Painful heat attenuates electrically induced muscle pain in men and women

• Is gender differences in pain inhibition the reason for high prevalence of pain in women?
• Muscle pain was inhibited by heat pain conditioning in both men and women.
• Women were investigated in the menstrual phase with highest pain inhibition.
• No gender differences in pain inhibition was found.

Background and purposeWomen exhibit higher prevalence of most painful disorders. Several explanations have been proposed for this discrepancy, one being that endogenous pain modulatory pathways, which affect incoming nociceptive signals, act differently in men and women. A less efficient pain inhibitory system has been proposed as a contributing factor to explain why women exhibit higher prevalence of most painful disorders. The present study determined whether muscle pain, induced experimentally by electrical stimulation, is inhibited by a painful heat stimulus. This conditioned pain modulation (CPM) paradigm was used to determine whether women show signs of reduced inhibition compared to men.MethodsForty self-reported healthy individuals (20 female, 20 male) participated in a cross-over design with painful and non-painful heat as a conditioning stimulus. Test stimuli were painful intramuscular electrical stimulation of the tibialis anterior muscle at two intensities; low (1.1 × pain threshold) and high (1.6 × pain threshold). Painful conditioning was contact heat (45–49 °C) to the contralateral forearm. Non-painful conditioning was contact heat at 35 °C. Ten test stimuli were delivered in three blocks (before, during and after conditioning) in two sessions (painful and non-painful conditioning). The women were tested during days 12–14 of the menstrual cycle. This interval corresponds to the ovulatory phase of the menstrual cycle, the interval during which women are reported to show the largest inhibitory effects.ResultsTest stimuli were rated significantly lower during painful conditioning, compared with before conditioning. This was found for both low and high test stimulus intensities. A nonspecific attenuation was seen during non-painful conditioning for the low test stimulus intensity. Test stimuli were rated significantly lower also 3 min after conditioning, compared with before conditioning. The inhibitory effects were not different between men and women. Similar findings were obtained also if six non-CPM-responders (subjects rating test stimuli higher during conditioning than before conditioning) were excluded.Conclusions and implicationsThe present findings indicate that painful contact heat inhibits electrically induced muscle pain and that inhibition was not different between men and women, when women were tested in the interval 12–14 days after their last menstruation. Some inhibition of muscle pain was seen during non-painful conditioning, indicating that nonspecific inhibitory effects were triggered. Also the nonspecific inhibitory effects were similar in men and women.