Special Topic Series: Musculoskeletal Pain: Book Reviews
Sex, Gender, and Pain. Edited by Roger B. Fillingim. Seattle: IASP Press, 2000, 416 pages, $79.00
Sex, Gender, and Pain contains an exhaustive range of expertise, from genetics and neuroscience to psychosocial gender issues, and it tries to uncover underlying mechanisms in regard to sex differences in the human pain experience. Premier scholars who apply their knowledge in their respective fields to the sex and gender issues associated with pain wrote seventeen chapters and a concluding chapter.
Pain is highly a personal experience; therefore, we encounter large individual differences. This situation causes much frustration in clinicians and researchers whose attempts to understand and to treat pain are marred by the simple reality that patients are individuals. John and Jane experience pain in different ways. Is this because of John's Y chromosome? Jane's estrogen level? How they were brought up? Or doctors' biases in evaluating men and women? Is it because John is from Mars and Jane is from Venus? Everyone experiences pain somewhat differently. Do sex and gender contribute to the individual differences in pain over and beyond other sex- and gender-neutral factors?
Given the history of our awareness in sex differences and gender differences in various human experiences, our understanding of the effects of sex and gender on pain experience is surprisingly primitive. The first part of this volume provides some idea of the complexity of the issue. Effects of reproductive hormones on the central nervous system, for example, are widespread and variable. Similarly, it seems difficult, if not impossible, to delineate the exact sequence of boyhood and girlhood circumstances determining how we express sensory experience. Moreover, sex and gender are salient issues in our identity, but they account only for a portion of what we are. It is a daunting task to delineate the responsibility of sex and gender in who we are and how we experience pain.
Pain is a complex, multifactorial experience. Attempts to find lawful, orderly relations among sex, gender, and pain necessitate careful investigation of all aspects of life. The middle part of the book explores various analog situations and investigates the roles of hormonal, menstrual, reproductive, and cultural factors in experimental pain and analgesic responses. The last third of the volume covers clinical epidemiology and specific clinical syndromes that are known to be more prevalent in women (headache, fibromyalgia, temporomandibular pain, and irritable bowel syndrome) or are femalespecific (genital pain). To be sure, Sex, Gender, and Pain does not have all the answers. One gets a clear sense that conflicting and inconsistent results are more the rule than the exception in this field. What the book provides is a chance to evaluate sex and gender differences in pain from a range of perspectives. The volume contains a variety of basic and clinical topics, and readers cannot help but feel privileged to explore unknown territory guided by the first-rate scientists who authored the chapters. Each chapter serves as a valuable resource, providing clear direction in its respective field. Our journey has just begun. This book is a milestone in our continuing quest for better understanding of the enigma of pain.
Akiko Okifuji, Ph.D.
University of Washington; Seattle, Washington, U.S.A.