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| DO MEN AND WOMEN EXPERIENCE THE SAME POST-SURGICAL PAIN? Jocelyne S. Feine, D.D.S., H.D.R., Chantal Morin, Ph.D., and James P. Lund, B.D.S., Ph.D., Faculty of Dentistry, McGill University, Montreal, Canada It seems that males and females respond differently to painful conditions. What is unclear is whether this response is due to physiological or to psychological/sociological differences between the sexes. Studies suggest that females feel more experimental pain than males and, although women tend to seek medical care for painful conditions more frequently than men, it has not been established whether this is due to higher levels of perceived pain or to differences in motivational factors. The surgical placement of intraoral implants is a highly standardized and precise procedure. We have used this intervention as a clinical pain model in a pilot study to measure post-operative pain experienced by men and women. Forty-eight edentulous subjects participated in the study. Each received 2 titanium implants in the anterior mandible. These varied in length from 10-20mm, depending on the thickness of the mandible. Following surgery, the subjects rated their pain intensity and unpleasantness on 100mm visual analogue scales (VAS) three times a day in a pain diary. They also completed the McGill Pain Questionnaire (MPQ) each evening. Subjects were instructed to complete the diary every day until the pain had "disappeared". Twenty-seven females and twenty-one males aged 33-63 years (mean 51.6±7.1 years) completed the pain diary. Age of subjects, duration of surgery, the amount of local anesthetic used and the amount of pain medication taken were not statistically different for the two groups (ps>0.32, t-test). No differences between the sexes were found for ratings of intensity or unpleasantness over time (ps>0.10, ANOVA). Similarly, maximal pain intensity (p=0.15, t-test) and unpleasantness ratings (p=0.31, t-test) were not significantly different, nor were the number of days that pain was reported (mean days: females=8, males=7; p=0.33, t-test). No differences between males and females were found for the total number of word descriptors chosen from the MPQ (p=0.61, Mann-Whitney) nor for the Pain Rating Index (PRI) over time (p=0.36, ANOVA). However, the relative unpleasantness ratio (Unpleasantness/Intensity) increased significantly with time for males, but not for females (p=0.016, ANOVA). This implant model for pain was "sensitive" enough to detect differences in pain ratings associated with implant length. Pain intensity ratings decreased significantly as implant length increased (p=0.03, Pearson correlation). Discussions with the surgeon revealed that soft tissue damage is greater when the mandible is highly resorbed. Although more male subjects received longer implants than female subjects (p=0.02, Mann Whitney), a univariate between-measures analysis controlling for implant length confirmed that there was still no effect of gender on ratings of pain intensity (p=0.70). The results of this study suggest that the placement of dental implants produces pain of similar intensity, quality and duration in males and females. However, males seem to show a greater relative affective response to their pain. In order to confirm that no differences exist between the sexes in absolute ratings of pain intensity and unpleasantness, the sample size will have to be increased considerably. The implant pain model appears to have great potential for studies of post-operative pain, because the surgical procedure varies little and is performed on adults of all ages.
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