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Differences in cerebral activation between males and females have been evaluated in a number of studies. Studies have examined brain activity through a number of methods including positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) in response to different pain modalities. Given the reported sex differences in experimental pain perception, the use of neuroimaging is a promising tool that may reveal sex differences in central representations of pain. Table 9 lists several studies that have compared the central processing of pain between males and females. These studies have revealed a number of common cortical and subcortical areas activated by pain, but they have also observed sex-specific areas of activation.

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• For example, in response to a laboratory public-speaking stressor, males exhibited a greater stress-related reduction in heat pain, whereas females showed a greater reduction with ischemic pain.45 Sternberg et al387 reported that cold pain was reduced in males during video game competition, whereas pain was more substantially reduced by physical exercise in females.
• Thus, on balance, the evidence supports the conclusion that temporal summation is greater among females than males.
• In this report, two of the three paternal cousins of their probands are known as infertile and the two probands share the same paternal haplotype for the SOX9 region, confirming the possibility that the father was indeed the carrier of the same triplication.

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Combining the data from Table 11 with the studies reviewed by Miaskowski and Levine,277 there is some suggestion that when using PCA women consume lower doses of morphine. Interestingly, the two studies showing lower morphine requirements for men involved provider administered morphine.16,62 It is tempting to speculate that men may be less willing to report pain or request analgesics from a provider, which would explain their lower opioid consumption in the provider-administered settings. Alternatively, one could argue that women benefit more from the increased sense of control that accompanies self-administration of opioids. Additional research will be required to confirm or refute these possibilities.

Sex Differences in Responses to Experimental Pain

46,XX male syndrome was first described in ), and the Chicago consensus renamed of this syndrome as 46,XX testicular DSD in ). Most patients have normal male phenotypes at birth, and are usually diagnosed in late adolescence because of delayed puberty, gynecomastia, or infertility2). Approximately 15% of XX males have hypospadias, cryptorchidism, or more severe genital ambiguity13). All 46,XX males are infertile owing to the absence of the azoospermia factor region in the long arm of the Y chromosome14,15).

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• Table 7 also presents information about 3 studies that examined sex differences in spatial summation.
• Epidemiologic studies of pain typically report point prevalence (currently in pain), period prevalence (ie, experiencing pain during the past month or year), or lifetime prevalence.
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Additional peptides are released from C fibers, and spinal N-methyl-D-aspartate (NMDA) receptor activation and nitric oxide production occur.450 This cascade of events can alter the transduction properties of nociceptors, lowering their activation thresholds, and this peripheral sensitization could ultimately lead to central sensitization. The growing body of evidence that has accumulated in the past 10 to 15 years continues to indicate substantial sex differences in clinical and experimental pain responses, and some evidence suggests that pain treatment responses may differ for women versus men. The results from 3 studies that examined sex differences in perceptual responses to electrical pain are presented in the middle portion of Table 5. Pain threshold and tolerance for electrical stimuli were significantly lower in healthy women compared with men. Even though electrical pain was reported for only 3 studies, it strongly favors the hypothesis that women are more sensitive to this pain modality in comparison to men. These recent findings present a more consistent picture than the 5 studies reviewed by Riley et al,327 who found that electrical stimuli produced inconsistent findings and a moderate effect size for the sex difference.

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Limited clinical research has addressed sex differences in outcomes from physical medicine or interdisciplinary treatments. Several studies have examined potential sex differences in outcomes of treatments for back pain. The experience of pain is endogenously modulated, and several experimental approaches to engaging pain modulatory systems are reviewed in this article. One experimental model of endogenous inhibition is diffuse noxious inhibitory controls (DNIC).