Background & Aims

With a noted higher pain prevalence in women than men1, it is critical to equity in pain management to understand sex differences in the experience of pain across the lifespan—especially with the high prevalence of pain in older adults2. Studies of sex differences in pain have disproportionately focused on younger adults compared to older adults. Our previous work using a perceptual matching paradigm identified average temperatures for “low” (34ºC), “medium” (39ºC), and “high” (44ºC) pain in older adults that may differ from younger adults. Additionally, there are limited studies examining pain intensity and pain unpleasantness in older adults, separable components of pain that need to be explored in the context of older adults. Thus, we sought to examine sex differences in a fixed temperature design with both self-reported pain intensity and unpleasantness in cognitively healthy older adults.

Methods

Our sample was recruited from older adults (? 60 years) who resided in the greater Columbus, Ohio, metropolitan region between 2019 and 2023. Upon completing informed consent, participants provided demographic information. Next, they completed standardized measures of depression using the Geriatric Depression Scale-Short Form (GDS-SF3)4,5 and pain using the Brief Pain Inventory Short Form (BPI-SF)6. Additional inclusion and exclusion criteria were 1) cognitively intact, 2) free from chronic pain, 3) not taking analgesics within 24 hours of data collection, and 4) ability to see and hear with or without corrective devices. Three thermal stimuli at each of the three intensities were pseudo-randomly administered for 10 seconds, followed by 20 seconds of rest to the thenar eminence of the dominant hand using the Medoc Pathway Pain and Sensory Evaluation System®. During the 10-second exposure, participants rated pain intensity and unpleasantness on 0–20-point numeric rating scales.

Results

The final sample included 61 adults, with a median age of 72.0 years, 37 female/24 male. There were no differences between the male and female groups based on age (p=.87), GDS-SF depression score (p=.34), BPI-SF average pain (p=.86), or BPI-SF pain right now (p=.72). The overall omnibus effect, across all three stimulus intensities, found that females reported statistically higher ratings of sensory pain intensity compared to males (p=.02). The estimated marginal mean (controlling for age, sex, and GDS score) in males was 3.5 (95% C.I.=2.9, 4.2) and in females was 4.6 (95% C.I.=3.9, 5.2). There was no interaction effect of sex and the different levels of thermal stimulus for pain intensity (p=.37). Likewise, there were no main (p=.26) or interaction effects of sex and thermal stimulus levels for reports of pain unpleasantness (p=.54).

Conclusions

The results corroborate the literature on sex differences in pain reporting. From our study sample, healthy, cognitively sound older adult females reported higher levels of pain intensity compared to older males, despite similar temperature exposure. There were no observed sex differences in self-reported pain unpleasantness. However, the characteristics of our sample (i.e., healthy older adults without cognitive deficits) and study design (i.e., 10-second fixed-temperature paradigm) may explain the observed discrepancies between pain intensity and unpleasantness. Overall, these findings continue to emphasize the importance of accounting for sex differences in pain measurement and interventions and including sex as a biological variable in research, particularly among older adults.

References

1.Osborne NR, Davis KD. Chapter Eight – Sex and gender differences in pain. In: Moro E, Arabia G, Tartaglia MC, Ferretti MT, eds. International Review of Neurobiology. Academic Press; 2022:277-307.
2.Gibson SJ, Lussier D. Prevalence and Relevance of Pain in Older Persons. Pain Medicine. 2012;13(suppl_2):S23-S26. doi:10.1111/j.1526-4637.2012.01349.x
3.McGivney SA, Mulvihill M, Taylor B. Validating the GDS depression screen in the nursing home. Journal of the American Geriatrics Society. 1994;42(5):490-492.
4.Kurlowicz L, Greenberg SA. The geriatric depression scale (GDS). AJN The American Journal of Nursing. 2007;107(10):67-68.
5.Yesavage JA, Sheikh JI. 9/Geriatric depression scale (GDS) recent evidence and development of a shorter version. Clinical gerontologist. 1986;5(1-2):165-173.
6.Mendoza T, Mayne T, Rublee D, Cleeland C. Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis. European journal of pain. 2006;10(4):353-361.

Presenting Author

Aaron McDaniel

Poster Authors

Aaron McDaniel

MS

The Ohio State University

Lead Author

Todd B. Monroe

PhD

The Ohio State University College of Nursing

Lead Author

Mary S. Dietrich

PhD

Vanderbilt University

Lead Author

Stephen P. Bruehl

PhD

Vanderbilt University Medical Center

Lead Author

Ronald L. Cowan

MD

The University of Tennessee Health Science Center

Lead Author

Michelle Failla

The Ohio State University

Lead Author

Karen O. Moss

PhD

The Ohio State University College of Nursing

Lead Author

Alison R. Anderson

PhD

University of Iowa College of Nursing

Lead Author

Diane Von Ah PhD

RN

The Ohio State University College of Nursing

Lead Author

Jeffrey T. Boon

PhD

The Ohio State University College of Nursing

Lead Author

Topics

  • Gender/Sex Differences