|Year : 2022 | Volume
| Issue : 1 | Page : 13-16
Gender differences in chronic musculoskeletal pain – Role of kinesiophobia, acceptance behaviors, pain catastrophizing, and quality of life
Vrushali P Panhale, Prachita Pravin Walankar, Mahvish A Sayed
Department of Physiotherapy, Mahatma Gandhi Mission's College of Physiotherapy, Navi Mumbai, Maharashtra, India
|Date of Submission||19-Oct-2021|
|Date of Decision||02-Feb-2022|
|Date of Acceptance||29-Jun-2022|
|Date of Web Publication||22-Aug-2022|
Dr. Prachita Pravin Walankar
Department of Physiotherapy, Mahatma Gandhi Mission's College of Physiotherapy, Plot No. 46, Sector-30, Vashi, Navi Mumbai - 400 705, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Chronic pain not only has an impact on the daily functioning but also affects the society, family, professional, and social environment, thus disrupting the quality of life. Pain-related characteristics vary between the genders and have an influence on the physical and mental well-being of patients having chronic musculoskeletal pain. Aim and Objective of the Study: The aim of study was to assess the gender differences in kinesiophobia, pain catastrophizing, acceptance behaviors, and quality of life in patients with chronic musculoskeletal pain. Methodology: A cross-sectional study was conducted in 219 (males = 103 and females = 116) chronic musculoskeletal pain patients. The following parameters were measured: Kinesiophobia using Tampa scale of kinesiophobia; pain catastrophizing using the pain catastrophizing scale; pain acceptance using chronic pain acceptance questionnaire; and quality of life using 36-Item Short Form Health Survey questionnaire. Results: No significant differences were observed between genders in kinesiophobia (P = 0.495), pain acceptance (P = 0.539); and pain catastrophizing (P = 0.422). However, a significant difference between genders was observed in quality of life, both physical (P = 0.000) and mental component summary (P = 0.01). Conclusions: Kinesiophobia, pain acceptance, and pain catastrophizing showed no difference between the genders in chronic musculoskeletal pain patients. However, women reported lower quality of life as compared to men. Pain-related characteristics and quality of life are important aspects to be evaluated and targeted rehabilitation programs addressing them in chronic musculoskeletal pain.
Keywords: Chronic pain, gender, kinesiophobia, quality of life
|How to cite this article:|
Panhale VP, Walankar PP, Sayed MA. Gender differences in chronic musculoskeletal pain – Role of kinesiophobia, acceptance behaviors, pain catastrophizing, and quality of life. J Integr Health Sci 2022;10:13-6
|How to cite this URL:|
Panhale VP, Walankar PP, Sayed MA. Gender differences in chronic musculoskeletal pain – Role of kinesiophobia, acceptance behaviors, pain catastrophizing, and quality of life. J Integr Health Sci [serial online] 2022 [cited 2023 Feb 5];10:13-6. Available from: https://www.jihs.in/text.asp?2022/10/1/13/354230
| Introduction|| |
Pain, a multidimensional phenomenon, is associated with unpleasant sensory and emotional experiences due to actual or potential tissue damage. Chronic pain is defined as persistent or recurrent pain lasting longer than 3 months. Chronic pain affects the patient's daily functioning and causes severe consequences for society, affecting not only the patient as well as their families, professional, and social environment, thus disrupting the quality of life.,
Musculoskeletal pain is a profoundly predominant condition and is one of the most common reasons for disability in the general population. The prevalence of chronic musculoskeletal pain has been reported as 37% in males and 51% in females in several studies.,,,
According to the fear-avoidance model of pain, individuals have a tendency toward fearful and tragic thoughts in response to pain., At the point, when pain is unacceptable to the patients, they try to avoid it at any cost and look for easily available interventions to get rid of it or reduce it. Kinesiophobia (also known as fear of movement) is defined as an unnecessary, irrational, incapacitating, and impairing fear to carry out a physical movement, due to a feeling of vulnerability to a painful injury or reinjury. Another known characteristic of chronic musculoskeletal pain is pain catastrophizing which can be explained as a form of negative, exaggerated, and repetitive thinking, which is abstract, intrusive, and difficult to separate from, during actual or expected pain experience. Kinesiophobia and pain catastrophizing lead to disability and impaired quality of life of an individual.
Acceptance of pain includes acknowledging pain-related experiences with no attempts to avoid, ignore or control pain, specifically when these attempts have limited the patient's quality of life, engaging in valued activities, and reaching personal goals despite pain. Acceptance-based interventions attempt to make patients aware of their emotions and bodily sensations more fully and without avoidance and help them notice the presence of thoughts without following, opposing, believing, or disbelieving them.
All these characteristics vary between the genders and have an influence on the physical and mental well-being of patients having chronic musculoskeletal pain. Research shows that men and women differ in their pain experiences and perceptions.,, Studies show that women demonstrate lower experimental pain threshold (i.e., level at which a pain stimulus is perceived) and tolerance (i.e., the greatest level of pain which a person is able to tolerate), report more musculoskeletal pain symptoms, and seek medical care more often than men.,,, It is important to know the differences in pain perception among men and women which will help to devise specific treatment strategies and improve the overall outcome. Hence, the need for the study. The aim of the study was to assess the gender differences in kinesiophobia, pain catastrophizing, acceptance behaviors, and quality of life in patients with chronic musculoskeletal pain.
| Methodology|| |
A cross-sectional study using the purposive sampling method was conducted from April to August 2021 at the Department of Musculoskeletal Physiotherapy, MGM College of Physiotherapy, Navi Mumbai, India. The study was approved by Institutional Research Review Committee (Ref No. MGM/COP/IRRC/143/2020) of MGM College of Physiotherapy, Navi Mumbai. The study population consisted of men and women having chronic musculoskeletal pain, pain persisting more than 3 months, aged between 36–59 years. The total number of participants in this study was 219 (males = 103 and females = 116). Inclusion criteria were chronic musculoskeletal pain for more than 3 months. Exclusion criteria were any history of recent injury or surgery in the past 6 months, unable to comprehend, any cardiovascular or neurological conditions, any COVID-19 infection last 6 months. Subjects were informed about the purpose and written informed consent was signed by the subjects who were willing to participate in the study. Socio-demographic profile including age, gender, dominance (right or left), marital status, occupation and education was noted for all the participants. Socioeconomic status was evaluated using Modified Kuppuswamy Scale.
Pain catastrophizing scale, a 13-item self-report measure was used to assess the pain catastrophizing. A 4-point Likert scale was used to rate each item with total score of 52. Higher the score, higher pain catastrophizing thoughts are present.
The Tampa Scale for Kinesophobia, a 17-item self-report questionnaire, was used to evaluate “fear of movement-related pain.” Each item was rated on a 4-point Likert scale with total score ranging from 17 to 68. Higher the score, higher the kinesiophobia.
Chronic Pain Acceptance Questionnaire, a 20-item self-report questionnaire was used to assess the acceptance to chronic pain. It comprises of two subscales, pain willingness subscale, and activity engagement subscale. Each item is rated on a seven-point Likert rating scale (0 = Never to 6 = Always). Yielding a score ranging from 0 to 156. Higher the score, higher the pain acceptance.
36-Item Short Form Health Survey questionnaire was used to assess the quality of life. It was grouped into physical component summary (PCS) and mental component summary (MCS). Subscales such as physical functioning, role limitations due to physical functioning, fatigue, and pain yielded PCS score. Whereas, role limitations due to emotional problems, emotional wellbeing, social functioning, and general health computed to MCS score. Higher score indicated superior quality of life.
Data were analyzed using the Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS version 24) (IBM Corporation, NY, USA). The normality of data was assessed using Kolmogorov–Smirnov test. Data were normally distributed. Hence, parametric tests were used. Mean and standard deviation was used to express quantitative variables, whereas numbers and percentages were used for qualitative variables as. Comparisons of pain-related characteristics between males and females were evaluated using independent t-test. A P < 0.05 was considered as statistically significant.
| Results|| |
A total of 219 participants were included in this study which comprised 106 males and 113 females. Majority of men were graduates (63.2%), employed (94.3%), married (88.67%), and belonged to upper-middle class (52.83%). Furthermore, majority of women were graduate (49.5%), unemployed (59.29%), married (95.57%), and belonged to upper-middle class (64.6%). [Table 1] represents the socio-demographic characteristics of the participants.
[Table 2] shows the comparison between males and females regarding all the pain-related characteristics using independent t-test. No significant differences were observed between the genders regarding the pain-related characteristics of kinesiophobia (P = 0.495), pain acceptance (P = 0.539), and pain catastrophizing (P = 0.422). However, a significant difference between men and women was observed in their quality of life, in both PCS (P = 0.000) and MCS (P = 0.01). Men had better quality of life as compared to women.
|Table 2: Comparison of pain related characteristics between males and females|
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| Discussion|| |
The present study evaluated the gender differences in kinesiophobia, pain catastrophizing, acceptance behaviors, and quality of life in patients with chronic musculoskeletal pain. It was noted that there was no difference in kinesiophobia, pain catastrophizing, and pain acceptance behaviors between genders. However, women reported significantly lower quality of life as compared to men.
A recent study revealed differences in scores of kinesiophobia between men and women with chronic pain. Furthermore, another study states that women have a higher level of pain acceptance as compared to that of men as they perceive it as a normal part of their life. However, our study contradicts the above findings.
This may be attributed to the sociodemographic characteristics of the participants. Majority of men and women in the study received higher level of education. Literature reveals that level of education has an impact on the perception of pain. Subjects with lower level of education believe pain as signal of harm, disabling and uncontrollable. They are more likely to develop maladaptive pain beliefs and coping strategies. Whereas, people with higher education level perceive pain in a better manner and try to develop strategies to overcome the disabling thoughts., Furthermore, literature reports that higher education is associated with better critical thinking skills, understanding capacity to deal with health care personnel and systems effectively and are more aware about self-health.
In addition, socioeconomic status was another factor having an impact on the perception of pain. It has been reported that people with lower socioeconomic status are less educated and have poor access to health-care systems. This has an impact on their ability to control pain experience and are more distressed with higher level of negative thoughts and poor pain acceptance. Majority of participants in this study belonged to upper middle class socioeconomic status who are usually aware of their painful experiences and are able to work on them wisely.
Our findings are also supported by a well-known fact that companionship and support system of the spouses play an important role as the maximum number of the samples in our study was married. These sociodemographic characteristics of the participants recruited in the study may be the reason for no difference between genders in the aspects of kinesiophobia, pain acceptance and pain catastrophizing.
However, a significant difference between men and women was observed in their quality of life in both physical and mental components. Women had lower level of quality of life as compared to men. Men and women also seem to differ in their responses to pain. They are more variable in women than in men, with higher pain sensitivity, negative thoughts and more painful experience commonly reported among women. In addition, women neglect pain, continue to work and do not seek immediate treatment as compared to men. This may lead to more disability and reduced quality of life in women than men.
The strength of the study was that pain related characteristics were studied in men and women which may assist for assessment and management strategies in chronic musculoskeletal pain patients. The study has several limitations. First, a cross-sectional study design was utilized to analyze gender differences in pain characteristics. Future longitudinal study design can be conducted to analyze differences over a period of time. Second, further demographic characteristics such as age, ethnicity, work status, body mass index, level of physical activity, and medication usage should also be considered when comparing the genders for pain differences. This can be the future scope of the study.
Kinesiophobia, pain acceptance, pain catastrophizing, and quality of life are important aspects which are commonly seen in patients with chronic musculoskeletal pain. The evaluation of these factors and targeted rehabilitation programs addressing them should be highlighted in subjects with chronic musculoskeletal pain.
| Conclusion|| |
Kinesiophobia, pain acceptance, and pain catastrophizing showed no difference between the genders in chronic musculoskeletal pain patients. However, women reported lower quality of life as compared to men.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Treede RD. The International Association for the Study of Pain definition of pain: As valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain Rep 2018;3:e643.
Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al.
A classification of chronic pain for ICD-11. Pain 2015;156:1003-7.
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain 2006;10:287-333.
Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res 2016;9:457-67.
Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: A systematic review. Br J Sports Med 2019;53:554-9.
Muthunarayanan L, Ramraj B, Russel JK. Prevalence of pain among rural adults seeking medical care through medical camps in Tamil Nadu. Indian J Pain 2015;29:36-40. [Full text]
Gerdle B, Björk J, Henriksson C, Bengtsson A. Prevalence of current and chronic pain and their influences upon work and healthcare-seeking: A population study. J Rheumatol 2004;31:1399-406.
Stubbs D, Krebs E, Bair M, Damush T, Wu J, Sutherland J, et al.
Sex differences in pain and pain-related disability among primary care patients with chronic musculoskeletal pain. Pain Med 2010;11:232-9.
Panhale VP, Walankar PP, Khedekar SS. Chronic pain and fear avoidance beliefs: A narrative review. Int J Health Sci Res 2021;11:219-25.
McCracken LM. Learning to live with the pain: Acceptance of pain predicts adjustment in persons with chronic pain. Pain 1998;74:21-7.
Kori S, Miller R, Todd DD. Kinesiophobia: A new view of chronic pain behavior. Pain Manage 1990;3:34-43.
Flink IL, Boersma K, Linton SJ. Pain catastrophizing as repetitive negative thinking: A development of the conceptualization. Cogn Behav Ther 2013;42:215-23.
McCracken LM, Eccleston C. A prospective study of acceptance of pain and patient functioning with chronic pain. Pain 2005;118:164-9.
Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy. New York: Guildford; 1999.
Ochroch EA, Gottschalk A, Troxel AB, Farrar JT. Women suffer more short and long-term pain than men after major thoracotomy. Clin J Pain 2006;22:491-8.
Keogh E, McCracken LM, Eccleston C. Do men and women differ in their response to interdisciplinary chronic pain management? Pain 2005;114:37-46.
Rhudy JL, Williams AE. Gender differences in pain: Do emotions play a role? Gend Med 2005;2:208-26.
Soetanto AL, Chung JW, Wong TK. Are there gender differences in pain perception? J Neurosci Nurs 2006;38:172-6.
Chesterton LS, Barlas P, Foster NE, Baxter DG, Wright CC. Gender differences in pressure pain threshold in healthy humans. Pain 2003;101:259-66.
Wijnhoven HA, de Vet HC, Picavet HS. Explaining sex differences in chronic musculoskeletal pain in a general population. Pain 2006;124:158-66.
Keogh E, Herdenfeldt M. Gender, coping and the perception of pain. Pain 2002;97:195-201.
Saleem SM, Jan SS. Modified Kuppuswamy socioeconomic scale updated for the year 2021. Indian J Forensic Community Med 2021;8:1-3.
Sullivan MJ, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychol Assess 1995;7:524-32.
McCracken LM, Carson JW, Eccleston C, Keefe FJ. Acceptance and change in the context of chronic pain. Pain 2004;109:4-7.
Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, et al.
Validating the SF-36 health survey questionnaire: New outcome measure for primary care. BMJ 1992;305:160-4.
Bränström H, Fahlström M. Kinesiophobia in patients with chronic musculoskeletal pain: Differences between men and women. J Rehabil Med 2008;40:375-80.
Ramírez-Maestre C, Esteve R. The role of sex/gender in the experience of pain: Resilience, fear, and acceptance as central variables in the adjustment of men and women with chronic pain. J Pain 2014;15:608-18.e1.
Roth RS, Geisser ME. Educational achievement and chronic pain disability: Mediating role of pain-related cognitions. Clin J Pain 2002;18:286-96.
Dionne CE, Von Korff M, Koepsell TD, Deyo RA, Barlow WE, Checkoway H. Formal education and back pain: A review. J Epidemiol Community Health 2001;55:455-68.
Shavers VL. Measurement of socioeconomic status in health disparities research. J Natl Med Assoc 2007;99:1013-23.
Brekke M, Hjortdahl P, Kvien TK. Severity of musculoskeletal pain: Relations to socioeconomic inequality. Soc Sci Med 2002;54:221-8.
Pieretti S, Di Giannuario A, Di Giovannandrea R, Marzoli F, Piccaro G, Minosi P, et al.
Gender differences in pain and its relief. Ann Ist Super Sanita 2016;52:184-9.
[Table 1], [Table 2]