The Role of Sex/Gender in the Experience of Pain: Resilience, Fear, and Acceptance as Central Variables in the Adjustment of Men and Women With Chronic Pain

  • Carmen Ramírez-Maestre
    Address reprint requests to Carmen Ramírez-Maestre, PhD, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071 Málaga, Spain.
    Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, Málaga, Spain
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  • Rosa Esteve
    Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, Málaga, Spain
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      The aim of the present study was to analyze differences between men and women in the experience of chronic pain. Resilience, fear-avoidance of pain, and pain acceptance were included in a hypothetical model as variables involved in chronic pain adjustment. A sample of 400 chronic spinal pain patients (190 men and 210 women) attending primary care units participated in the study. Student's t-test analyses showed that the women's scores were significantly higher than men's scores on pain intensity, pain anxiety, and current functioning. A LISREL multisample analysis of the theoretical model across genders was conducted. As expected, statistically significant associations were found between resilience and confrontation in both samples. Thus, resilient people will probably develop accepting behavior when faced with chronic pain. Confrontation yielded 3 statistically significant path coefficients: to pain intensity, functional status, and negative mood. Statistically significant associations were found between fear-avoidance and negative mood in both samples, but no association was found between fear-avoidance and functional status in either sample. Finally, fear-avoidance was associated with pain intensity in the sample of men alone. Despite this difference, the results suggest that the theoretical model had an adequate fit across both groups.


      In the context of fear-avoidance models, this article analyzed differences between men and women with spinal pain in relation to the pain experience. The fear-avoidance model appeared to be a good theoretical reference model in both men and women.

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