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Chronic pain and sex-differences; women accept and move, while men feel blue
Open accessAbstract
PURPOSE: The aim of this study is to explore differences between male and female patients entering a rehabilitation program at a pain clinic in order to gain a greater understanding of different approaches to be used in rehabilitation. METHOD: 1371 patients referred to a specialty pain rehabilitation clinic, completed sociodemographic and pain related questionnaires. They rated their pain acceptance (CPAQ-8), their kinesiophobia (TSK), the impact of pain in their life (MPI), anxiety and depression levels (HAD) and quality of life scales: the SF-36, LiSat-11, and the EQ-5D. Because of the large sample size of the study, the significance level was set at the p ≤.01. RESULTS: Analysis by t-test showed that when both sexes experience the same pain severity, women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia, mood disturbances and lower activity level. CONCLUSION: Pain acceptance (CPAQ-8) and kinesiophobia (TSK) showed the clearest differences between men and women. Pain acceptance and kinesiophobia are behaviorally defined and have the potential to be changed.
Checked 2026-10-09 · 1 reference not checked yet
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TL;DR
In 1,371 patients referred to a Swedish specialty pain rehabilitation clinic, women and men reported similar pain severity, but women showed higher pain acceptance, activity engagement, and social/life satisfaction, while men showed higher kinesiophobia and worse mental health. The clearest sex differences were in pain acceptance (CPAQ-8) and kinesiophobia (TSK), both behaviorally defined and potentially modifiable in rehabilitation.
Key findings
- At comparable pain severity (MPI pain severity: women 4.54 vs men 4.43, p = .123), women reported significantly higher pain acceptance: CPAQ-8 Activity Engagement 13.46 vs 11.45 (p < .001, d = .21) and Pain Willingness 10.08 vs 8.36 (p < .001, d = .33).
- Men reported significantly higher kinesiophobia (TSK: 43.52 vs 39.50, p < .001, d = -.44) and lower general activity level (MPI: 2.16 vs 2.36, p < .001, d = .21).
- Men scored significantly lower on SF-36 Mental Health than women (52.47 vs 56.53, p = .007, d = .18), while HAD anxiety and depression did not differ significantly (anxiety p = .245; depression p = .056).
- Women had more pain locations (14 vs 10, p < .001, d = .50) and more widespread pain (35.1% vs 21.8%, p < .001), and reported higher satisfaction with life as a whole, friends/acquaintances, sexual life, and family life.
Methods
- Cross-sectional pre-rehabilitation data from 1,371 consecutive patients with chronic musculoskeletal non-malignant pain referred to the Pain and Rehabilitation Centre, University Hospital, Linköping, Sweden, between 2009 and April 2011; 68.4% were women.
- Participants completed sociodemographic and pain-related questionnaires including CPAQ-8, TSK, MPI, HAD, SF-36, LiSat-11, and EQ-5D.
- Analyses used descriptive statistics, chi-squared tests, and two-tailed t-tests, with significance set at p ≤ .01 and “highly” significant at p ≤ .001; Cohen’s d effect sizes were calculated, and missing data were excluded pairwise.
Limitations
- The authors state that the large sample size can produce statistically significant but small-magnitude differences; effect sizes were sometimes low, and results should be treated with caution.
- The authors note reliance on self-reports, lack of observational measures such as physical capacity or sedentary time, and a heterogeneous sample with large SDs; they also state that exploratory cross-sectional design prevents causal inferences or conclusions about treatment response.
- Evident from the text: several analyses had smaller subsamples than the full 1,371 (e.g., TSK n = 869; CPAQ-8 Pain Willingness n = 1,086), and the sample was predominantly women, which may affect generalizability.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“according to the Mental Health subscale of SF-36, men scored significantly lower than women, indicating that men were experiencing more problem with their mental health than women t(1109) = 2.78, p = .007, d = .18 (mean difference = 4.08, 99% CI: 0.18 to 7.98) (Table 3).”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
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In the paper
“35% of them suffered from widespread pain while the majority of men (78%) suffered from localized pain χ2 (one, n = 1283) = 22.63, p = .000 (Table 1).”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“showing no statistically significant difference in anxiety according to HAD.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“women reported a greater number of pain locations than men t (1316) = 8.63, p = < .0001, d = .50. The magnitude of the differences in these means was large (mean difference = 4.032, 99% CI: 2.82 to 5.24).”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“More men than women (34% vs 30%) scored at a level of depression.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“According to CPAQ, women scored significantly higher levels of Activity Engagement than men t (1323) = 3.59, p = < .001, d = .21 (mean difference = 2.01, 99% CI: .56 to 3.45)”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most of the men that worked, were working full time χ2 (1, n = 1331) = 7.012, p = .030”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No differences were in the single item from EQ-5D item about Anxiety and depression.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“According to LiSat-11, women stated higher satisfaction with: life as a whole friends and acquaintances as well as greater satisfaction with their family life, and their sexual life (See LiSat-11 Table 3).”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The main results were that at the same pain severity, women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia, mood disturbances and lower activity level.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
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- Probably not a substantial claim. 27
- The quote only partly states this claim. 3
- It may state two separate claims as one. 15
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and more were born in Sweden (Table 1).”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Women were significantly younger than men (Age M = 45 vs. men’s M = 51) t (1367) = -6.52, p < .001, d = .41 (Table 2)”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the 1371 patients, 68.4% were women”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Strength:plain· not yet calibratedn = 1,371Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“while most women were working to some extent χ2 (1, n = 1331) = 6.684, p = .035 (Table 1)”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Results
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“The overall poor quality of life of the patients in this study, according to the SF-36, was consistent with previously published pain studies [67–69] but distinctively lower than the Swedish population norm [38].”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
What the sources say
- Not checked yetcites [67] BS Laursen, 2005, Health related quality of life and quantitative pain measurement in females with chronic non‐malignant pain, European journal of pain source
- Not checked yetcites [68] M Peolsson, 2004, Coping in patients with chronic whiplash-associated disorders: a descriptive study, Journal of rehabilitation medicine source
- Not checked yetcites [69] MK Wallin, 2008, Quality of life in subgroups of individuals with whiplash associated disorders, European Journal of Pain source
- Not checked yetcites [38] M Sullivan, 1995, The Swedish SF-36 Health Survey—I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden, Social science & medicine source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Even though women had pain in several regions (widespread pain, see Table 2) they expressed being more satisfied with their social life (intimate, private, family and friends) and with life in general (Li-Sat11).”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“They reported higher activity level (MPI) and activity engagement (CPAQ-8), despite the fact that they have the same level of pain, the same severity of symptoms, the same discomfort and the same somatic health as men.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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In the paper
“The effect size was in some cases low, which is an indication of that the significance found may not be a meaningful difference.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“More women than men seek rehabilitation, they present with pain in more body areas, and or widespread pain, while men report having more often localized pain.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the present population, there were fewer men than women born in Sweden were as well as men being older.”
- Also stated in: § Discussion · plain
“Among the group of patients in this study, more men were born outside Sweden and they were older than women (Tables 1 and 2).”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Discussion · plain
None of the sources cited for this claim have been checked yet.
In the paper
“Basic research in laboratory environments show that women are more sensitive to pain [14–16]”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Introduction
What the sources say
- Not checked yetcites [14] KJ Berkley, 1997, Sex differences in pain, Behavioral and Brain Sciences source
- Not checked yetcites [15] RB Fillingim, 1998, Sex differences in temporal summation but not sensory-discriminative processing of thermal pain, Pain source
- Not checked yetcites [16] JL Riley III, 1998, Sex differences in the perception of noxious experimental stimuli: a meta-analysis, Pain source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“The TSK has proven to be a reliable assessment tool for chronic pain [60, 62, 63]”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
What the sources say
- Not checked yetcites [60] JW Vlaeyen, 1995, Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance, Pain source
- Not checked yetcites [62] G Crombez, 1999, Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability, Pain source
- Not checked yetcites [63] MK Lundberg, 2004, A psychometric evaluation of the Tampa Scale for Kinesiophobia—from a physiotherapeutic perspective, Physiotherapy Theory and Practice source
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Depression is twice as common in women as in men [29].”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Introduction
What the sources say
- Not checked yetcites [29] SE Munce, 2007, Gender differences in depression and chronic pain conditions in a national epidemiologic survey, Psychosomatics source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Alpha in the current study was .79.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The internal consistency of the eight scales of the SF-36 in the Swedish norm is between .79 to .93, comparable to US and UK scales [39]”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
What the sources say
- Not checked yetcites [39] M Sullivan, 2002, SF-36 H? lsoenk? t, Svensk Manual och Tolkningsguide(Swedish Manual and Interpretation Guide)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“and are more sensitive to both dosage and type of medication [22–24]”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Introduction
What the sources say
- Not checked yetcites [22] RB Fillingim, 2009, Sex, gender, and pain: a review of recent clinical and experimental findings, The journal of pain source
- Not checked yetcites [23] JE Manson, 2010, Pain: sex differences and implications for treatment, Metabolism source
- Not checked yetcites [24] C Pieh, 2012, Gender differences in outcomes of a multimodal pain management program, Pain source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The EQ-5D has been well-validated across a number of countries, settings and conditions.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
What the sources say
- Not checked yetcites [40] EuroQol Group, 1990, EuroQol—a new facility for the measurement of health-related quality of life, The EuroQol Group. Health Policy source
- Not checked yetcites [41] R Brooks, 1996, EuroQol: the current state of play, Health Policy source
- Not checked yetcites [42] RG Brooks, 1991, EuroQol: health-related quality of life measurement. Results of the Swedish questionnaire exercise, Health Policy source
- Not checked yetcites [43] M Sullivan, 2002, SF-36 hälsoenkät: svensk manual och tolkningsguide (Swedish manual and interpretation guide)
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“the factor structure has been demonstrated to be stable across pain diagnoses and nationalities [64].”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
What the sources say
- Not checked yetcites [64] J Roelofs, 2007, Fear of movement and (re) injury in chronic musculoskeletal pain: Evidence for an invariant two-factor model of the Tampa Scale for Kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples, Pain source
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“in this study the Alpha were between .70 to.87.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In the current study, the internal consistency of the anxiety sub-scale was .77 and.76 for the depression subscale.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Because of the large sample size of the study, stringent p-values were chosen, to reduce the likelihood of Type 1 error. In this study, results that were significant at the p ≤.01 were considered significant”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Statistics
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
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In the paper
“Ethical approval was obtained from the Regional Ethics Board in Gothenburg (815–12).”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Ethics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“The Swedish version (MPI-S), includes 61 items, has good internal consistency, with a Cronbach’s alpha of between 0.6 and 0.9 [47–50].”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
What the sources say
- Not checked yetcites [47] DC Turk, 1987, Towards a comprehensive assessment of chronic pain patients, Behaviour research and therapy source
- Not checked yetcites [48] DC Turk, 1988, Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment data, Journal of consulting and clinical psychology source
- Not checked yetcites [49] DC Turk, 1987, Towards a comprehensive assessment of chronic pain patients, Behav Res Ther source
- Not checked yetcites [50] DC Turk, 1988, Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment data, J Consult Clin Psychol source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The Swedish translation has shown acceptable psychometric properties [36].”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
What the sources say
- Not checked yetcites [36] J Lisspers, 1997, Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample, Acta Psychiatrica Scandinavica source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“the Cronbach alpha for this study was .58.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“What it is known from clinical studies is that women use more analgesic medication [21]”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Introduction
What the sources say
- Not checked yetcites [21] RJ Gatchel, 1999, Psychosocial factors in pain: Critical perspectives
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In the current study, the internal consistency of the AE sub-scale was .88 and .74 for the PW.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Materials and methods > Psychometric instruments
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To counteract this, we made the value of p to be accepted as significant to be lower than convention, and we provided effect sizes as a guide to the overall magnitude of effect, uninfluenced by sample size.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“It has been demonstrated that kinesiophobia has shown to be a strong predictor for pain disability and pain chronicity in the longer term [73] associated with higher rates of sick-leaves [74], pain vigilance and disability as well as decreased physical activity levels [75–77].”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
What the sources say
- Not checked yetcites [73] M Grotle, 2010, Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care?, PAIN® source
- Not checked yetcites [74] TL Symonds, 1995, Absence resulting from low back trouble can be reduced by psychosocial intervention at the work place, Spine source
- Not checked yetcites [75] M Monticone, 2015, Group‐based task‐oriented exercises aimed at managing kinesiophobia improved disability in chronic low back pain, European Journal of Pain
- Not checked yetcites [76] M Monticone, 2014, A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study, European Spine Journal source
- Not checked yetcites [77] JW Vlaeyen, 2002, The treatment of fear of movement/(re) injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo, The Clinical journal of pain source
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Pain acceptance and kinesiophobia are behaviorally defined and have the potential to be changed.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Abstract > Conclusion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“Although initially developed for use with chronic lower back pain patients and later validated in other musculoskeletal pain populations, recent studies suggest that it is a valid measure of pain-related fear of movement in Swedish [63] and for heterogeneous chronic pain samples.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
What the sources say
- Not checked yetcites [63] MK Lundberg, 2004, A psychometric evaluation of the Tampa Scale for Kinesiophobia—from a physiotherapeutic perspective, Physiotherapy Theory and Practice source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Another limitation are the potential flaws that self-reports can contain.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“However, the total group of patients included in this study was representative when compared with a European epidemiological study [1] in terms of age and sex (middle-aged women), and pain duration (> 7 years) and with the pain population attending specialty pain care clinics in Sweden [66].”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
What the sources say
- Not checked yetcites [1] H Breivik, 2006, Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment, European journal of pain source
- Not checked yetcites [66] V Nyberg, 2011, Swedish quality registry for pain rehabilitation: purpose, design, implementation and characteristics of referred patients, Journal of rehabilitation medicine source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“To conclude, this study indicate differences between men and women regarding symptomatology and their reaction or handling these.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Another limitation in this this study is that due to its exploratory and cross-sectional design, no causal inferences can be made, nor can it be established that the found differences necessarily influence treatment response.”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“This capacity for positivity has also been found in a previous study, where it has been linked to greater social support among women with chronic pain, compared to men [70].”
§ Chronic pain and sex-differences; women accept and move, while men feel blue > Discussion
What the sources say
- Not checked yetcites [70] M Löfgren, 2006, ‘A constant struggle’: successful strategies of women in work despite fibromyalgia, Disability and rehabilitation source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
Understanding baseline sex differences in pain-related measures can inform different approaches in rehabilitation.
“The aim of this study is to explore differences between male and female patients entering a rehabilitation program at a pain clinic in order to gain a greater understanding of different approaches to be used in rehabilitation.”
The paper relies on this without support.
The observed sex differences in pain-related measures are not explained by age differences between men and women.
“Women were significantly younger than men (Age M = 45 vs. men’s M = 51) t (1367) = -6.52, p < .001, d = .41 (Table 2)”
The paper relies on this without support.
The observed sex differences in activity, pain acceptance, social support, kinesiophobia, and mood are not explained by demographic differences between men and women (e.g., age, birthplace).
“In the present population, there were fewer men than women born in Sweden were as well as men being older.”
“These demographic differences may or may not be clinical significant, while differences in how they react and behave while in pain, might have a clinical impact in rehabilitation.”
The paper relies on this without support.
Self-reported measures (e.g., activity level) accurately reflect the actual behavior or state they intend to measure.
“Another limitation are the potential flaws that self-reports can contain.”
“This study may have benefited from gathering observational measures, such as physical capacity, activity level, strength, sedentary-time, etc. in order to see how the self-reported activity level correlates with the factual one.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“A recent study (n=1371) in the context of a rehabilitation program found that women have better activity level, pain acceptance, and social support, while men report more fear of movement and mood disturbances [70].”
From Tailored web-based interventions for pain: Systematic review and meta-analysis (2017) · cites this paper as [70]
Statistics that don’t add up
Each reported p-value recomputed from its test statistic and degrees of freedom.
Inconsistent p-value: t(1109) = 2.78, p = .007
MinorThe paper reports p = .007 here; recomputing from the test statistic and its degrees of freedom gives p = .006 (two-tailed). The check cannot tell whether the statistic or the p-value is the misprint.
Reported p = .007 · recomputed p = .006
“t(1109) = 2.78, p = .007”
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- Doesn’t add upt(1109) = 2.78reported p = .007 · recomputed p = .006
“t(1109) = 2.78, p = .007”
- Consistentt(1367) = -6.52reported p < .001 · recomputed p < .001
“t (1367) = -6.52, p < .001”
- Consistentt(1212) = 3.31reported p < .001 · recomputed p < .001
“t (1212) = 3.31, p < .001”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Physical-functioning p-value differs between results and table
MajorThe results report p < .001 for physical functioning, whereas Table 3 reports p = .010 for that comparison.
“Women scored less on physical function (SF-36 PF) than men, t (1114) = 12.04, p = < .001, d = .04”
“| SF-36 | Physical functioning (0–100) (1115) | 48.74 | 24.42 | 48.38 | 23.78 | 49.47 | 25.68 | .010* | -0.04 |”
Claim of significantly higher social support conflicts with Table 3
MajorThe abstract and discussion identify higher social support among women as a significant result, but the MPI social-support scores are 4.20 for women and 4.15 for men, with p = .594.
“women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia”
“| | Social support (0–6) (1216) | 4.18 | 1.46 | 4.20 | 1.40 | 4.15 | 1.60 | .594 | 0.03 |”
Reported share receiving full sickness benefit conflicts with Table 1
MinorThe results say one third of participants received full sickness benefit, while Table 1 lists 13.9% receiving 100% sickness benefit and another 5.6% receiving time-limited 100% sickness benefit. Even combined, these categories total only 19.5%.
“A quarter of participants were working full time and one third were receiving full sickness benefit.”
“| Sickness benefit 100% (1368) | 13.9 | 13.8 | 14.1 | .866 | | Time-limited sickness benefit 100% (1368) | 5.6 | 6.0 | 4.6 | .310 |”
Reported physical-functioning mean difference is incorrect
MinorTable 3 gives physical-functioning means of 49.47 for men and 48.38 for women, a difference of 1.09 rather than the reported 0.20.
Reported 0.2 · recomputed 1.09
“Women scored less on physical function (SF-36 PF) than men, t (1114) = 12.04, p = < .001, d = .04 (mean difference = 0.20, 99% CI: 0.084 to 1.30)”
Table 3 stars p-values above its stated threshold
MinorThe table note defines an asterisk as p ≤ .001, but the mental-health result at p = .007 is starred. The physical-functioning and friends/acquaintances results at p = .010 are starred as well.
“*p≤ .001”
“| | Mental Health (0–100) (1110) | 55.19 | 23.08 | 56.53 | 22.36 | 52.47 | 24.27 | .007* | 0.18 |”
Work-status p-values are reversed between text and table
MinorThe text assigns p = .030 to full-time work and p = .035 to working to some extent. Table 1 assigns those values to the opposite categories.
“Most of the men that worked, were working full time χ2 (1, n = 1331) = 7.012, p = .030, while most women were working to some extent χ2 (1, n = 1331) = 6.684, p = .035”
“| Working/studying 100% (1331) | 25.3 | 23.6 | 29.0 | .035 | | Working/studying to some extent (1331) | 37.3 | 39.4 | 32.9 | .030 |”
Partner-relationship SD exceeds what its scale permits
MinorOn a scale bounded by 1 and 6, a sample with mean 3.70 cannot have an SD as high as 2.76; its maximum possible SD is about 2.49.
“| | Partner relationship (1–6) (1135) | 3.70 | 2.76 | 3.86 | 2.17 | 3.54 | 2.31 | .027 | 0.14 |”
“consists of 11 items relating to satisfaction with life, activities and participation (Likert scale 1–6)”
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Sorted by citations
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Metadata
- Authors
- Rovner, G. S., Sunnerhagen, K. S., Björkdahl, A., Gerdle, B., Börsbo, B., Johansson, F., & Gillanders, D.
- Affiliations
- Karolinska Institutet (SE)
- University of Gothenburg (SE)
- Linköping University (SE)
- Danderyds sjukhus (SE)
- University of Edinburgh (GB)
- Corresponding author
- Sunnerhagen, Katharina S.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-04-25
- Volume
- 12
- Issue
- 4
- Pages
- e0175737
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5404887
- OpenAlex
- W2605316699
- Semantic Scholar
- 82ec502d541fb7f49311b5e1f8dc56583b72f893
- Cited by
- 179
- References
- 79
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 25 · 2023: 24 · 2022: 27 · 2021: 24 · 2020: 11 · 2019: 34 · 2018: 12 · 2017: 4
- FWCI
- 11.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- Vårdalstiftelsen
- AFA Försäkring
- Sveriges Kommuner och Landsting
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- chronic pain, sex differences, pain acceptance, kinesiophobia, pain rehabilitation, anxiety, depression, quality of life, social support, activity level
- MeSH terms
- Adult, Affect, Anxiety, Behavior, Depression, Female, Humans, Male, Middle Aged, Pain Measurement, Psychometrics, Quality of Life, Surveys and Questionnaires, Sex Characteristics, Sex Factors, Social Support, Chronic Pain
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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