Gender aspects of the pain syndrome

  • K O Ostrovska Zdorovoe pokolenie, Private Clinic, Dnipro, Ukraine
Keywords: pain, pain syndrome, gender aspects, sex differences, sex hormones, estrogen, progesterone, testosterone

Abstract

In recent years, the subject of sex differences in the pain experience attracts a growing interest. The epidemiological and clinical data indicate that women have increased risk of chronic pain, and according to some sources, even experience more intense pain.
The hypothetical biological mechanisms underlying sex differences in pain perception consist in the modulating effects produced by sex hormones in relation to the neural substrate. This is confirmed by data on the distribution of gonadal hormones and their receptors in the areas of the peripheral and central nervous system that provide nociceptive transmission.
The complexity of the estradiol and progesterone effects on pain sensitivity lies in the fact that, according to various data, both have pre-nociceptive and antinociceptive effects, and testosterone appears to be more characterized by antinociceptive properties. The lion’s share of researches demonstrates the effect of a clinical pain exacerbation during the menstrual cycle.
There is irrefutable information about gender differences in responses to drug and non-drug pain treatment, although the results vary depending on a specific therapy and may depend on pain characteristics. Since the recommended dosage of a medication is often based on an “average” male weigh 70 kg, female patients may be facing the risk of increased therapeutic or adverse effects of a drug. The cause is in a higher average percentage of body fat, a lower mean body weight, which contributes to higher median drug concentrations compared with male patients.
At present, the available evidence does not allow adapting the methods of pain syndrome treatment to a gender. However, such innovations are quite possible and desirable in the foreseeable future. Additional studies will be required to clarify the mechanisms that determine sex differences in pain responses in order to provide adequate pain relief, according to the patient’s needs.

Downloads

Download data is not yet available.

Author Biography

K O Ostrovska, Zdorovoe pokolenie, Private Clinic, Dnipro, Ukraine

The Ukrainian Society for Gender and Anti-Aging Medicine

References

Robinson ME, Riley JL, Myers CD, Papas RK, Wise EA, Waxenberg LB, et al. Gender role expectations of pain: Relationship to sex differences in pain. The Journal of Pain [Internet]. Elsevier BV; 2001 Oct;2(5):251–7. Available from: https://doi.org/10.1054/jpai.2001.24551

Wise EA, Price DD, Myers CD, Heft MW, Robinson ME. Gender role expectations of pain: relationship to experimental pain perception. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2002 Apr;96(3):335–42. Available from: https://doi.org/10.1016/s0304-3959(01)00473-0

Defrin R, Shramm L, Eli I. Gender role expectations of pain is associated with pain tolerance limit but not with pain threshold. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2009 Sep;145(1):230–6. Available from: https://doi.org/10.1016/j.pain.2009.06.028

Walsh CA, Jamieson E, MacMillan H, Boyle M. Child Abuse and Chronic Pain in a Community Survey of Women. Journal of Interpersonal Violence [Internet]. SAGE Publications; 2007 Dec;22(12):1536–54. Available from: https://doi.org/10.1177/0886260507306484

Fillingim RB, Edwards RR. Is Self-Reported Childhood Abuse History Associated With Pain Perception Among Healthy Young Women and Men? The Clinical Journal of Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2005 Sep;21(5):387–97. Available from: https://doi.org/10.1097/01.ajp.0000149801.46864.39

Edwards PW, Zeichner A, Kuczmierczyk AR, Boczkowski J. Familial pain models: the relationship between family history of pain and current pain experience. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 1985 Apr;21(4):379–84. Available from: https://doi.org/10.1016/0304-3959(85)90166-6

Fillingim RB, Edwards RR, Powell T. Sex-dependent effects of reported familial pain history on recent pain complaints and experimental pain responses. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2000 May;86(1):87–94. Available from: https://doi.org/10.1016/s0304-3959(00)00239-6

Gerdle B, Björk J, Cöster L, Henriksson K, Henriksson C, Bengtsson A. Prevalence of widespread pain and associations with work status: a population study. BMC Musculoskeletal Disorders [Internet]. Springer Science and Business Media LLC; 2008 Jul 15;9(1). Available from: https://doi.org/10.1186/1471-2474-9-102

Edwards R, Augustson E, Fillingim R. Differential Relationships Between Anxiety and Treatment-Associated Pain Reduction Among Male and Female Chronic Pain Patients. The Clinical Journal of Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2003 Jul;19(4):208–16. Available from: https://doi.org/10.1097/00002508-200307000-00003

Fillingim RB, Doleys DM, Edwards RR, Lowery D. Clinical Characteristics of Chronic Back Pain as a Function of Gender and Oral Opioid Use. Spine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2003 Jan;28(2):143–50. Available from: https://doi.org/10.1097/00007632-200301150-00010

Keefe FJ, Lefebvre JC, Egert JR, Affleck G, Sullivan MJ, Caldwell DS. The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2000 Aug;87(3):325–34. Available from: https://doi.org/10.1016/s0304-3959(00)00296-7

BARNABE C, BESSETTE L, FLANAGAN C, LeCLERCQ S, STEIMAN A, KALACHE F, et al. Sex Differences in Pain Scores and Localization in Inflammatory Arthritis: A Systematic Review and Metaanalysis. The Journal of Rheumatology [Internet]. The Journal of Rheumatology; 2012 Apr 15;39(6):1221–30. Available from: https://doi.org/10.3899/jrheum.111393

Tang Y, Yang W, Wang Y-L, Lin L. Sex differences in the symptoms and psychological factors that influence quality of life in patients with irritable bowel syndrome. European Journal of Gastroenterology & Hepatology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2012 Jun;24(6):702–7. Available from: https://doi.org/10.1097/meg.0b013e328351b2c2

Robinson ME, Wise EA, Riley JLI. Sex differences in clinical pain: a multi-sample study. J Clin Psychol Med Settings 1998; 5: 413–23. Available from: https://doi.org/10.1023/A:1026282210848

Turk DC, Okifuji A. Does sex make a difference in the prescription of treatments and the adaptation to chronic pain by cancer and non-cancer patients? Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 1999 Aug;82(2):139–48. Available from: https://doi.org/10.1016/s0304-3959(99)00041-x

Ruau D, Liu LY, Clark JD, Angst MS, Butte AJ. Sex Differences in Reported Pain Across 11,000 Patients Captured in Electronic Medical Records. The Journal of Pain [Internet]. Elsevier BV; 2012 Mar;13(3):228–34. Available from: https://doi.org/10.1016/j.jpain.2011.11.002

Craft RM. Modulation of pain by estrogens. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2007 Nov;132:S3–S12. Available from: https://doi.org/10.1016/j.pain.2007.09.028

Craft RM, Mogil JS, Aloisi AM. Sex differences in pain and analgesia: the role of gonadal hormones. European Journal of Pain [Internet]. Wiley; 2004 Oct;8(5):397–411. Available from: https://doi.org/10.1016/j.ejpain.2004.01.003

Greenspan JD, Craft RM, LeResche L, Arendt-Nielsen L, Berkley KJ, Fillingim RB, et al. Studying sex and gender differences in pain and analgesia: A consensus report. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2007 Nov;132:S26–S45. Available from: https://doi.org/10.1016/j.pain.2007.10.014

Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. The Journal of Pain [Internet]. Elsevier BV; 2009 May;10(5):447–85. Available from: https://doi.org/10.1016/j.jpain.2008.12.001

Aloisi AM, Bonifazi M. Sex hormones, central nervous system and pain. Hormones and Behavior [Internet]. Elsevier BV; 2006 Jun;50(1):1–7. Available from: https://doi.org/10.1016/j.yhbeh.2005.12.002

Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and Burden of Migraine in the United States: Data From the American Migraine Study II. Headache: The Journal of Head and Face Pain [Internet]. Wiley; 2001 Jul 12;41(7):646–57. Available from: https://doi.org/10.1046/j.1526-4610.2001.041007646.x

Smith YR. Pronociceptive and Antinociceptive Effects of Estradiol through Endogenous Opioid Neurotransmission in Women. Journal of Neuroscience [Internet]. Society for Neuroscience; 2006 May 24;26(21):5777–85. Available from: https://doi.org/10.1523/jneurosci.5223-05.2006

Cairns BE, Gazerani P. Sex-related differences in pain. Maturitas [Internet]. Elsevier BV; 2009 Aug;63(4):292–6. Available from: https://doi.org/10.1016/j.maturitas.2009.06.004

LeResche L, Mancl L, Sherman JJ, Gandara B, Dworkin SF. Changes in temporomandibular pain and other symptoms across the menstrual cycle. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2003 Dec;106(3):253–61. Available from: https://doi.org/10.1016/j.pain.2003.06.001

Ader DN, South-Paul J, Adera T, Deuster PA. Cyclical mastalgia: prevalence and associated health and behavioral factors. Journal of Psychosomatic Obstetrics & Gynecology [Internet]. Informa UK Limited; 2001 Jan;22(2):71–6. Available from: https://doi.org/10.3109/01674820109049956

Silberstein SD, Merriam GR. Sex hormones and headache. Journal of Pain and Symptom Management [Internet]. Elsevier BV; 1993 Feb;8(2):98–114. Available from: https://doi.org/10.1016/0885-3924(93)90107-7

Huerta-Franco MR, Malacara JM. Association of physical and emotional symptoms with the menstrual cycle and life-style. J Reprod Med. 1993 Jun;38(6):448-54.

Riley JL, Robinson ME, Wise EA, Price D. A meta-analytic review of pain perception across the menstrual cycle. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 1999 Jun;81(3):225–35. Available from: https://doi.org/10.1016/s0304-3959(98)00258-9

LeResche L, Saunders K, Von Korff MR, Barlow W, Dworkin SF. Use of exogenous hormones and risk of temporomandibular disorder pain. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 1997 Jan;69(1):153–60. Available from: https://doi.org/10.1016/s0304-3959(96)03230-7

Tedford WH, Warren DE, Flynn WE. Alteration of shock aversion thresholds during the menstrual cycle. Perception & Psychophysics [Internet]. Springer Science and Business Media LLC; 1977 Mar;21(2):193–6. Available from: https://doi.org/10.3758/bf03198725

Goolkasian P. Cyclic changes in pain perception: An ROC analysis. Perception & Psychophysics [Internet]. Springer Science and Business Media LLC; 1980 Nov;27(6):499–504. Available from: https://doi.org/10.3758/bf03198677

Dao TTT, Knight K, Ton-That V. Modulation of myofascial pain by the reproductive hormones: A preliminary report. The Journal of Prosthetic Dentistry [Internet]. Elsevier BV; 1998 Jun;79(6):663–70. Available from: https://doi.org/10.1016/s0022-3913(98)70073-3

Hapidou EG, Rollman GB. Menstrual cycle modulation of tender points. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 1998 Aug;77(2):151–61. Available from: https://doi.org/10.1016/s0304-3959(98)00087-6

Sherman JJ, LeResche L, Huggins KH, Mancl LA, Sage JC, Dworkin SF. The Relationship of Somatization and Depression to Experimental Pain Response in Women With Temporomandibular Disorders. Psychosomatic Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2004 Nov;66(6):852–60. Available from: https://doi.org/10.1097/01.psy.0000140006.48316.80

Berman SM, Naliboff BD, Suyenobu B, Labus JS, Stains J, Bueller JA, et al. Sex differences in regional brain response to aversive pelvic visceral stimuli. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology [Internet]. American Physiological Society; 2006 Aug;291(2):R268–R276. Available from: https://doi.org/10.1152/ajpregu.00065.2006

Berman S, Munakata J, Naliboff BD, Chang L, Mandelkern M, Silverman D, et al. Gender differences in regional brain response to visceral pressure in IBS patients. European Journal of Pain [Internet]. Wiley; 2000 Jun;4(2):157–72. Available from: https://doi.org/10.1053/eujp.2000.0167

Moulton EA, Keaser ML, Gullapalli RP, Maitra R, Greenspan JD. Sex differences in the cerebral BOLD signal response to painful heat stimuli. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology [Internet]. American Physiological Society; 2006 Aug;291(2):R257–R267. Available from: https://doi.org/10.1152/ajpregu.00084.2006

Kern MK, Jaradeh S, Arndorfer RC, Jesmanowicz A, Hyde J, Shaker R. Gender differences in cortical representation of rectal distension in healthy humans. American Journal of Physiology-Gastrointestinal and Liver Physiology [Internet]. American Physiological Society; 2001 Dec;281(6):G1512–G1523. Available from: https://doi.org/10.1152/ajpgi.2001.281.6.g1512

Derbyshire SWG, Nichols TE, Firestone L, Townsend DW, Jones AKP. Gender differences in patterns of cerebral activation during equal experience of painful laser stimulation. The Journal of Pain [Internet]. Elsevier BV; 2002 Oct;3(5):401–11. Available from: https://doi.org/10.1054/jpai.2002.126788

Vincent K, Warnaby C, Stagg CJ, Moore J, Kennedy S, Tracey I. Brain imaging reveals that engagement of descending inhibitory pain pathways in healthy women in a low endogenous estradiol state varies with testosterone. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2013 Apr;154(4):515–24. Available from: https://doi.org/10.1016/j.pain.2012.11.016

Blomqvist A. Sex hormones and pain: a new role for brain aromatase?. Journal of Comparative Neurology. 2000 Aug 7;423(4):549-51.

Aloisi AM, Ceccarelli I, Fiorenzani P, De Padova AM, Massafra C. Testosterone affects formalin-induced responses differently in male and female rats. Neuroscience Letters [Internet]. Elsevier BV; 2004 May;361(1-3):262–4. Available from: https://doi.org/10.1016/j.neulet.2003.12.023

Gaumond I, Arsenault P, Marchand S. Specificity of female and male sex hormones on excitatory and inhibitory phases of formalin-induced nociceptive responses. Brain Research [Internet]. Elsevier BV; 2005 Aug;1052(1):105–11. Available from: https://doi.org/10.1016/j.brainres.2005.06.011

STOFFEL E, ULIBARRI C, FOLK J, RICE K, CRAFT R. Gonadal hormone modulation of mu, kappa, and delta opioid antinociception in male and female rats. The Journal of Pain [Internet]. Elsevier BV; 2005 Apr;6(4):261–74. Available from: https://doi.org/10.1016/j.jpain.2004.12.006

Fillingim RB, Ness TJ. Sex-related hormonal influences on pain and analgesic responses. Neuroscience & Biobehavioral Reviews [Internet]. Elsevier BV; 2000 Jun;24(4):485–501. Available from: https://doi.org/10.1016/s0149-7634(00)00017-8

ALOISI AM, CECCARELLI I, FIORENZANI P. Gonadectomy Affects Hormonal and Behavioral Responses to Repetitive Nociceptive Stimulation in Male Rats. Annals of the New York Academy of Sciences [Internet]. Wiley; 2003 Dec;1007(1):232–7. Available from: https://doi.org/10.1196/annals.1286.022

Sternberg WF, Mogil JS, Kest B, Page GG, Leong Y, Yam V, et al. Neonatal testosterone exposure influences neurochemistry of non-opioid swim stress-induced analgesia in adult mice. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 1995 Dec;63(3):321–6. Available from: https://doi.org/10.1016/0304-3959(95)00059-3

Berkley KJ. Sex differences in pain. Behavioral and Brain Sciences [Internet]. Cambridge University Press (CUP); 1997 Sep;20(3):371–80. Available from: https://doi.org/10.1017/s0140525x97221485

Unruh AM. Gender variations in clinical pain experience. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 1996 May;65(2):123–67. Available from: https://doi.org/10.1016/0304-3959(95)00214-6

Hargreaves R. New Migraine and Pain Research. Headache: The Journal of Head and Face Pain [Internet]. Wiley; 2007 Apr;47(s1):S26–S43. Available from: https://doi.org/10.1111/j.1526-4610.2006.00675.x

Aloisi AM, Bachiocco V, Costantino A, Stefani R, Ceccarelli I, Bertaccini A, et al. Cross-sex hormone administration changes pain in transsexual women and men. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2007 Nov;132:S60–S67. Available from: https://doi.org/10.1016/j.pain.2007.02.006

Procacci P, Buzzelli G, Passeri I, Sassi R, Voegelin MR, Zoppi M. Studies on the cutaneous pricking pain threshold in man. Circadian and circatrigintan changes. InInternational Migraine-Headache Symposium 1972 (Vol. 3, pp. 260-276). Karger Publishers.

Tedford WH, Warren DE, Flynn WE. Alteration of shock aversion thresholds during the menstrual cycle. Perception & Psychophysics [Internet]. Springer Science and Business Media LLC; 1977 Mar;21(2):193–6. Available from: https://doi.org/10.3758/bf03198725

BRINCAT M, O’DOWD T, MAGOS AL, MONTGOMERY J, STUDD JWW, MONIZ CF, et al. Decline in skin collagen content and metacarpal index after the menopause and its prevention with sex hormone replacement. BJOG: An International Journal of Obstetrics and Gynaecology [Internet]. Wiley; 1987 Feb;94(2):126–9. Available from: https://doi.org/10.1111/j.1471-0528.1987.tb02338.x

LeResche L, Saunders K, Von Korff MR, Barlow W, Dworkin SF. Use of exogenous hormones and risk of temporomandibular disorder pain. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 1997 Jan;69(1):153–60. Available from: https://doi.org/10.1016/s0304-3959(96)03230-7

Brandes JL. The Influence of Estrogen on Migraine. JAMA [Internet]. American Medical Association (AMA); 2006 Apr 19;295(15):1824. Available from: https://doi.org/10.1001/jama.295.15.1824

Martin VT, Lipton RB. Epidemiology and Biology of Menstrual Migraine. Headache: The Journal of Head and Face Pain [Internet]. Wiley; 2008 Nov;48:S124–S130. Available from: https://doi.org/10.1111/j.1526-4610.2008.01310.x

Cassidy EM, Tomkins E, Sharifi N, Dinan T, Hardiman O, OʼKeane V. Differing central amine receptor sensitivity in different migraine subtypes? A neuroendocrine study using buspirone. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2003 Feb;101(3):283–90. Available from: https://doi.org/10.1016/s0304-3959(02)00335-4

Hayashi T, Yamada K, Esaki T, Mutoh E, Iguchi A. Effect of Estrogen on Isoforms of Nitric Oxide Synthase: Possible Mechanism of Anti-Atherosclerotic Effect of Estrogen. Gerontology [Internet]. S. Karger AG; 1997;43(1):24–34. Available from: https://doi.org/10.1159/000213883

Levine JD, Taiwo YO. Beta-estradiol induced catecholamine-sensitive hyperalgesia: a contribution to pain in Raynaud’s phenomenon. Brain Res 1989;487:143–7. Available from: https://doi.org/10.1016/0006-8993(89)90949-9

Calderone KL. The influence of gender on the frequency of pain and sedative medication administered to postoperative patients. Sex Roles [Internet]. Springer Nature; 1990 Dec;23(11-12):713–25. Available from: https://doi.org/10.1007/bf00289259

LeResche L. Defining Gender Disparities in Pain Management. Clinical Orthopaedics and Related Research® [Internet]. Ovid Technologies (Wolters Kluwer Health); 2011 Jan 6;469(7):1871–7. Available from: https://doi.org/10.1007/s11999-010-1759-9

Weisse CS, Sorum PC, Sanders KN, Syat BL. Do gender and race affect decisions about pain management? Journal of General Internal Medicine [Internet]. Springer Nature; 2001 Apr;16(4):211–7. Available from: https://doi.org/10.1046/j.1525-1497.2001.016004211.x

Robinson M, Alqudah A, Hirsh A, Stutts L. (349) Sex and race differences in rating others’ pain, pain-related negative mood, pain coping, and need for medical treatment. The Journal of Pain [Internet]. Elsevier BV; 2008 Apr;9(4):63. Available from: https://doi.org/10.1016/j.jpain.2008.01.272

Wandner, Stutts, L. A., Alqudah, A. F., Craggs, J. G., Scipio, C. D., Hirsh, A. T., et al. Virtual human technology: patient demographics and healthcare training factors in pain observation and treatment recommendations. Journal of Pain Research [Internet]. Dove Medical Press Ltd.; 2010 Dec;241. Available from: https://doi.org/10.2147/jpr.s14708

Hirsh AT, George SZ, Robinson ME. Pain assessment and treatment disparities: A virtual human technology investigation. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2009 May;143(1):106–13. Available from: https://doi.org/10.1016/j.pain.2009.02.005

White HD, Robinson TD. A novel use for testosterone to treat central sensitization of chronic pain in fibromyalgia patients. International Immunopharmacology [Internet]. Elsevier BV; 2015 Aug;27(2):244–8. Available from: https://doi.org/10.1016/j.intimp.2015.05.020

Gandhi M, Aweeka F, Greenblatt RM, Blaschke TF. SEX DIFFERENCES IN PHARMACOKINETICS AND PHARMACODYNAMICS. Annual Review of Pharmacology and Toxicology [Internet]. Annual Reviews; 2004 Feb 10;44(1):499–523. Available from: https://doi.org/10.1146/annurev.pharmtox.44.101802.121453

Soldin OP, Chung SH, Mattison DR. Sex Differences in Drug Disposition. Journal of Biomedicine and Biotechnology [Internet]. Hindawi Limited; 2011;2011:1–14. Available from: https://doi.org/10.1155/2011/187103

Nicolson TJ, Mellor HR, Roberts RRA. Gender differences in drug toxicity. Trends in Pharmacological Sciences [Internet]. Elsevier BV; 2010 Mar;31(3):108–14. Available from: https://doi.org/10.1016/j.tips.2009.12.001

Anderson GD. Chapter 1 Gender Differences in Pharmacological Response. Epilepsy in Women - The Scientific Basis for Clinical Management [Internet]. Elsevier; 2008;1–10. Available from: https://doi.org/10.1016/s0074-7742(08)00001-9

http://www.simg.it/Documenti/Rivista/2008/03_2008/10.pdf.

FRANCONI F, BRUNELLESCHI S, STEARDO L, CUOMO V. Gender differences in drug responses. Pharmacological Research [Internet]. Elsevier BV; 2007 Feb;55(2):81–95. Available from: https://doi.org/10.1016/j.phrs.2006.11.001

Chen, M. L. 2000. Gender-related differences in drug pharmacokinetics: Do they translate into clinical outcome? Report to the FDA Office of Women’s Health.

https://www.gao.gov/new.items/d01286r.pdf.

Dominick KL, Ahern FM, Gold CH, Heller DA. Gender Differences in NSAID Use among Older Adults with Osteoarthritis. Annals of Pharmacotherapy [Internet]. SAGE Publications; 2003 Nov;37(11):1566–71. Available from: https://doi.org/10.1345/aph.1c418

Bäckryd E. Gender differences in dispensed analgesics in Sweden during 2006–2015 – an observational, nationwide, whole-population study. International Journal of Women’s Health [Internet]. Dove Medical Press Ltd.; 2018 Jan;Volume 10:55–64. Available from: https://doi.org/10.2147/ijwh.s142052

Nikose S, Arora M. Gastrointestinal Adverse Effects due to Use of Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) in Non-Traumatic Painful Musculoskeletal Disorders. Journal of Gastrointestinal & Digestive System [Internet]. OMICS Publishing Group; 2015;05(06). Available from: https://doi.org/10.4172/2161-069x.1000348

Гендерные аспекты болевого синдрома
Published
2019-04-29
How to Cite
1.
Ostrovska KO. Gender aspects of the pain syndrome. PMJUA [Internet]. 2019Apr.29 [cited 2019Aug.18];4(1):50-. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/190