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, 13 (3), 228-34

Sex Differences in Reported Pain Across 11,000 Patients Captured in Electronic Medical Records


Sex Differences in Reported Pain Across 11,000 Patients Captured in Electronic Medical Records

David Ruau et al. J Pain.


Clinically recorded pain scores are abundant in patient health records but are rarely used in research. The use of this information could help improve clinical outcomes. For example, a recent report by the Institute of Medicine stated that ineffective use of clinical information contributes to undertreatment of patient subpopulations--especially women. This study used diagnosis-associated pain scores from a large hospital database to document sex differences in reported pain. We used de-identified electronic medical records from Stanford Hospital and Clinics for more than 72,000 patients. Each record contained at least 1 disease-associated pain score. We found over 160,000 pain scores in more than 250 primary diagnoses, and analyzed differences in disease-specific pain reported by men and women. After filtering for diagnoses with minimum encounter numbers, we found diagnosis-specific sex differences in reported pain. The most significant differences occurred in patients with disorders of the musculoskeletal, circulatory, respiratory and digestive systems, followed by infectious diseases, and injury and poisoning. We also discovered sex-specific differences in pain intensity in previously unreported diseases, including disorders of the cervical region, and acute sinusitis (P = .01, .017, respectively). Pain scores were collected during hospital encounters. No information about the use of pre-encounter over-the-counter medications was available. To our knowledge, this is the largest data-driven study documenting sex differences of disease-associated pain. It highlights the utility of electronic medical record data to corroborate and expand on results of smaller clinical studies. Our findings emphasize the need for future research examining the mechanisms underlying differences in pain.

Perspective: This article highlights the potential of electronic medical records to conduct large-scale pain studies. Our results are consistent with previous studies reporting pain differences between sexes and also suggest that clinicians should pay increased attention to this idea.

Conflict of interest statement

Competing Interests: The authors declare that there are no conflicts of interest related to this manuscript.


Figure 1
Figure 1
Scatterplot of average pain scores for men and women across 47 diagnosis sections. Each point represents average pain scores for a single diagnosis. Blue circles represent diagnoses with 41–68 encounters, and red triangles represent diagnoses with more than 68 encounters. The black line is a hypothetical perfect correlation between male and female pain scores. The dashed black lines show average pain score difference of one unit between men and women. Colored line segments on the x- and y-axes show the distribution of female and male pain scores for each encounter threshold.
Figure 2
Figure 2
Slopegraph representing the average pain score change between men and women for 22 diagnoses with >68 encounters. Abbreviations: disorder (dis); disease (dx).

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