Sex differences in perceived pain, pain-related affective distress, and pain-related disability with low back pain

The aims of this study were to examine whether there are sex differences in (1) prediction of epidural corticosteroid injection (ESI) outcomes and in (2) responses to chronic low back pain and to the ESI procedure itself. Twenty male and 37 female patients seen in the Pain Clinic of a regional medical center for ESI therapy participated. They rated not only the pain intensity of the procedure itself, but also their worst and least low back pain initially, at two weeks, and at two months after the ESI. Participants also were queried about depressive symptomatology, coping strategies, fear of pain, and pain-related disability.; Although females reported a higher expectation of successful pain relief from the ESI than males, the difference was not significant. However, the greater the worst pain initially reported by participants, the lower were their expectations of success. Moreover, males reported greater worst pain initially as well as at two weeks and at two months after the ESI than females and reported significantly greater pain with the procedure itself.; Females used significantly more behavioral and cognitive distraction as strategies to cope with pain than males. Use of such avoidance strategies was associated with lower reported worst low back pain and, similarly, reported lower pain with the procedure itself.; Although males reported greater symptoms of depression than females, the difference was not significant. However, greater number of depressive symptoms was associated with greater worst low back pain and greater reported pain-related disability. In addition, males reported significantly greater fear of pain responses than females. The greater the fear of pain reported, the greater the pain-related disability and the greater the pain intensity of the procedure itself.; Thus, for males greater fear of pain and lower expectation of successfulness were predictive of increased perceived pain, depressive symptomatology, and disability reported after the ESI. However, greater expectation of successful pain relief and use of problem-focused avoidance coping strategies were predictive for females of decreased perceived pain, depressive symptomatology, and disability reported.