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GENDER AND PAIN PERCEPTION

Regarding “New Insights on the Role of Prostaglandins in Hardwiring the Brain for Sex” (Dec. 19, page 12) on the role of gender in pain perception, there are gender differences in the perception of pain and the sensitivity to analgesics. Indeed, there is a large literature in this area going back over 20 years. Dr. Richard Bodnar at Queens College in New York is a leader in this field. Thus, the “take-home message of the article” is a sound one. However, there are a number of statements about which I strongly disagree.

The most egregious is the statement: “A dose of morphine that barely touches the pain in a female is above the lethal dose for males.” This is simply not true. Opioids are, in most circumstances, quite safe. Animal models display a relatively large therapeutic index, with a 50-fold difference between the dose-response curves for analgesia and “lethality” in mice. Clinical experience supports this.

While women may require higher doses of opioids, their doses do not come close to those lethal in men. To a reader not experienced in pain management, the statement may have a major adverse impact in patient care. Hopefully, most readers will have the common sense to know that the statement is simply false.

Gavril W. Pasternak, MD, PhD

Sloan-Kettering, Memorial Hospital, Weill College of Medicine, of Cornell University, New York, NY