Background & Aims
It has been widely established that women and men differ in their pain experience [5]. In accordance with the biopsychosocial pain model [6], it is assumed that biological, psychological, and social factors contribute to these sex and gender differences [5]. One psychological factor that plays a role in pain perception are gender stereotypes. This refers to the person’s gender role expectation that they will experience, e.g., a higher pain intensity or a lower pain threshold due to their sex or gender [7]. A meta-analysis has shown that gender stereotypes correlate with pain perception [1]. To date, only one study has shown that gender stereotypes can be manipulated, which influences pain intensity in an experimental paradigm [8]. However, that study included only male participants. The aim of the proposed study is to assess whether a manipulation of gender stereotypes influences pain perception in healthy women in an experimental acute pain paradigm.
Methods
Data will be collected at the Institute of Psychology, University of Duisburg-Essen (Essen, Germany). Healthy women aged ?18 years are eligible for participation. Participants are excluded if they report chronic pain, acute pain or contraindications for thermal pain stimulation. A thermosensory stimulator (TSA 2 [4]) is used to apply tonic heat pain stimuli. Participants are randomized into 3 groups: positive manipulation, negative manipulation, control group. A cover story informs them that the effect of the menstrual cycle on pain is studied. After giving informed consent, participants receive a first set of pain stimuli, and pain intensity is assessed. They complete a set of questionnaires (e.g., Gender Role Expectations of Pain [7]). A video is used to manipulate the gender stereotype of pain perception in the manipulation groups. Then, a second set of pain stimuli is applied and pain ratings collected. A manipulation check is performed and all participants are debriefed.
Results
The study protocol will be presented according to the SPIRIT guidelines [2]. Power analysis with G*Power [3] revealed a required sample size of n=66. The study participants will be described with regard to their demographic data (e.g., gender, mean age, education). The results of a mixed 2 x 3 analysis of variance (ANOVA) with the within-factor time (pre-manipulation/post-manipulation) and the between-factor condition (negative manipulation/positive manipulation/control group) will be reported. Mean pain intensity is the dependent variable in this ANOVA. Effects will be considered as significant if p<0.05. If main and interaction effects emerge as expected, the results of simple effects analyses and post hoc tests will be reported as a further assessment of group differences.
Conclusions
The proposed study will be the first to assess whether a manipulation of gender stereotypes can influence pain perception in women. If the expected effect is found (i.e., a change in pain intensity following the stereotype manipulation), it will lay the foundation for future studies that include all genders as well as clinical populations of persons living with chronic pain. A limitation of the proposed study is that the role of gender itself will not be analyzed. The inclusion criterion refers to the biological sex of the participants. The gender of the participants will be assessed and reported. If possible, a subgroup analysis will be performed for participants who indicate that their gender does not correspond to their biological sex. However, this requires a certain size of the subgroup that enables statistical analyses. Future studies should also include a second follow up assessment to investigate whether the manipulation has stable long-term effects on pain perception.
References
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[3] Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods 2007;39(2):175-191.
[4] Medoc Ltd. TSA2 Thermal Sensory Analyzer, 2019.
[5] Osborne NR, Davis KD. Chapter Eight – Sex and gender differences in pain. In: E Moro, G Arabia, MC Tartaglia, MT Ferretti, editors. International Review of Neurobiology, Vol. 164: Academic Press, 2022. pp. 277-307.
[6] Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song X-j, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K. The revised International Association for the Study of Pain definition of pain : concepts , challenges , and compromises. PAIN 2020;161(9):1976-1982.
[7] Robinson ME, Riley JL, III, Myers CD, Papas RK, Wise EA, Waxenberg LB, Fillingim RB. Gender role expectations of pain: Relationship to sex differences in pain. The Journal of Pain 2001;2(5):251-257.
[8] Schwarz KA, Sprenger C, Hidalgo P, Pfister R, Diekhof EK, Büchel C. How stereotypes affect pain. Scientific Reports 2019;9(1):8626.
Presenting Author
Beatrice Korwisi
Poster Authors
Topics
- Gender/Sex Differences