Gender differences in pain perception: psychosocial factors

Gender Differences in the Perception of Pain

Psychosocial Approach to Understanding Factors Influencing Gender Differences in the Perception of Pain

Pain as a concept is commonly considered a physical experience, as reflected in its most-often cited definition, "pain is defined as the sensation that accompanies impending or ongoing tissue damage" (Hama, 2000:92). This definition primarily comes from the physiological dimension associated with pain. However, while it is an accurate description of the physiology that is pain, this definition does not take into account other dimensions in an individual's life that could be associated with pain, such as psychological and social factors.

Psychological factors are closely related to physiological processes associated with pain; social factors, meanwhile, are radically different in the sense that the external environment is purported to be also influential to pain the individual perceives and experiences, and not just his/her body and its bodily reactions. Combining both psychological and social aspects related to pain, in the opinion of the researcher, would give the study on pain a holistic approach. This holistic approach is pursued in this proposed study, wherein both psychological and social factors are accounted for to determine if indeed, individual attitudes towards pain and social environment play a critical role in determining the threshold and tolerance of the individual to pain.

More than just providing a holistic approach to studying pain by including both psychological and social factors to this concept, the researcher is also proposing that the analysis of pain be taken further by specifically studying specific segments of the society. Hama (2000) posited that among the demographic differences among individuals, the sex of the individual are considered to be significantly related to one's perception of pain. The author found out in his study of pain that females perceive pain more and greater than males, and this is attributed to the 'differences in function of the male and female sensory organs.' Further, females were found to be "more sensitive to visual, olfactory, and gustatory stimuli than males" (276). This evidence, supported by other extant literature cited in Hama's study, proved that indeed, sex differences significantly influences the way males and females perceive and react to pain.

Hama's study is useful in determining the effective treatment for individuals with different thresholds and tolerance to pain. While it is established that physiologically, males and females differ on how they perceive pain, it is also interesting to establish if, more than just biological differences, perception of pain is also dependent on psychological factors such as personality, and social factors such as pain experienced by the individual as perceived and reported by medical practitioners and family members.

This proposed research study focuses on the psycho-social factors influential to perceived pain of the individual. Furthermore, this proposed study will look into gender differences between males and females, looking at how differently they perceive pain that they experience, based on their personalities and on how medical professionals and family members perceived the pain they experienced at a specific occasion.

Research Objectives/Hypotheses

Research Question:

Is there a significant difference between males and females on how they perceive pain?

Hypotheses:

H1: There is a significant relationship between sex of the individual and perceived pain.

H2: There is a significant relationship between perceived pain and individual personality.

H3: There is a significant relationship between perceived pain and perceived pain as reported by medical practitioners.

H4: There is a significant relationship between perceived pain and perceived pain as reported by family members.

H5: Male extroverts perceive pain lesser than female extroverts.

H6: Males are perceived by medical practitioners as experiencing pain lesser than females.

H7: Males are perceived by their immediate family members as experiencing pain lesser than females.

Review of Related Literature

The proposed organization of the related literature will focus on two important dimensions influential to perceived pain: psychological and social factors.

Psychological factors are considered relevant and influential to how people perceive pain, according to Ramirez-Maestre (2004), in her study on personality and coping strategies in relation to perceived pain. In this study, the personality of the individual, specifically his or her level of extraversion, and the coping strategies of the individual experiencing pain were analyzed in relation to perceived pain (157-8).

Findings from the study demonstrated that coping strategies influence perceived pain, and it was found out that active coping strategies contribute to alleviating pain better than passive coping strategies. Active coping strategies is characterized as the individual "handling the pain or carry on functioning despite the pain," unlike passive coping strategies wherein the individual 'allows the pain to take over his or her life' and "adversely affect other areas" of the individual's life (155). Though there were no significant differences between males and females when it comes to coping strategies, this concept is still critical to studying the psychological dimension of perceived pain because it will allow the researcher to have an in-depth look into the ways by which people cope with pain.

The level of extraversion of the individual, meanwhile, was found to be critical and significantly influential to the individual's strategies for coping and perception of pain experienced. The author posited that "high extraversion levels in subjects would lead to a lower intensity of perceived pain" (158). Extraversion was determined in the study using the Eysenck Personality Inventory, a scale containing 48 questions in determining the individual's level of extraversion or neuroticism.

Perceived pain also has its social dimension, as it also helps in validating the pain perceived and reported by the individual. Medical practitioners and family members are considered to be the groups most relevant to the individual/patient, and because of the trust and closeness of the individual to these groups, they became the most reliable sources of reported perceived pain, as reflected in Babl's (2008) study on the measurement of pain and distress among children as perceived by the medical and nursing staff.

Findings from a survey of ninety-two (92) medical practitioners showed that the medical practitioners group perceived pain of children significantly through physiological observations. From these observations, medical practitioners were able to formulate the children's perceived pain and distress, and more enlightening is that "perceptions of pain and distress during procedures in children in our study appear stable with increasing level of staff experience" (415). This study illustrated the importance of relevance of people to the individual's life in order to make significantly correct and accurate assessments of an individual's pain, as perceived by the medical staff and/or his or her family members.

Framework of the Study

The proposed theoretical framework of the study will center on the dualist theory of brain processing, positing that "brain and mind are different systems" (Tiengo, 2003:S78).

This theory confronts the brain-mind debate about how the brain processes information and reacts to this information, a process that is similarly illustrated when pain in the body occurs. In the dualist theory, the brain is described as the domain of "physical things, including organisms and the forces with which they interact." The mind, meanwhile, covers areas related to responses to the sensory stimuli the brain experiences. The mind is responsible for "conscious experiences," such as pleasure, pain, hopes, fear, and expectations; the perceptions of things and events, and the memories of past events, the experience of understanding an argument or a theory; and furthermore, if they exist, unconscious experiences (S78).

The focus given on psychological and social factors influential is based on this theoretical framework. While the brain is critical in understanding the physiological processes involved in the creation and escalation of pain, it is the mind concept in this framework that is essential in giving pain and its perception greater meaning to those who seek to understand the depth and breadth of the pain concept, as determined by patients and observers (medical practitioners and family members) alike.

Methodology

Units of Analysis/Respondent Type

Primary units of analysis will be males and females, with ages 18-55 years old, divided into three (3) segments, based on the frequency of pain occurrence experienced: (a) individuals experiencing chronic pain, (b) individuals experiencing occasional pain, and - individual experiencing pain less often than the other two segments.

Methods

The qualitative approach will use the diary method and focus group discussion (FGD) methods to generate insights and understanding of the pain perceived by participants who will be chosen for the study. The quantitative approach, meanwhile, will make use of the survey method, focusing on three (3) segments each for males and females (criteria mentioned earlier in the preceding section).

Diary Method

The diary method is recommended because this will generate information that is insightful and in-depth, as it provides participants with an opportunity to express their thoughts and feelings without being conscious of the people who might be interviewing them or be with them, as what happens during an FGD.

Focus Group Discussion (FGD)

The FGDs will provide breadth of information about perceived pain. There will be twelve (12) mini-groups per segment, broken down into the following discussant types:

Group Type

Age group

Males

Youth/Young Adult (13-25 years old)

Adults (26-55 years old)

Females

Youth/Young Adult (13-25 years old)

Adults (26-55 years old)

Survey

The survey method will make use of the multi-stage sampling, using once again the respondent criteria enumerated in the previous section. Quota sampling will be set, however, to control for the number of interviews per sex type per segment (i.e., males and females per segment).

Variables & Measures

Variables for the study are as follows: pain perception (self-assessment), personality type, coping strategies, and pain as perceived and reported by medical staff and family members. In addition to these variables, instruments gauging the level of perceived pain will be used, particularly the Eysenck Personality Inventory and the Pain Beliefs Questionnaire. An index of attitudes and perceptions on pain will also be formulated, and will be tested for internal and construct validity.

Data Analysis

Data analysis will make use of both bivariate and multivariate analysis. For the multivariate analysis, step-wise logistic regression is recommended, to determine which among the variables under study has the significant relationship with pain perception. Analyses will be set at 95% confidence level and 2% margin of error.

Relevance of the Study

Results of the study will be particularly useful in unearthing new dimensions related to perceived pain -- that is, psychological and social dimensions to perceiving pain. Ultimately, a suggested 'unified' theoretical framework to understanding pain and perceptions of it is the ideal end-product of this study, taking into account biological (physiological), psychological, and social dimensions significantly influential to pain.