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

  • David Ruau
    Correspondence
    Address reprint requests to David Ruau, PhD, Division of Systems Medicine, MSOB, X1C23, 1265 Welch Road, Stanford, CA 94305-5415.
    Affiliations
    Division of Systems Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

    Department of Anesthesia, Stanford University School of Medicine, Stanford, California

    Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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  • Linda Y. Liu
    Affiliations
    Division of Systems Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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  • J. David Clark
    Affiliations
    Department of Anesthesia, Stanford University School of Medicine, Stanford, California

    Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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  • Martin S. Angst
    Affiliations
    Department of Anesthesia, Stanford University School of Medicine, Stanford, California
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  • Atul J. Butte
    Affiliations
    Division of Systems Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Published:January 16, 2012DOI:https://doi.org/10.1016/j.jpain.2011.11.002

      Abstract

      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.

      Key words

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