We know that there are sex and gender differences in the perception and experience of pain, with women generally reporting more painful episodes across their lifespan than men. While reasons for these sex differences focus on vulnerability factors (e.g., sex hormones), there are alternative ways of thinking about them. For example, as well as asking why women might experience more pain, we could also ask why men report less pain, are less likely to take analgesics and less likely to attend pain clinics? One possibility is that the lower incidence of pain in men reflects a lower need for help and support. Alternatively, it could be that men are less willing to express pain, and subsequently, less likely to seek help for it.
This idea, that men might not actively engage as much in positive health behaviours or seek help, is not new of course. After all, isn’t it generally well recognised that men have less healthy lifestyles, and are more likely to avoid or delay visits to their physician? As a consequence, there are now an increasing number of health campaigns encouraging men to talk about their concerns. But whilst it might seem obvious that a reluctance to seek help about health concerns in men would also translate to their painful experiences, few take a men’s health approach to pain, and so we cannot assume that this is actually the case.
With this in mind, I decided to read around the men’s health literature, to get an idea for the key issues and debates. Once key themes were identified, I then looked at whether they have been considered within the context of pain. The results of this reading were illuminating, and confirmed my view that taking a men’s health approach to pain might help us better understand issues relevant to men and women’s pain. Much of this work is now summarised in a new topical review, which is published in the journal PAIN (Keogh, in press). In this review I outline three core themes that appear in the men’s health literature, which I think are relevant to sex, gender and pain. These general themes are:
- Health-survival gender paradox: women suffer from more health conditions, yet men seem to die at an earlier age. There are various reasons for this difference, including lifestyle factors. Importantly, there are also large sex differences in suicide rates, with men showing a much greater vulnerability.
- Male health behaviours: Men seem to engage in poorer health behaviours, including worse diets, and high rates of alcohol/nicotine consumption. Men are also less likely to engage in positive health behaviours, including health screening and regular check-ups.
- Masculinity and male identity: Gender identity and related gender-roles are closely related to health and health behaviours. Identifying with traditional views of masculinity (e.g., stoic, less emotional) can negatively impact on help seeking health behaviours. Similarly, poor health can effect masculine gender identity, and challenge views about the self and social roles.
The key question to ask is whether these themes, commonly found in men’s health, are also relevant to pain, and whether they help us better understand the influence of sex and gender variables in pain. As becomes apparent in the review, I think the answer is yes, although the amount of research that has been conducted to date is fairly limited. For example, while we know the prevalence of pain is higher in women for a number of conditions, it is less clear whether pain-related mortality affects men more than women. There is, however, emerging evidence that there may be sex differences, but the exact pattern is unclear (Docking et al. 2015; Kaplovitch et al., 2015). Furthermore, little is known about potential male-female differences in pain-related suicide. Other questions include whether there are male-female differences in pain-related support seeking, and other pain coping behaviours? Is there a relationship between gender identity and pain, and does greater identification with masculine roles mean it is more difficult for men to express pain and seek help?
There has not been a focus on men’s health themes within sex, gender and pain research, and so, whilst risking cries of ‘research cliché’, there really is still much to do and learn. However, I am optimistic, and believe we are beginning to see these interesting themes being looked at within the context of pain. At the University of Bath, we are currently running investigations into the issues raised within the review (e.g., masculinity, support seeking), to look at men and women’s pain and related behaviours. More generally, what I hope this review achieves is to highlight that men’s health is of relevance to those interested in pain, as well as to those who have specific interests in sex and gender issues.
About Ed Keogh
Ed is Deputy Director of the Bath Centre for Pain Research and a Reader in the Department of Psychology, both based at the University of Bath in the United Kingdom (www.bath.ac.uk/pain). His primary research interests are in understanding why there are sex/gender differences in pain, with a focus on psychological factors. He also has interests in pain communication, and the role of attention in our perception and experience of pain. He is currently co-chair of IASP’s Special Interest Group on Sex, Gender and Pain.
Docking RE, Fleming J, Brayne C, Zhao J, Macfarlane GJ, Jones GT (2015). Cambridge City over-75s Cohort (CC75C) study collaboration. The relationship between back pain and mortality in older adults varies with disability and gender: results from the Cambridge City over-75s Cohort (CC75C) study. Eur J Pain;19(4):466-72. doi:10.1002/ejp.568.
Kaplovitch E, Gomes T, Camacho X, Dhalla IA, Mamdani MM, Juurlink DN. (2015). Sex differences in dose escalation and overdose death during chronic opioid therapy: a population-based cohort study. PLoS One;10(8):e0134550. doi: 10.1371/journal.pone.0134550.
Keogh, E. (in press). Men, masculinity and pain. Pain. doi:10.1097/j.pain.0000000000000328