A comparison of diffuse noxious inhibitory controls in men and women
Abstract
Results from clinical and experimental pain studies provide consistent evidence of sex differences in pain perception, with women reporting more clinical pain and demonstrating lower pain threshold and tolerance levels than men. The present study was designed to assess the notion that sex differences in pain perception may be related to differential activation of supraspinal pain modulation systems. Specifically, the phenomenon of diffuse noxious inhibitory controls (DNIC) was examined in healthy young adult men (n = 39) and women (n = 44) using repeated assessment of nociceptive flexion reflex activity before, during and after exposure to forearm ischemia. Consistent with previous research, women exhibited significantly lower nociceptive flexion reflex thresholds than men, and reported significantly greater pain in response to both forearm ischemia and repeated electrocutaneous stimulation required to elicit the nociceptive flexion reflex. Application of forearm ischemia was associated with a significant decrease in nociceptive flexion reflex activity in both men and women, however, the degree of attenuation of nociceptive flexion reflex activity was not significantly different between the sexes. These findings suggest that men and women exhibit similar activation of diffuse noxious inhibitory controls, but they do not exclude the possibility of sex differences in other forms of central pain modulation.
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Parental pain catastrophizing is strongly related to children's persistent pain after major surgery and to the child's disability.
“parental pain catastrophizing is strongly related to the development of children’s persistent pain following major surgery 115, and to the child’s disability 116.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [115]
Catastrophizing by individuals in supportive roles, such as a parent or spouse, also influences pain-related outcomes.
“there is also evidence to suggest that catastrophizing by individuals in supportive roles (e.g. parent, spouse) also influences pain-related outcomes112, 115, 344.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [115]
Cites
(1970) · Cited by 24,983 · see citing works
The McGill Pain Questionnaire: Major properties and scoring methods
Melzack, R. (1975) · Pain · doi:10.1016/0304-3959(75)90044-5 · Cited by 6,873 · see citing works
Gender variations in clinical pain experience
Unruh, A. M. (1996) · Pain · doi:10.1016/0304-3959(95)00214-6 · Cited by 1,550 · see citing works
Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat
Bars, D. L., Dickenson, A. H., & Besson, J. (1979) · Pain · doi:10.1016/0304-3959(79)90049-6 · Cited by 1,370 · see citing works
Sex differences in the perception of noxious experimental stimuli: a meta-analysis
Riley, J. L., Robinson, M. E., Wise, E. A., Myers, C. D., & Fillingim, R. B. (1998) · Pain · doi:10.1016/s0304-3959(97)00199-1 · Cited by 1,085 · see citing works
Comparative study of perceived pain and nociceptive flexion reflex in man
Willer, J. C. (1977) · Pain · doi:10.1016/0304-3959(77)90036-7 · Cited by 554 · see citing works
Gender differences in the responses to noxious stimuli
Fillingim, R. B., & Maixner, W. D. (1995) · Pain Forum · doi:10.1016/s1082-3174(11)80022-x · Cited by 475 · see citing works
Pain Tolerance: Differences According to Age, Sex and Race
Woodrow, K. M., FRIEDMAN, G. D., SIEGELAUB, A. B., & Collen, M. F. (1972) · Psychosomatic Medicine · doi:10.1097/00006842-197211000-00007 · Cited by 436 · see citing works
Jc, W., Roby-Brami, A., & Bars, D. L. (1984) · Brain · doi:10.1093/brain/107.4.1095 · Cited by 387 · see citing works
The effects of experimenter gender on pain report in male and female subjects
Levine, F. M., & Simone, L. L. D. (1991) · Pain · doi:10.1016/0304-3959(91)90149-r · Cited by 369 · see citing works
Paulson, P. E., Minoshima, S., Morrow, T. J., & Casey, K. L. (1998) · Pain · doi:10.1016/s0304-3959(98)00048-7 · Cited by 325 · see citing works
Sex differences in the perception of noxious heat stimuli
Feine, J. S., Bushnell, C. M., Miron, D., & Duncan, G. H. (1991) · Pain · doi:10.1016/0304-3959(91)90094-e · Cited by 278 · see citing works
Giamberardino, M. A., Berkley, K. J., Iezzi, S., de Bigontina, P., & Vecchiet, L. (1997) · Pain · doi:10.1016/s0304-3959(97)03362-9 · Cited by 253 · see citing works
Cephalic muscle tenderness and pressure pain threshold in a general population
Jensen, R., Rasmussen, B. K., Pedersen, B., Lous, I., & Olesen, J. (1992) · Pain · doi:10.1016/0304-3959(92)90059-k · Cited by 252 · see citing works
Encoding of nociceptive thermal stimuli by diffuse noxious inhibitory controls in humans
Willer, J. C., de Broucker, T., & Bars, D. L. (1989) · Journal of Neurophysiology · doi:10.1152/jn.1989.62.5.1028 · Cited by 226 · see citing works
Quantitative assessment of thermal and pain sensitivity
Meh, D., & Denišlič, M. (1994) · Journal of the Neurological Sciences · doi:10.1016/0022-510x(94)90069-8 · Cited by 224 · see citing works
Lautenbacher, S., & Rollman, G. B. (1993) · Pain · doi:10.1016/0304-3959(93)90221-a · Cited by 210 · see citing works
DIFFUSE NOXIOUS INHIBITORY CONTROLS IN MAN:
de Broucker, T., Césaro, P., Jc, W., & Bars, D. L. (1990) · Brain · doi:10.1093/brain/113.4.1223 · Cited by 207 · see citing works
Sex differences and personality factors in responsivity to pain
Otto, M. W., & Dougher, M. J. (1985) · Perceptual and Motor Skills · doi:10.2466/pms.1985.61.2.383 · Cited by 193 · see citing works
Kugelberg, E., Eklund, K., & Grimby, L. (1960) · Brain · doi:10.1093/brain/83.3.394 · Cited by 190 · see citing works
Analysis of gender effects on pain perception and symptom presentation in temporomandibular pain
Bush, F. M., Harkins, S. W., Harrington, W. G., & Price, D. D. (1993) · Pain · doi:10.1016/0304-3959(93)90058-w · Cited by 188 · see citing works
Diffuse noxious inhibitory controls in man: Involvement of an opioidergic link
Willer, J. C., Bars, D. L., & de Broucker, T. (1990) · European Journal of Pharmacology · doi:10.1016/0014-2999(90)90293-f · Cited by 186 · see citing works
Comparison of muscle cross-sectional area and strength between untrained women and men
Kanehisa, H., Ikegawa, S., & Fukunaga, T. (1994) · European Journal of Applied Physiology · doi:10.1007/bf00244028 · Cited by 179 · see citing works
Roby-Brami, A., Bussel, B., Jc, W., & Bars, D. L. (1987) · Brain · doi:10.1093/brain/110.6.1497 · Cited by 171 · see citing works
Exteroceptive Reflexes to Stimulation of the Sural Nerve in Normal Man
Hugon, M. (2015) · KARGER eBooks · doi:10.1159/000394186 · Cited by 169 · see citing works
Comparison of ketamine and pethidine in experimental and postoperative pain
Maurset, A., Skoglund, L. A., Hustveit, O., & Øye, I. (1989) · Pain · doi:10.1016/0304-3959(89)90109-7 · Cited by 143 · see citing works
Morphine blocks descending pain inhibitory controls in humans
Bars, D. L., Willer, J. C., & de Broucker, T. (1992) · Pain · doi:10.1016/0304-3959(92)90126-v · Cited by 139 · see citing works
Subjective pain sensation is linearly correlated with the flexion reflex in man
Chan, C. W. Y., & Dallaire, M. (1989) · Brain Research · doi:10.1016/0006-8993(89)91344-9 · Cited by 132 · see citing works
Willer, J., & Albe-Fessard, D. (1980) · Brain Research · doi:10.1016/0006-8993(80)90755-6 · Cited by 130 · see citing works
Blitz, B., & Dinnerstein, A. J. (1971) · Journal of Abnormal Psychology · doi:10.1037/h0030418 · Cited by 114 · see citing works
The detectability, discriminability, and perceived magnitude of painful electrical shock
Rollman, G. B., & Harris, G. (1987) · Perception & Psychophysics · doi:10.3758/bf03203077 · Cited by 111 · see citing works
Gender Differences in Pain and Cardiovascular Responses to Forearm Ischemia
Maixner, W. D., & Humphrey, C. (1993) · Clinical Journal of Pain · doi:10.1097/00002508-199303000-00003 · Cited by 111 · see citing works
Hapidou, E. G., & de Catanzaro, D. (1988) · Pain · doi:10.1016/0304-3959(88)90123-6 · Cited by 106 · see citing works
Cyclic changes in pain perception: An ROC analysis
Goolkasian, P. A. (1980) · Perception & Psychophysics · doi:10.3758/bf03198677 · Cited by 97 · see citing works
Sex differences in pain and thermal sensitivity: The role of body size
Lautenbacher, S., & Strian, F. (1991) · Perception & Psychophysics · doi:10.3758/bf03212218 · Cited by 91 · see citing works
Evidence of gender differences in esophageal pain threshold.
Nguyen, P. T., Lee, S. D., & Do, C. (1995) · PubMed · Cited by 89 · see citing works
Objective evidence of decreased pain perception in normotensives at risk for hypertension
Page, G. D., & France, C. R. (1997) · Pain · doi:10.1016/s0304-3959(97)00111-5 · Cited by 80 · see citing works
Self-citationPossible startle response contamination of the spinal nociceptive withdrawal reflex
Dowman, R. (1992) · Pain · doi:10.1016/0304-3959(92)90142-x · Cited by 80 · see citing works
Aging and right-left asymmetry in experimental pain measurement
Neri, M., & Agazzani, E. (1984) · Pain · doi:10.1016/0304-3959(84)90063-0 · Cited by 79 · see citing works
The Cutaneous Pricking Pain Threshold in Old Age
Procacci, P., Bozza, G., Buzzelli, G., & Corte, F. D. (2009) · Gerontologia Clinica · doi:10.1159/000245281 · Cited by 76 · see citing works
Withdrawal reflex, skin resistance reaction and pain ratings due to electrical stimuli in man
Bromm, B., & Treede, R. (1980) · Pain · doi:10.1016/0304-3959(80)90048-2 · Cited by 73 · see citing works
Bouhassira, D., Bars, D. L., Bolgert, F., Laplane, D., & Willer, J. C. (1993) · Annals of Neurology · doi:10.1002/ana.410340406 · Cited by 72 · see citing works
France, C. R., & STEWART, K. M. (1995) · Psychophysiology · doi:10.1111/j.1469-8986.1995.tb01233.x · Cited by 70 · see citing works
Self-citationAlteration of shock aversion thresholds during the menstrual cycle
Tedford, W. H., Warren, D. E., & Flynn, W. E. (1977) · Perception & Psychophysics · doi:10.3758/bf03198725 · Cited by 69 · see citing works
Inhibition of a somatic nociceptive reflex by gastric distention in humans
Bouhassira, D., Chollet, R., Coffin, B., Lémann, M., Bars, D. L., Willer, J. C., & Jian, R. (1994) · Gastroenterology · doi:10.1016/0016-5085(94)90222-4 · Cited by 61 · see citing works
Historical Methods of Counter-irritation
Wand-Tetley, J. I. (1956) · Lara D. Veeken · doi:10.1093/rheumatology/iii.3.90 · Cited by 61 · see citing works
Sex difference in pain tolerance and pain apperception.
Sl, N., & Mm, T. (1967) · PubMed · Cited by 60 · see citing works
Family history of hypertension and pain during blood donation.
France, C. R., Adler, P. S. J., France, J. L., et al. (1994) · Psychosomatic Medicine · doi:10.1097/00006842-199401000-00007 · Cited by 52 · see citing works
Self-citationA new version of the ischemic tourniquet pain test.
Maurset, A., Skoglund, L. A., Hustveit, O., et al. (1991) · PubMed · Cited by 45 · see citing works
STEWART, K. M., & France, C. R. (1996) · Pain · doi:10.1016/s0304-3959(96)03184-3 · Cited by 42 · see citing works
Self-citationWestcott, T. B., Huesz, L., Boswell, D. L., & HEROLD, P. L. (1977) · Perceptual and Motor Skills · doi:10.2466/pms.1977.44.2.401 · Cited by 36 · see citing works
Determination of the Pain Threshold on Untrained Subjects
Clausen, J., & King, H. E. (1950) · The Journal of Psychology · doi:10.1080/00223980.1950.9916067 · Cited by 35 · see citing works
Effects of dothiepin on nociceptive flexion reflex and diffuse noxious inhibitory controls in humans
Sandrini, G., Ruiz, L., Capararo, M., Ab, D., Beretta, A., & Nappi, G. (1993) · European Journal of Pharmacology · doi:10.1016/0014-2999(93)90175-h · Cited by 26 · see citing works
THE RESPONSES TO PAINFUL STIMULI OF PATIENTS WITH SEVERE CHRONIC PAINFUL CONDITIONS
Kennard, M. A. (1952) · Journal of Clinical Investigation · doi:10.1172/jci102599 · Cited by 19 · see citing works
Pain Perception and Extraversion
Leon, B. N. (1974) · Perceptual and Motor Skills · doi:10.2466/pms.1974.38.2.510 · Cited by 14 · see citing works
Normal and radiculopathic cutaneous pain tolerance levels evaluated by heat-beam dolorimetry
Lipman, J. J., Blumenkopf, B., & Lawrence, P. L. (1990) · Journal of neurosurgery · doi:10.3171/jns.1990.72.6.0883 · Cited by 11 · see citing works
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Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Rahim-Williams, B., & Riley, J. L. (2009) · The Journal of Pain · doi:10.1016/j.jpain.2008.12.001 · Cited by 2,766 · see citing works
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Racine, M., Tousignant-Laflamme, Y., Kloda, L. A., Dion, D., Dupuis, G., & Choinière, M. (2012) · Pain · doi:10.1016/j.pain.2011.11.025 · Cited by 691 · see citing works
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Weissman-Fogel, I., Sprecher, E., & Pud, D. (2008) · Experimental Brain Research · doi:10.1007/s00221-007-1206-7 · Cited by 214 · see citing works
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- Authors
- France, C. R., & Suchowiecki, S.
- Affiliations
- Ohio University (US)
- Corresponding author
- France, Christopher R.
- Venue
- Pain
- Published
- 1999-05-01
- Volume
- 81
- Issue
- 1
- Pages
- 77-84
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2070264067
- Cited by
- 165
- References
- 56
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 5 · 2021: 2 · 2020: 4 · 2019: 4 · 2018: 4 · 2017: 2 · 2016: 4 · 2015: 3 · 2014: 9 · 2013: 6 · 2012: 6
- FWCI
- 4.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- McGill University
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- diffuse noxious inhibitory control, sex differences, pain perception, nociceptive flexion reflex, forearm ischemia, central pain modulation, supraspinal pain modulation, electrocutaneous stimulation, pain threshold, pain tolerance
- MeSH terms
- Adolescent, Adult, Ankle, Cardiovascular Physiological Phenomena, Electric Stimulation, Female, Forearm, Humans, Ischemia, Male, Pain, Pain Measurement, Sex Characteristics, Skin Physiological Phenomena, Sural Nerve, Pain Threshold
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