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| CHRONIC PAIN AND PAIN ASSOCIATED WITH CANCER: DO MEN AND WOMEN RESPOND DIFFERENTLY? Dennis C. Turk, Ph.D., and Akiko Okifuji, Ph.D., Department of Anesthiology, University of Washington School of Medicine, Seattle, Washington Prescribing specific treatments for patients with chronic pain is essential to facilitate outcomes. There are many ways to subdivide individuals reporting persistent pain. For example, patients may be subdivided on the basis of their medical diagnosis, characteristics of their symptoms, age, or emotional status. Sex differences have recently received considerable attention and it has been suggested that men and women respond differently to nociceptive stimulation. The purpose of this paper is to address the question of whether sex of the patient has a significant impact on adaptation to two categories of persistent pain, namely, non-cancer chronic pain and pain associated with metastatic disease. In the first study, 428 (202 males, 226 females) consecutive patients referred to a facility treating chronic, non-cancer pain were included. Subjects were compared on the basis of prior treatment for pain, pain severity, emotional distress, interference of pain with life, and impact of pain on functional activities. There were no significant differences between men and women on any demographic factors except for age. The males were slightly younger (mean age = 41yrs, sd = 12 years) than the women (mean age 44yrs, sd = 13yrs). The sexes did not differ on marital satisfaction nor on the location of their pain. There were no significant differences between the sexes on any of these measures with the exception of emotional distress. Despite comparable levels of pain, interference, and similar body locations, women reported higher levels of depression and were more likely to be treated with antidepressants than men. However, the ratio of depression in women to men in this sample was comparable to community samples. Thus, the differences observed may not necessarily be attributable to pain per se. In order to replicate these results, a second sample of patients were examined. In the second study, 143 consecutive cancer patients (91 men and 52 women) seeking treatment for pain were included. As was the case for the first sample, there were no significant differences between the sexes on any of the demographic variables, duration of pain, pain severity, or functional limitations. Contrary to the non-cancer sample, there were no differences in levels of depression between the sexes. This result suggest that when confronted with a potentially lethal disease, both men and women are equally susceptible to depression. There has been a growing number of studies demonstrating that chronic pain patients, regardless of medical diagnoses, can be subdivided on the basis of psychological characteristics. Using a standard measure to assess persistent pain suffers, the two samples were subdivided on the basis of their psychosocial and behavioral responses. Over 70% of the patients in both samples could be classified into one of 3 empirically derived subgroups - dysfunctional, interpersonally distressed, and adaptive copers. There were no differences between men and women in the proportion assigned to each of the subgroups. Regardless of patients' sex there were significant differences between the subgroups in marital satisfaction, depression, interference with activities, and life interference. Thus, the between sex variability seemed to be smaller than the between psychosocial subgroup variability. These results suggest that, for persistent pain sufferers, sex may be less important than psychosocial characteristics. This is not to suggest that sex is unimportant, but rather, knowing the psychosocial and behavioral characteristics may be more useful for prescribing treatment than knowing their sex.
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