Sex effects in the interaction of acute stress and pain perception

Nirit Geva, Sari Golan, Lior Pinchas, Ruth Defrin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


A reciprocity between the stress and the pain system is recognized; however, the manner by which sex affects this reciprocity is unclear. Understanding the interactions of stress, pain, and sex may shed light on the apparent women's vulnerability to chronic pain, which often coexists with increased distress, and to affective disorders, which often coexist with chronic pain. The study's aim was to examine the effect of acute, validated, psychosocial stress on pain perception and modulation of women and men in a controlled manner. Participants were 82 women and 66 men. Heat-pain threshold, heat-pain tolerance, and pain modulation by temporal summation of pain (TSP), and pain adaptation were measured before and after exposure to the Montreal Imaging Stress Task (MIST) or to a sham task. The stress response was verified by perceived ratings of stress and anxiety, autonomic variables, and salivary cortisol. A significant stress response was obtained by the MIST among both sexes; however, women displayed a greater increase in perceived distress, and men displayed a greater increase in cortisol. Among women, TSP decreased and pain adaptation increased following the MIST, responses that were predicted by perceived distress levels. Among men, TSP increased following the MIST but was not predicted by the stress variables. In conclusion, acute stress manipulation seems to differentially affect both stress and pain responses of women and men: women exhibited stress-induced antinociception and men exhibited stress-induced pronociception. Higher perceived stress levels among women may trigger a temporary increase in pain inhibition mechanisms to serve evolutionary purposes.

Original languageEnglish
Pages (from-to)587-597
Number of pages11
Issue number3
StatePublished - 1 Mar 2023


FundersFunder number
Israeli Pain Association


    • Autonomic function
    • Cortisol
    • Pain modulation
    • Pain perception
    • Sex
    • Stress


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