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A Meta-Analysis of Sex Differences in Pain Threshold, Tolerance, and Intensity.
Teresa A Graziano1, Olivia Orphanos2, José Ortiz3
1Department of Nursing, University of Vermont, Burlington, VT.
Summary
Males exhibit higher pain thresholds and tolerances, and lower pain intensity than females, according to a meta-analysis. However, the extent to which sex or gender contributes to these pain sensitivity differences remains unclear.
Area of Science:
- Pain research
- Sex differences in health
- Analgesia
Background:
- Substantial research over 70 years suggests males may have higher pain thresholds and tolerances than females.
- No meta-analytic review has been conducted in over 20 years, highlighting a need for updated synthesis of evidence.
Purpose of the Study:
- To conduct a meta-analysis of cross-sectional studies examining sex differences in pain threshold, tolerance, and intensity.
- To assess the effect size of sex across different pain outcomes and explore potential moderators such as sample type and pain stimulus.
Main Methods:
- A meta-analysis of 90 cross-sectional studies involving 7,464 participants for pain threshold, 4,935 for tolerance, and 4,911 for intensity.
- Assessed effect size of sex for threshold, tolerance, and intensity, with moderation testing for clinical vs. healthy samples and pain stimulus type.
- Evaluated sources for sex and gender conflation, finding it present in over 80% of studies.
Main Results:
- Males demonstrated significantly higher pain thresholds (d = 0.66) and tolerances (d = 0.79) than females.
- Males reported significantly lower pain intensity (d = -0.58) compared to females.
- Pain stimulus type moderated sex differences in pain threshold (electrical stimuli showed largest difference), and clinical samples showed smaller sex differences in pain tolerance.
Conclusions:
- Sex differences in pain sensitivity appear robust, but effect sizes vary by stimulus and sample type.
- The conflation of sex and gender in most studies (over 80%) makes it unclear whether observed differences are due to biological sex or gender identity.
- Further research is needed to disentangle the roles of sex and gender in pain perception.
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