title: Sex Differences in Pain and Pain-Related Disability among Primary Care Patients with Chronic Musculoskeletal Pain.
abstract: BACKGROUND
  Although previous research suggests women report more severe pain than men, evidence for sex-related differences in pain-related disability is conflicting. Also, the impact of psychological factors on sex differences in disability is uncertain.
  
  
  OBJECTIVE
  The purpose of this study is to assess sex differences in pain-related disability and evaluate whether they are accounted for by psychological factors.
  
  
  METHODS
  Analysis of baseline data from the Stepped Care for Affective disorders and Musculoskeletal Pain study. Participants included 241 male and 249 female primary care patients with moderately severe persistent pain of the back, hip, or knee. Multivariable log-linear models were used to determine the association between sex and pain-related disability and whether sex differences persisted after adjustment for psychiatric comorbidity and potential psychological mediators.
  
  
  RESULTS
  Compared with men, women reported worse pain intensity, greater pain-related interference with function, and more disability days due to pain. They also had worse depression, anxiety, and self-efficacy. Sex differences in pain interference with function and pain disability days remained significant in multivariable models. Depression, poor self-efficacy, and fear of reinjury were independently associated with disability in both men and women.
  
  
  CONCLUSIONS
  Women report greater pain-related disability than do men, even after controlling for depression, anxiety, and other psychological factors. Pain management strategies that target functional disability may be particularly important in the treatment of women with pain.
authors.affiliation: Department of Medicine, Indiana University, Indianapolis, Indiana, USA. dstubbs@iupui.edu
authors.forename: Dawana
authors.initials: D
authors.lastname: Stubbs
authors.forename: Erin
authors.initials: E
authors.lastname: Krebs
authors.forename: Matthew
authors.initials: M
authors.lastname: Bair
authors.forename: Teresa
authors.initials: T
authors.lastname: Damush
authors.forename: Jingwei
authors.initials: J
authors.lastname: Wu
authors.forename: Jason
authors.initials: J
authors.lastname: Sutherland
authors.forename: Kurt
authors.initials: K
authors.lastname: Kroenke
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001168:Arthritis / Q000503:physiopathology; D001290:Attitude; D002908:Chronic Disease; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D010146:Pain / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement; D011320:Primary Health Care; D011446:Prospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors