疼痛知覺的性別差異：“信號識別理論”方法

Gender Differences in Pain Perception: A Signal Detection Theory Approach

背景：國外的研究表明，與男性相比，女性述及疼痛較多，且容易遭受更多的慢性疼痛狀態困擾。但對於這種疼痛知覺的差別是否由感覺或非感覺因素，如焦慮，引起的尚不明瞭。既然疼痛的性別差異對於疼痛的管理具有重要意義，那麼，在當前文化背景下澄清疼痛、性別和焦慮的關係也就至關重要了。方法：“信號識別理論”方法通過感覺差別[P(A)]和反應偏差[B]確定性別差異。126名香港成年人接受30對溫度刺激(36°C～48°C)，其反應運用計算機軟件進行處理分析，“狀態──素質焦慮量表＂(STAI-Y)調整為中文版用於評價受試對象的焦慮狀態和素質。結果：與男性相比，女性的感覺辨別力較強(P = 0.004)，而對疼痛刺激的忍耐力較差(P = 0.03)。儘管焦慮狀態和素質沒有差別，但感覺辨別力與焦慮狀態呈顯著正相關(γ = 0.19)，反應偏差卻與焦慮素質呈顯著負相關(γ = -0.18)。STAI-Y的內容效度為0.9，焦慮狀態和素質的α相關係數分別為0.88，0.92。結論：與男性相比，較強的感覺辨別力可能是女性較多述及疼痛和經常尋求健康照顧的原因。男性對疼痛的忍耐可能受到社會心理因素，如性別角色期待的影響。焦慮對疼痛的總體感知能力影響顯著，信號識別量表是一能對痛覺知覺的感覺因素逕行有效測量的工具。意識到性別和焦慮對疼痛知覺的影響，能使醫護人員更有效地管理疼痛。

Background: Overseas studies suggest women report more pain and are more vulnerable to chronic pain conditions compared with men, however, it is unclear whether this difference in pain perception is due to sensory or non-sensory factors such as anxiety. Since gender differences in pain perception may have important implications for pain management, it is crucial that the relationship between pain, gender and anxiety in this culture be clarified. Methods: The Signal Detection Theory Approach was used to determine gender differences in sensory discrimination [P(A)] and response bias (B). One hundred and twenty six Hong Kong Chinese adults responded to thirty pairs of thermal stimuli (36°C-48°C) and their responses to these stimuli were analyzed by computer software. The adapted Chinese version of the State-Trait Anxiety Inventory (STAI-Y) was used to assess state and trait anxiety of participants. Results: Compared with men, women showed enhanced sensory discriminability (P = 0.004) and were less stoical in their response to pain (P = 0.03). Although there was no significant gender difference in state and trait anxiety, sensory discrimination was positively correlated with state anxiety (γ = 0.19) and response bias was negatively correlated with trait anxiety (γ = -0.18). The content validity index for the STAI-Y was 0.9 and the co-efficient alpha for reliability for state and trait anxiety was 0.88 and 0.92, respectively. Conclusions: Enhanced sensory discriminability in women may explain why women report more pain and seek healthcare more frequently compared with men. Men showed more stoical response to pain possibly because of gender-role expectations. The Signal Detection Theory approach was instrumental in assessing the sensory and non-sensory dimensions of pain perception. Awareness of the effects of gender and anxiety in pain perception will enable clinicians to be more efficient pain managers.