worth people's time! (and thank you for taking the time to look at it)

[edited to amend the link]

 

None of which makes any difference when it's common for physicians to assume they can tell, then go on to ignore the patient if there is any conflict between the two. Because this is entirely a matter of judgment about something that can't be independently verified. So even if there are some small differences between sexes, there are variations between individuals that make this irrelevant, and so many additional factors that go into increasing or lowering perception of pain. Even more so that all of this goes out the window when you involve the kind of pain you will see in health care settings, which have nothing at all to do with the levels that can be studied using lukewarm water and other artificial attempts.

Basically it's a lot like most of the fundamental issues humanity has faced from the beginning of civilization, things like fairness and justice, without technology nothing gets resolved, and some things can't be quantified technologically so cannot be resolved. Even more so that there are opinions out there that can directly conflict with individual cases, some people think suffering brings character, and other weird things.

There is a fundamental uncertainty principle going on when it comes to health that medicine knows but almost never fully applies. Usually they can't know for sure, and can't possibly verify, and that makes everything more complicated. Which isn't really the issue in itself, the problem is with the usual habit of making stuff up to account for this uncertainty, all of which come in and around the psychobehavioral ideology. It's a problem made worse by the addition of even more of the problem. All this junk nonsense about central sensitization and this weird obsession with making everything about illness be a behavioral issue and so on.

Basically, this is left to human judgment. Which is the worst thing to work with. So it's all terrible.

 

I definitely understand the difficulties with this. That there are some people who do lie, but even then that means that there is a different problem, possibly more than one. But it's impossible to tell the difference, in the moment or with hindsight, so there is never any basis to reliably make such a judgment.

Also some of this exaggerating pain is likely to be an adaptation to the scarcity of health care, which leads to a lot of people falling down in priority, which can be remedied by exaggerating a bit, but all that means is you now have three problems and counting.

To think that all of this would just go away if we could just find one painkiller that works without causing problems, would not lead to habituation, or can be euphoric in some people in some circumstances, that somehow get applied to everyone. It would be completely transformative.

About as textbook an example of throwing babies out with the bathwater as it gets. Some people lie? Some people experience euphoria from opioids? Let's ruin the whole concept of pain management for everyone! Double time over with the completely failed war on drugs, where the drugs have won but everyone pretends like it's some stalemate.