Sources of variation in assessing male and female responses to pain

The question bf differential pain response between men and women has recently received much attention. In general, women present with pain and ill-health problems at least twice as often as do men and are therefore greater users of the health care system. One common explanation of this disproportionate use is that women respond to stimuli as painful at a lower intensity than do men. Thus, in the same situation, more women are liable to present with pain and illness than are men. Such a suggestion, however, is at odds with the highly variable psychological responses to painful stimuli in both men and women and returns to an essentially Cartesian understanding of pain which draws on the largely discredited 'direct transmission model'. It is suggested here that differential ill-health and pain response between the sexes can be understood through an extension of the biopsychosocial model of pain and ill-health which is used to describe three types of clinical pain disorder: post extraction pain, rheumatoid arthritis and atypical facial pain. The differential experiences of men and women give women both greater opportunity and reason to be ill by altering the factors influencing the biopsychosocial model of pain. (C) 1997 Elsevier Science Ltd.