Sex Differences in Pain Sensitivity Among Cognitively Healthy Older Adults

Objective: This study examined sex differences in pain intensity and unpleasantness among cognitively healthy older adults. While females generally exhibit heightened pain sensitivity, research on sex differences in older adults remains limited. We aimed to determine whether these differences persist in aging populations without cognitive impairment. Methods: A sample of 58 community-dwelling older adults (≥60 years, 34 females, 24 males) were included in this pain psychophysics study to assess differences by sex. Cognitive status was assessed using the Mini-Mental Status Exam (MMSE) or Telephone Interview for Cognitive Status (TICS). Depression, anxiety, and baseline pain were also assessed. Evoked heat pain stimuli at fixed temperatures (34°C, 39°C, 44°C) were delivered via the Medoc Q-Sense system with pain intensity and unpleasantness rated immediately after each stimulus. Results: Females reported significantly higher pain intensity than males (p = .02; female mean = 4.6 [95% CI: 3.9, 5.3], male mean = 3.5 [95% CI: 2.9, 4.2]). Sex differences in reported pain intensity were consistent across the three stimulus intensity levels (sex by temperature interaction p = .35). Pain unpleasantness did not differ significantly between sexes (p = .14) nor was the sex by temperature interaction significant (p = .35). Conclusion: Findings confirm sex differences in perceived pain intensity among cognitively healthy older adults, with females reporting higher pain levels. In contrast, no significant sex differences were observed in the affective component of pain. These results underscore the importance of incorporating sex-specific considerations in the assessment and management of pain intensity in older adults.