Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jan 2;95(1-2):604-616.
doi: 10.1002/jnr.23856.

Sex-based differences in brain alterations across chronic pain conditions

Arpana Gupta  1   2 , Emeran A Mayer  1   2   3   4 , Connor Fling  1 , Jennifer S Labus  1   2   3   4 , Bruce D Naliboff  1   2 , Jui-Yang Hong  1   2 , Lisa A Kilpatrick  1   2   4
Affiliations
Review

Sex-based differences in brain alterations across chronic pain conditions

Arpana Gupta et al. J Neurosci Res. .

Abstract

Common brain mechanisms are thought to play a significant role across a multitude of chronic pain syndromes. In addition, there is strong evidence for the existence of sex differences in the prevalence of chronic pain and in the neurobiology of pain. Thus, it is important to consider sex when developing general principals of pain neurobiology. The goal of the current Mini-Review is to evaluate what is known about sex-specific brain alterations across multiple chronic pain populations. A total of 15 sex difference and 143 single-sex articles were identified from among 412 chronic pain neuroimaging articles. Results from sex difference studies indicate more prominent primary sensorimotor structural and functional alterations in female chronic pain patients compared with male chronic pain patients: differences in the nature and degree of insula alterations, with greater insula reactivity in male patients; differences in the degree of anterior cingulate structural alterations; and differences in emotional-arousal reactivity. Qualitative comparisons of male-specific and female-specific studies appear to be consistent with the results from sex difference studies. Given these differences, mixed-sex studies of chronic pain risk creating biased data or missing important information and single-sex studies have limited generalizability. The advent of large-scale neuroimaging databases will likely aid in building a more comprehensive understanding of sex differences and commonalities in brain mechanisms underlying chronic pain. © 2016 Wiley Periodicals, Inc.

Keywords: neuroimaging; pain; sex differences.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Figure 1
Figure 1
The manuscript selection process is depicted.
Figure 2
Figure 2
The number of manuscripts as classified in terms of the treatment of sex is shown for the chronic pain conditions included in the review. IBS, irritable bowel syndrome; GERD, gastroesophageal reflux disease; TT: tension-type; FM, fibromyalgia; UCPPS, urological chronic pelvic pain syndrome; IC/PBS, interstitial cystitis/painful bladder syndrome; CP, chronic prostatitis; CFS, chronic fatigue syndrome; OA, osteoarthritis; BMS, burning mouth syndrome; AFP, atypical facial pain; VVD, vulvodynia; VVS, vulvar vestibulitis syndrome; PDM, primary dysmenorrhea; PMDD, premenstrual dysphoric disorder; ENDO, endometriosis. No temporomandibular disorder manuscripts were identified.
Figure 3
Figure 3
A co-citation network analysis of chronic pain neuroimaging studies with a focus on the treatment of sex is depicted. Each manuscript of interest was coded according to its treatment of sex (represented by the color of the inside of the associated vertex: green, sex differences; red, female-specific; blue, male-specific; white, mixed-sex) and pain population (represented by the color of the vertex border: gastrointestinal, dark green; fibromyalgia and chronic fatigue syndrome, lavender; chronic back/limb pain, brown; urological pain, yellow; headache pain, teal; menstrual and vulvar pain, purple; other, gray). The size of each vertex was determined by the total number of citations the manuscript received by December 2015. Examination of Figure 3 indicates a fair degree of cross-citation among chronic pain neuroimaging researchers of different pain conditions, but less so for headache pain studies. The largest cluster in the figure (lower center) represents mainly migraine and cluster headache studies where despite the existence of sex difference manuscripts, sex appears to be generally not well-considered.
See this image and copyright information in PMC

References

    1. Albuquerque RJC, de Leeuw R, Carlson CR, Okeson JP, Miller CS, Andersen AH. Cerebral activation during thermal stimulation of patients who have burning mouth disorder: An fMRI study. Pain. 2006;122(3):223–234. - PubMed
    1. Aloisi AM, Bonifazi M. Sex hormones, central nervous system and pain. Horm Behav. 2006;50(1):1–7. - PubMed
    1. Andersson HI, Ejlertsson G, Leden I, Rosenberg C. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain. 1993;9(3):174–182. - PubMed
    1. Arkink EB, Bleeker EJW, Schmitz N, Schoonman GG, Wu O, Ferrari MD, van Buchem MA, van Osch MJP, Kruit MC. Cerebral perfusion changes in migraineurs: a voxelwise comparison of interictal dynamic susceptibility contrast MRI measurements. Cephalalgia. 2012;32(4):279–288. - PMC - PubMed
    1. Aronoff GM. What Do We Know About the Pathophysiology of Chronic Pain? Implications for Treatment Considerations. Med Clin North Am. 2016;100(1):31–42. - PubMed

Publication types

LinkOut - more resources