Does gender identity affect pain?

There are known differences in the pain experience, pain processing and prevalence of chronic pain between men and women. Research shows that women are more sensitive to pain, and are more susceptible to chronic pain conditions like migraine and fibromyalgia. Less is known about how gender identity affects the pain experience. Strath et al. (2020) investigated pain sensitivity in African-American people living with HIV and suffering from chronic pain. Three age-matched groups were compared: cisgender women (CW), cisgender men (CM), and transgender women (TW).

What QST was performed?

Quantitative sensory testing consisted of heat pain thresholds, heat pain tolerance, heat temporal summation with Medoc’s TSA-II, mechanical temporal summation with monofilaments and conditioned pain modulation with pressure pain threshold (PPT) by Medoc’s AlgoMed as the test stimulus and a cold pressor as the conditioning stimulus.

Differences between cisgender women, transgender women and cisgender men

Heat pain and heat pain tolerance thresholds did not differ significantly between the groups. In heat temporal summation (TS), consisting of five short stimuli of 46 degrees, the delta in pain ratings between the first and fifth stimulus did not differ between groups. Interestingly, pain ratings of all stimuli across the series in TS, were significantly higher for both CW and TW as compared to CM. There was no significant difference in pain ratings during TS between CW and TW. Additionally, TW had greater mechanical TS than CW and CM. There were no differences between the groups in PPTs or in CPM efficacy.

These findings point to a dominant role of gender identity above biological sex in pain experience, and this should be considered when treating patients suffering from chronic pain.

Reference:

Strath, L. J., Sorge, R. E., Owens, M. A., Gonzalez, C. E., Okunbor, J. I., White, D. M., ... & Goodin, B. R. (2020). Sex and Gender are Not the Same: Why Identity Is Important for People Living with HIV and Chronic Pain. Journal of Pain Research, 13, 829.‏

Link to the full-text article:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187934/pdf/jpr-13-829.pdf