title: Sex differences in subjective and objective measures of pain, functional impairment, and health-related quality of life in patients with lumbar degenerative disc disease.
abstract: Sex differences in pain perception are known to exist; however, the exact pathomechanism remains unclear. This work aims to elucidate sex differences in subjective and objective measures of pain, functional impairment, and health-related quality of life (HRQoL) in patients with lumbar degenerative disc disease. In a prospective 2-center study, back and leg pain (visual analogue scale [VAS]), functional disability (Oswestry Disability Index and Roland-Morris Disability Index), and HRQoL (EuroQol-5D and Short Form [SF12]) were collected for consecutive patients undergoing lumbar spine surgery. Objective functional impairment (OFI) was estimated using age-adjusted and sex-adjusted cutoff values for the timed-up-and-go (TUG) test. A healthy cohort of n = 110 subjects served as the control group. Univariate and multivariate analyses were performed to test the association between sex and pain, subjective and OFIs, and HRQoL. The study comprised n = 305 patients (41.6% females). Female patients had more VAS back pain (P = 0.002) and leg pain (P = 0.014). They were more likely to report higher functional impairment in terms of Oswestry Disability Index (P = 0.005). Similarly, HRQoL measured with the EuroQol-5D index (P = 0.012) and SF12 physical composite score (P = 0.005) was lower in female patients. Female patients reported higher VAS back and leg pain, functional impairment, and reduced HRQoL than male patients. However, there were no sex differences with respect to the presence and degree of OFI measured by the TUG test using age-adjusted and sex-adjusted cutoff values. As such, the TUG may be a good test to overcome sex bias for the clinical assessment of patients with degenerative disc disease.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland Department of Neurology, John Hunter Hospital, Newcastle, Australia Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
authors.forename: Marco V
authors.initials: MV
authors.lastname: Corniola
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Smoll
authors.forename: Holger
authors.initials: H
authors.lastname: Joswig
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.forename: Martin N
authors.initials: MN
authors.lastname: Stienen
mesh_terms: D000328:Adult; D000368:Aged; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000145:classification / Q000150:complications* / Q000523:psychology*; D007405:Intervertebral Disc Displacement / Q000145:classification / Q000150:complications* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology*; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D010147:Pain Measurement; D058748:Pain Perception / Q000502:physiology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012727:Sex Characteristics