title: Gender differences in patient-described pain, stress, and anxiety among patients undergoing treatment for painful conditions in the emergency department.
abstract: OBJECTIVE
  The primary objective of this study was to determine whether patient-described pain correlates with patient-described stress, anxiety, and satisfaction with ongoing treatment and if that correlation differs by gender.
  
  
  METHODS
  This was a prospective observational study at an urban, Level I trauma center conducted between June 1, 2010, and January 1, 2013. Patients reporting pain rated greater than 3 of 10 were eligible. Patients who qualified and consented for participation completed demographic and pain, anxiety, stress, and satisfaction scales at baseline, every 30 minutes, and at discharge. Data were analyzed using analysis of variance, chi-square tests, t-tests, multiple regression, and the Wilcoxon-Mann-Whitney rank test.
  
  
  RESULTS
  A total of 7,124 patients were screened for enrollment. Of those, 3,495 (49%) did not qualify at screening for various reasons, including insufficient pain levels (17.5%), elected not to participate (37.7%), did not qualify for other reasons (12.4%), and reason not captured (32.4%). A total of 3,629 (51%) screened patients were eligible and consented. Of those, 620 (16.8%) did not have any data collected past baseline, leaving 3,009 as the final sample size. The patients completing data collection had a median age of 39 years (range = 18 to 90 years), and 50% were male. The mean presenting pain visual analog scale (VAS) score was 71.5 mm. Presenting stress and anxiety VAS scores were significantly higher in females (0.61 and 0.53, respectively) than males (0.56 and 0.50, respectively), whereas presenting pain VAS (0.71 male and 0.72 female) and satisfaction VAS (0.34 male and 0.35 female) did not differ by sex. Ethnicity, education, and income were all statistically different when compared with baseline pain, stress, anxiety, and satisfaction. Male gender was associated with a significant change in pain over time from baseline (coefficient = 0.040, p = 0.037); however, when adjusting for age, ethnicity, education, and income, and for changes in stress, anxiety, and satisfaction VAS scores, changes in pain related to male gender was no longer significant (coefficient = 0.034, p = 0.11). When asked about their satisfaction with the results of the pain treatment that had been provided, patients reported a median of 2 (out of 6, 1 = satisfied, 6 = dissatisfied; interquartile range = 1 to 2). There was no significant difference between sexes (p > 0.90).
  
  
  CONCLUSIONS
  Patient-reported stress and anxiety were higher among female patients than male patients, but there was no significant difference in reported pain and satisfaction between sexes. Sex alone was not a significant predictor of change in pain for patients presenting to the emergency department with pain-related complaints. Anxiety and stress may potentially influence the pain-gender relationship.
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Roma
authors.initials: R
authors.lastname: Patel
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Biros
authors.forename: Johanna
authors.initials: J
authors.lastname: Moore
authors.forename: James R
authors.initials: JR
authors.lastname: Miner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000453:epidemiology* / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011446:Prospective Studies; D012727:Sex Characteristics; D012737:Sex Factors; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D014193:Trauma Centers; D055815:Young Adult