Pain thresholds and intensities of CRPS type I and neuropathic pain in respect to sex.
Journal
European journal of pain (London, England)
ISSN: 1532-2149
Titre abrégé: Eur J Pain
Pays: England
ID NLM: 9801774
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
24
05
2019
revised:
19
01
2020
accepted:
18
02
2020
pubmed:
26
2
2020
medline:
6
1
2021
entrez:
26
2
2020
Statut:
ppublish
Résumé
Healthy women have generally been found to have increased experimental pain perception and chronic pain has a higher prevalence in female as compared to male patients. However, no study has investigated whether pain intensity and pain perception thresholds are distinct or similar between sexes within various chronic pain entities. We investigated whether average pain intensities and pain thresholds assessed using quantitative sensory testing (QST) differed between women and men suffering from three distinct chronic pain conditions: Complex Regional Pain Syndrome (CRPS type I), peripheral nerve injury (PNI) or polyneuropathy (PNP), as compared to paired healthy volunteers. QST data of 1,252 patients (669 female, 583 male) with PNI (n = 342), PNP (n = 571) or CRPS (n = 339), and average pain intensity reports from previously published studies were included. Absolute and z-values (adjusted for age and body region) of cold, heat, pressure (PPT) and pinprick pain thresholds were compared in generalized linear models with aetiology, duration of underlying pain disease and average pain intensity as fixed effects. Average pain intensity during the past four weeks did not differ between women and men, in both mean and range. In women absolute pain thresholds for cold, heat and pinprick were lower than in males across all diagnoses (p < .05). However, after z-transformation these differences disappeared except for PPT in CRPS (p = .001). Pain thresholds in patients show only minor sex differences. However, these differences mimic those observed in healthy subjects and do not seem to be linked to specific pathophysiological processes. Female healthy participants and female patients with neuropathic pain conditions or CRPS I report lower pain thresholds compared to males, but pain intensity is similar and there is no sex difference in the extent to which the thresholds are altered in neuropathic pain or CRPS. Thus, the sex differences observed in various chronic pain conditions mimic those obtained in healthy participants, indicating that these differences are not linked to specific pathophysiological processes and are of minor clinical relevance.
Sections du résumé
BACKGROUND AND AIMS
Healthy women have generally been found to have increased experimental pain perception and chronic pain has a higher prevalence in female as compared to male patients. However, no study has investigated whether pain intensity and pain perception thresholds are distinct or similar between sexes within various chronic pain entities. We investigated whether average pain intensities and pain thresholds assessed using quantitative sensory testing (QST) differed between women and men suffering from three distinct chronic pain conditions: Complex Regional Pain Syndrome (CRPS type I), peripheral nerve injury (PNI) or polyneuropathy (PNP), as compared to paired healthy volunteers.
METHODS
QST data of 1,252 patients (669 female, 583 male) with PNI (n = 342), PNP (n = 571) or CRPS (n = 339), and average pain intensity reports from previously published studies were included. Absolute and z-values (adjusted for age and body region) of cold, heat, pressure (PPT) and pinprick pain thresholds were compared in generalized linear models with aetiology, duration of underlying pain disease and average pain intensity as fixed effects.
RESULTS
Average pain intensity during the past four weeks did not differ between women and men, in both mean and range. In women absolute pain thresholds for cold, heat and pinprick were lower than in males across all diagnoses (p < .05). However, after z-transformation these differences disappeared except for PPT in CRPS (p = .001).
DISCUSSION
Pain thresholds in patients show only minor sex differences. However, these differences mimic those observed in healthy subjects and do not seem to be linked to specific pathophysiological processes.
SIGNIFICANCE
Female healthy participants and female patients with neuropathic pain conditions or CRPS I report lower pain thresholds compared to males, but pain intensity is similar and there is no sex difference in the extent to which the thresholds are altered in neuropathic pain or CRPS. Thus, the sex differences observed in various chronic pain conditions mimic those obtained in healthy participants, indicating that these differences are not linked to specific pathophysiological processes and are of minor clinical relevance.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1058-1071Subventions
Organisme : Department of Health
ID : CDRF-2013-04-009
Pays : United Kingdom
Organisme : Pfizer Ltd
Pays : International
Organisme : Innovative Medicines Initiative Joint Undertaking
ID : 115007
Pays : International
Organisme : German Ministry of Education and Research
ID : 01EM0902
Pays : International
Informations de copyright
© 2020 European Pain Federation - EFIC®.
Références
Arap, A., Siqueira, S. R. D. T., Silva, C. B., Teixeira, M. J., & Siqueira, J. T. T. (2010). Trigeminal pain and quantitative sensory testing in painful peripheral diabetic neuropathy. Archives of Oral Biology, 55, 486-493. https://doi.org/10.1016/j.archoralbio.2010.03.021
Aslaksen, P. M., Myrbakk, I. N., Høifødt, R. S., & Flaten, M. A. (2007). The effect of experimenter gender on autonomic and subjective responses to pain stimuli. Pain, 129, 260-268. https://doi.org/10.1016/j.pain.2006.10.011
Attal, N., Lanteri-Minet, M., Laurent, B., Fermanian, J., & Bouhassira, D. (2011). The specific disease burden of neuropathic pain: Results of a French nationwide survey. Pain, 152, 2836-2843. https://doi.org/10.1016/j.pain.2011.09.014
Baron, R., Maier, C., Attal, N., Binder, A., Bouhassira, D., Cruccu, G., … Treede, R.-D. (2017). Peripheral neuropathic pain: A mechanism-related organizing principle based on sensory profiles. Pain, 158, 261-272. https://doi.org/10.1097/j.pain.0000000000000753
Bartley, E. J., & Fillingim, R. B. (2013). Sex differences in pain: A brief review of clinical and experimental findings. British Journal of Anaesthesia, 111, 52-58. https://doi.org/10.1093/bja/aet127
Bartley, E. J., King, C. D., Sibille, K. T., Cruz-Almeida, Y., Riley, J. L., Glover, T. L., … Fillingim, R. B. (2016). Enhanced pain sensitivity among individuals with symptomatic knee osteoarthritis: Potential sex differences in central sensitization. Arthritis Care & Research, 68, 472-480. https://doi.org/10.1002/acr.22712
Bouhassira, D., Lantéri-Minet, M., Attal, N., Laurent, B., & Touboul, C. (2008). Prevalence of chronic pain with neuropathic characteristics in the general population. Pain, 136, 380-387. https://doi.org/10.1016/j.pain.2007.08.013
Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain, 10, 287-333. https://doi.org/10.1016/j.ejpain.2005.06.009
Chesterton, L. S., Barlas, P., Foster, N. E., Baxter, G. D., & Wright, C. C. (2003). Gender differences in pressure pain threshold in healthy humans. Pain, 101, 259-266. https://doi.org/10.1016/S0304-3959(02)00330-5
Craft, R. M., Mogil, J. S., & Aloisi, A. M. (2004). Sex differences in pain and analgesia: The role of gonadal hormones. European Journal of Pain, 8, 397-411. https://doi.org/10.1016/j.ejpain.2004.01.003
Davis, J. A., Robinson, R. L., Le, T. K., & Xie, J. (2011). Incidence and impact of pain conditions and comorbid illnesses. Journal of Pain Research, 4, 331-345. https://doi.org/10.2147/JPR.S24170
Dawson, A., & List, T. (2009). Comparison of pain thresholds and pain tolerance levels between Middle Easterners and Swedes and between genders. Journal of Oral Rehabilitation, 36, 271-278. https://doi.org/10.1111/j.1365-2842.2009.01943.x
de Mos, M., de Bruijn, A. G. J., Huygen, F. J. P. M., Dieleman, J. P., Stricker, B. H. C., & Sturkenboom, M. C. J. M. (2007). The incidence of complex regional pain syndrome: A population-based study. Pain, 129, 12-20. https://doi.org/10.1016/j.pain.2006.09.008
Defrin, R., Shramm, L., & Eli, I. (2009). Gender role expectations of pain is associated with pain tolerance limit but not with pain threshold. Pain, 145, 230-236. https://doi.org/10.1016/j.pain.2009.06.028
Demir, S. E., Ozaras, N., Karamehmetoğlu, S. S., Karacan, I., & Aytekin, E. (2010). Risk factors for complex regional pain syndrome in patients with traumatic extremity injury. Ulusal Travma ve Acil Cerrahi Dergisi = Turkish Journal of Trauma and Emergency Surgery: TJTES, 16, 144-148.
Enax-Krumova, E. K., Lenz, M., Frettlöh, J., Höffken, O., Reinersmann, A., Schwarzer, A., … Maier, C. (2017). Changes of the sensory abnormalities and cortical excitability in patients with complex regional pain syndrome of the upper extremity after 6 months of multimodal treatment. Pain Medicine, 18(1), 95-106.
England, J. D., Gronseth, G. S., Franklin, G., Miller, R. G., Asbury, A. K., Carter, G. T., … American Academy of Physical Medicine and Rehabilitation. (2005). Distal symmetric polyneuropathy: A definition for clinical research: Report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology, 64, 199-207. https://doi.org/10.1212/01.WNL.0000149522.32823.EA
Fillingim, R. B. (2000). Sex, gender, and pain: Women and men really are different. Current Review of Pain, 4, 24-30. https://doi.org/10.1007/s11916-000-0006-6
Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Rahim-Williams, B., & Riley, J. L. (2009). Sex, gender, and pain: A review of recent clinical and experimental findings. The Journal of Pain, 10, 447-485. https://doi.org/10.1016/j.jpain.2008.12.001
Freynhagen, R., Baron, R., Gockel, U., & Tölle, T. R. (2006). painDETECT: A new screening questionnaire to identify neuropathic components in patients with back pain. Current Medical Research and Opinion, 22, 1911-1920. https://doi.org/10.1185/030079906X132488
Friessem, C. H., Willweber-Strumpf, A., & Zenz, M. W. (2009). Chronic pain in primary care. German figures from 1991 and 2006. BMC Public Health, 9, 299. https://doi.org/10.1186/1471-2458-9-299
Gelfand, S. (1964). The relationship of experimental pain tolerance to pain threshold. Canadian Journal of Psychology/Revue Canadienne de Psychologie, 18, 36-42. https://doi.org/10.1037/h0083283
Gierthmühlen, J., Enax-Krumova, E. K., Attal, N., Bouhassira, D., Cruccu, G., Finnerup, N. B., … Maier, C. (2015). Who is healthy? Aspects to consider when including healthy volunteers in QST-based studies-a consensus statement by the EUROPAIN and NEUROPAIN consortia. Pain, 156, 2203-2211. https://doi.org/10.1097/j.pain.0000000000000227
Gierthmühlen, J., Maier, C., Baron, R., Tölle, T., Treede, R.-D., Birbaumer, N., …German Research Network on Neuropathic Pain (DFNS) study group. (2012). Sensory signs in complex regional pain syndrome and peripheral nerve injury. Pain, 153, 765-774. https://doi.org/10.1016/j.pain.2011.11.009
Gijsbers, K., & Nicholson, F. (2005). Experimental pain thresholds influenced by sex of experimenter. Perceptual and Motor Skills, 101, 803-807. https://doi.org/10.2466/PMS.101.7.803-807
Goswami, R., Anastakis, D. J., Katz, J., & Davis, K. D. (2016). A longitudinal study of pain, personality, and brain plasticity following peripheral nerve injury. Pain, 157, 729-739. https://doi.org/10.1097/j.pain.0000000000000430
Greenspan, J. D., Craft, R. M., LeResche, L., Arendt-Nielsen, L., Berkley, K. J., Fillingim, R. B., … Traub, R. J. (2007). Studying sex and gender differences in pain and analgesia: A consensus report. Pain, 132, S26-S45. https://doi.org/10.1016/j.pain.2007.10.014
Harden, R. N., Bruehl, S., Perez, R. S. G. M., Birklein, F., Marinus, J., Maihofner, C., … Vatine, J.-J. (2010a). Validation of proposed diagnostic criteria (the “Budapest Criteria”) for complex regional pain syndrome. Pain, 150, 268-274. https://doi.org/10.1016/j.pain.2010.04.030
Harden, R. N., Bruehl, S., Perez, R. S. G. M., Birklein, F., Marinus, J., Maihofner, C., … Vatine, J.-J. (2010b). Development of a severity score for CRPS. Pain, 151, 870-876. https://doi.org/10.1016/j.pain.2010.09.031
Hashmi, J. A., & Davis, K. D. (2014). Deconstructing sex differences in pain sensitivity. Pain, 155, 10-13. https://doi.org/10.1016/j.pain.2013.07.039
Iacovides, S., Avidon, I., & Baker, F. C. (2015). Does pain vary across the menstrual cycle? A review. European Journal of Pain, 19, 1389-1405. https://doi.org/10.1002/ejp.714
IASP. (2017). IASP terminology. Retrieved from https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698
Kállai, I., Barke, A., & Voss, U. (2004). The effects of experimenter characteristics on pain reports in women and men. Pain, 112, 142-147. https://doi.org/10.1016/j.pain.2004.08.008
Kilo, S., Schmelz, M., Koltzenburg, M., & Handwerker, H. O. (1994). Different patterns of hyperalgesia induced by experimental inflammation in human skin. Brain, 117(Pt 2), 385-396. https://doi.org/10.1093/brain/117.2.385
Krämer, H. H., Rolke, R., Bickel, A., & Birklein, F. (2004). Thermal thresholds predict painfulness of diabetic neuropathies. Diabetes Care, 27, 2386-2391. https://doi.org/10.2337/diacare.27.10.2386
Lamerato, L. E., Dryer, R. D., Wolff, G. G., Hegeman-Dingle, R., Mardekian, J., Park, P. W., & Zlateva, G. (2016). Prevalence of chronic pain in a large integrated healthcare delivery system in the U.S.A. Pain Practice, 16, 890-898. https://doi.org/10.1111/papr.12334
Levine, F. M., & De Simone, L. L. (1991). The effects of experimenter gender on pain report in male and female subjects. Pain, 44, 69-72. https://doi.org/10.1016/0304-3959(91)90149-R
Magerl, W., Krumova, E. K., Baron, R., Tölle, T., Treede, R.-D., & Maier, C. (2010). Reference data for quantitative sensory testing (QST): Refined stratification for age and a novel method for statistical comparison of group data. Pain, 151, 598-605. https://doi.org/10.1016/j.pain.2010.07.026
Maier, C., Baron, R., Tölle, T. R., Binder, A., Birbaumer, N., Birklein, F., … Treede, R.-D. (2010). Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes. Pain, 150, 439-450. https://doi.org/10.1016/j.pain.2010.05.002
Mainka, T., Bischoff, F. S., Baron, R., Krumova, E. K., Nicolas, V., Pennekamp, W., … Maier, C. (2014). Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin. Pain, 155, 591-597. https://doi.org/10.1016/j.pain.2013.12.014
Meints, S. M., Wang, V., & Edwards, R. R. (2018). Sex and race differences in pain sensitization among patients with chronic low back pain. The Journal of Pain, 19, 1461-1470. https://doi.org/10.1016/j.jpain.2018.07.001
Meyer-Frießem, C. H., Szalaty, P., Zahn, P. K., & Pogatzki-Zahn, E. M. (2019). A prospective study of patients' pain intensity after cardiac surgery and a qualitative review: Effects of examiners' gender on patient reporting. Scandinavian Journal of Pain, 19, 39-51. https://doi.org/10.1515/sjpain-2018-0111
Mogil, J. S. (2012). Sex differences in pain and pain inhibition: Multiple explanations of a controversial phenomenon. Nature Reviews Neuroscience, 13, 859-866. https://doi.org/10.1038/nrn3360
Moulin, D. E., Clark, A. J., Speechley, M., & Morley-Forster, P. K. (2002). Chronic pain in Canada-Prevalence, treatment, impact and the role of opioid analgesia. Pain Research and Management, 7, 179-184. https://doi.org/10.1155/2002/323085
Ott, S., & Maihöfner, C. (2018). Signs and symptoms in 1,043 patients with complex regional pain syndrome. The Journal of Pain, 19, 599-611. https://doi.org/10.1016/j.jpain.2018.01.004
Packiasabapathy, S., & Sadhasivam, S. (2018). Gender, genetics, and analgesia: Understanding the differences in response to pain relief. Journal of Pain Research, 11, 2729-2739. https://doi.org/10.2147/JPR.S94650
Pfau, D. B., Krumova, E. K., Treede, R.-D., Baron, R., Toelle, T., Birklein, F., … Maier, C. (2014). Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Reference data for the trunk and application in patients with chronic postherpetic neuralgia. Pain, 155, 1002-1015. https://doi.org/10.1016/j.pain.2014.02.004
Pfau, D. B., Rolke, R., Nickel, R., Treede, R.-D., & Daublaender, M. (2009). Somatosensory profiles in subgroups of patients with myogenic temporomandibular disorders and fibromyalgia syndrome. Pain, 147, 72-83. https://doi.org/10.1016/j.pain.2009.08.010
Pogatzki-Zahn, E. M., Mengersen, C., Englbrecht, J. S., Klein, T., Magerl, W., & Zahn, P. K. (2019). Progesterone relates to enhanced incisional acute pain and pinprick hyperalgesia in the luteal phase of female volunteers. Pain, 160(8), 1781-1793.
Pons, T., Shipton, E. A., Williman, J., & Mulder, R. T. (2015). Potential risk factors for the onset of complex regional pain syndrome type 1: A systematic literature review. Anesthesiology Research and Practice, 2015, 956539. https://doi.org/10.1155/2015/956539
Racine, M., Tousignant-Laflamme, Y., Kloda, L. A., Dion, D., Dupuis, G., & Choinière, M. (2012). A systematic literature review of 10 years of research on sex/gender and experimental pain perception-Part 1: Are there really differences between women and men? Pain, 153, 602-618. https://doi.org/10.1016/j.pain.2011.11.025
Rahim-Williams, B., Riley, J. L., Williams, A. K. K., & Fillingim, R. B. (2012). A quantitative review of ethnic group differences in experimental pain response: Do biology, psychology, and culture matter? Pain Medicine, 13, 522-540. https://doi.org/10.1111/j.1526-4637.2012.01336.x
Reitsma, M., Tranmer, J. E., Buchanan, D. M., & VanDenKerkhof, E. G. (2012). The epidemiology of chronic pain in Canadian men and women between 1994 and 2007: Longitudinal results of the National Population Health Survey. Pain Research and Management, 17, 166-172. https://doi.org/10.1155/2012/875924
Riley, J. L., Robinson, M. E., Wise, E. A., Myers, C. D., & Fillingim, R. B. (1998). Sex differences in the perception of noxious experimental stimuli: A meta-analysis. Pain, 74, 181-187. https://doi.org/10.1016/S0304-3959(97)00199-1
Roh, Y. H., Lee, B. K., Noh, J. H., Baek, J. R., Oh, J. H., Gong, H. S., & Baek, G. H. (2014). Factors associated with complex regional pain syndrome type I in patients with surgically treated distal radius fracture. Archives of Orthopaedic and Trauma Surgery, 134, 1775-1781. https://doi.org/10.1007/s00402-014-2094-5
Rolke, R., Baron, R., Maier, C., Tölle, T. R., Treede, R.-D., Beyer, A., … Wasserka, B. (2006). Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values. Pain, 123, 231-243. https://doi.org/10.1016/j.pain.2006.01.041
Schäfer, A. G. M., Hall, T. M., Rolke, R., Treede, R.-D., Lüdtke, K., Mallwitz, J., & Briffa, K. N. (2014). Low back related leg pain: An investigation of construct validity of a new classification system. Journal of Back and Musculoskeletal Rehabilitation, 27, 409-418. https://doi.org/10.3233/BMR-140461
Selim, M. M., Wendelschafer-Crabb, G., Hodges, J. S., Simone, D. A., Foster, S.-X.-Y.-L., Vanhove, G. F., & Kennedy, W. R. (2010). Variation in quantitative sensory testing and epidermal nerve fiber density in repeated measurements. Pain, 151, 575-581. https://doi.org/10.1016/j.pain.2010.06.034
Torrance, N., Smith, B. H., Bennett, M. I., & Lee, A. J. (2006). The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. The Journal of Pain, 7, 281-289. https://doi.org/10.1016/j.jpain.2005.11.008
Üçeyler, N., Vollert, J., Broll, B., Riediger, N., Langjahr, M., Saffer, N., … Sommer, C. (2018). Sensory profiles and skin innervation of patients with painful and painless neuropathies. Pain. 159, 1867-1876. https://doi.org/10.1097/j.pain.0000000000001287
Vigil, J. M., & Alcock, J. (2014). Tough guys or sensitive guys? Disentangling the role of examiner sex on patient pain reports. Pain Research and Management, 19, e9-e12. https://doi.org/10.1155/2014/531396
Vollert, J., Attal, N., Baron, R., Freynhagen, R., Haanpää, M., Hansson, P., … Maier, C. (2016). Quantitative sensory testing using DFNS protocol in Europe: An evaluation of heterogeneity across multiple centers in patients with peripheral neuropathic pain and healthy subjects. Pain, 157, 750-758. https://doi.org/10.1097/j.pain.0000000000000433
Vollert, J., Kramer, M., Barroso, A., Freynhagen, R., Haanpää, M., Hansson, P., … Baron, R. (2016). Symptom profiles in the painDETECT Questionnaire in patients with peripheral neuropathic pain stratified according to sensory loss in quantitative sensory testing. Pain, 157, 1810-1818. https://doi.org/10.1097/j.pain.0000000000000588
Vollert, J., Magerl, W., Baron, R., Binder, A., Enax-Krumova, E. K., Geisslinger, G., … Treede, R.-D. (2018). Pathophysiological mechanisms of neuropathic pain: Comparison of sensory phenotypes in patients and human surrogate pain models. Pain, 159, 1090-1102. https://doi.org/10.1097/j.pain.0000000000001190
Vollert, J., Maier, C., Attal, N., Bennett, D. L. H., Bouhassira, D., Enax-Krumova, E. K., … Baron, R. (2017). Stratifying patients with peripheral neuropathic pain based on sensory profiles: Algorithm and sample size recommendations. Pain, 158, 1446-1455. https://doi.org/10.1097/j.pain.0000000000000935
Vollert, J., Mainka, T., Baron, R., Enax-Krumova, E. K., Hüllemann, P., Maier, C., … Treede, R.-D. (2015). Quality assurance for Quantitative Sensory Testing laboratories: Development and validation of an automated evaluation tool for the analysis of declared healthy samples. Pain, 156, 2423-2430. https://doi.org/10.1097/j.pain.0000000000000300
Williamson, P. R., Altman, D. G., Bagley, H., Barnes, K. L., Blazeby, J. M., Brookes, S. T., … Young, B. (2017). The COMET handbook: Version 1.0. Trials, 18, 280. https://doi.org/10.1186/s13063-017-1978-4