Pain, 44 (1991) 69-72 0 1991 Elsevier Science Publishers B.V. (Biomedical Division) 0304-3959/91/$03.50 ADONIS
69
0304395991000588
PAIN 01715
The effects of experimenter gender on pain report in male and female subjects Fredric M. Levine and Laura Lee De Simone State University ofNew York, Stony Brook, NY (U.S.A.) (Received 22 February 1990. revision received 17 July 1990, accepted 18 July 1990)
An experiment was conducted that investigated the effect of experimenter gender on the report of pain of male and female subjects. In order to evoke gender-related motives, experimenters were selected for their attractiveness. Subjects were asked to rate cold pressor pain
SummarY
in front of either a male or female experimenter. The results indicated that males reported significantly less pain in front of a female experimenter than a male experimenter. The difference in female subjects was not significant although they tended to report higher pain to the male experimenter.
Key words: Pain report;
Sex; Experimenter
gender
Introduction
Pain report is complex and multidetermined. It is known to be influenced by physical, psychological, and social factors [e.g., 3,6]. According to Chapman [l, p. 12661, “All pain expression is determined in part by the social context in which it takes place.” The report of pain is virtually always conducted in the immediate or the eventual presence of a person, and usually in a person’s immediate presence, e.g., a physician asking about the patient’s pain level. Craig [2] presented compelling evidence of the importance of the social context upon pain report. The following experiment was specifically interested in the effect gender of the experimenters would have on pain report of male and female subjects. Traditionally, men are expected to be more stoic and be able to impress women with their macho abilities which include strength and ability to withstand pain. On the other hand, women have traditionally been encouraged to assume a more delicate role and to relate as being helpless, often specifically to bring out the protection of men. Previous research in the area of sex differences in pain has demonstrated either that females report higher pain levels than males or no significant differences between the genders. For example, Hardy et al. [5] found no pain threshold differences between males and well
Correspondenceto: Dr. Fredric M. Levine, Psychology University of New York, Stony Brook, NY, 11794-2500,
Dept., State U.S.A.
females using their radiant-heat stimulation method. Using the cold pressor method, Westcott et al. [ll] found that females had a lower tolerance for emersion of their hand in ice-water, as measured by verbal report and time in the ice-water. In a review of research on differences in pain as a function of gender, Weisenberg [lo] cited 4 studies of experimental pain that showed no differences in threshold between the genders and two that indicated males had a higher threshold. Weisenberg [lo] also cited 3 studies that indicated that males had a higher tolerance level for pain than females. No studies indicated that females had a higher threshold or tolerance level than males. Otto and Dougher [7] found that females reported higher pain levels than males. These investigators also reported that there was no interaction between the gender of the experimenters and the report of pain. The previous research, however, did not attempt to elicit sex role motives by creating conditions of sexual interests. If pain report is influenced by gender in the traditional role model manner, then males should report lower levels than females. However, it is not clear whether males would compete with another male in being better at dealing with pain, or if males will report less pain in front of a female. If females respond in the traditional gender role manner, it is expected that they would report higher pain levels to males than to another female. The current experiment attempted to maximize the likelihood of gender-influenced pain report by selection of the experimenters and by increasing interaction be-
70
tween the experimenters and the subjects. Snyder et al. [8a] found that male subjects related in a more positive manner to a woman they believed (through photographs) to be more attractive. Sigall and Aronson [8] had an attractive experimenter dress up in either an attractive or in an unattractive manner. When she was dressed in an attractive way, the male subjects were much more concerned about her evaluation. The current experimenters, therefore, were specifically selected to be attractive and instructed to dress in an attractive manner. If pain report can be influenced by social context effects, the experiment should be designed to provide the motivating conditions for the effect.
Method
Subjects The subjects were 35 male and 33 female undergraduates with an age range of 17-29 years (m = 19.13) who were meeting a psychology course requirement. Only subjects with no prior experimental exposure to the cold pressor task were used.
Apparatus The cold pressor test consisted of having subjects place their hands up to their wrists in a hard rubber bucket filled with ice-water and a layer of floating ice cubes. The water temperature was 0-1°C. Since pain is generally believed to have a sensory component and an affective component, the scales used were based on the Intensity and Affective pain rating scales from the Pain Perception Profile [9] and Gracely et al.‘s [4] SensoryIntensity and Unpleasantness scales. Pain Intensity was assessed by a numeric rating scale of exponentially spaced intervals (base 2) anchored with intensity words (e.g., mild, moderate, severe, etc.), and the Pain Affective scale used affective words (e.g., annoying, miserable, excruciating, etc.). Subjects were allowed to use any numeric value between the anchored items and even values higher than the maximum (32) value indicated on the scale. Thus the scale did not artifactually constrain subjects’ judgments. Both scales were posted in front of the subject. The order of presentation of the Affective and Intensity scales was randomly counterbalanced with the requirement that they be presented first an equal number of times. On an a priori basis, it was determined that withdrawal from the ice-water would be a meaningful response to the social situation, and all intervals during which the hand was withdrawn were scored 64, the next highest log base value. The first pain rating was considered a practice trial to establish a scale, and was not counted in the results.
Procedure Subjects were randomly assigned to either a male or female experimenter. Two undergraduate students (a male aged 23, and a female aged 28) were used as the experimenters. The experimenters were selected to be attractive and encouraged to dress in a manner which accentuated the stereotypical gender characteristics of masculinity and femininity. The male experimenter wore sleeveless or form fitting t-shirts, the female wore sweaters, A-line skirts and heels. Although the appearance of the experimenters was designed to elicit attraction, the procedure was conducted in a professional manner that required the experimenters to follow a script which delineated both verbal communications and movements. Instructions were read to all subjects. The experimenters were blind to the hypotheses. All directions were presented verbally to maximize subject--experimenter interactions, and subjects were required to verbally report pain ratings to the experimenter. Subjects were seated and told that the experiment was to measure different people’s response to pain. The pain scales were mounted on a wall in front of the subjects. The scales were explained to the subjects who were then required to place their non-dominant hand in the ice-water up to the wrist. Subjects reported their level of pain on both the Affective and the Intensity scales to the experimenter, who was seated at the same table. Pain reports were given every 15 set upon the flashing of a light. Full participation required 12 ratings (a total of 3 min in the cold pressor). Prior to participation subjects were advised that they could withdraw their hand from the cold pressor at any time without penalty. The experimenters recorded pain ratings from both the Affective and Intensity scales for each interval on standardized forms. The experimental session ended following the 12th rating or withdrawal from the cold pressor.
Results The Intensity measure of pain and the Affective measure correlated 0.99 and were essentially a high reliability coefficient. Since the results were identical for
TABLE 1 ANALYSIS
OF VARIANCE
Source of variation
SS
df
MS
F
Sig. of F
Sex Experimental class
74.71 2.33
1 1
74.71 2.33
15.23 0.47
0.001 0.493
Sex by experimental class
38.27
1
38.27
7.80
0.007
71
40
1 30
1 20
10
0
1
I
Same
1
Opposite
10
Sex of Experimenter Fig. 1. Means and S.D.s of
pain report.
both measures, only the results for the reactivity measure will be presented. Fig. 1 shows the means and standard deviations with the same or opposite sex experimenter. A 3-way analysis of variance with repeated measures on trials was performed. The results indicate that there was a significant effect due to sex of the subject. Female subjects reported significantly higher levels of pain than males (F= 15.30, P < 0.001). As shown in Table I, there was also a significant interaction between the class of the experimenter (the same or the opposite gender as the subject) and the gender of the subject (F = 7.80, P < 0.007). As shown in Fig. 1, men gave significantly lower pain ratings to the opposite sex than to another male (t = 2.53, P -c 0.02). Although females tended to give higher ratings to the opposite sex than to another female, the difference was not significant (t = 99, P -c 0.33). There were no differences between the pain reports of males and females when they rated pain for the same gender experimenter (t = 0.34, P > 0.40). The results indicated that males responded differentially to the gender of the experiment and reported significantly lower pain levels to a female than to a male. Although females tended to report higher levels of pain to a male experimenter than a female, the difference was not significant. There were no significant differences in pain report when males and females reported their level of pain to members of their own gender.
Discussion
Gender of the experimenter significantly influenced the report of cold pressor pain. Males reported significantly lower pain to a member of the opposite sex than to another male. This result is congruent with the standard gender role requirement of males appearing macho, and not allowing females to know they are weak. The results indicated that the male macho role was more influenced by females than by another male.
Although females tended to report higher pain to opposite gender experimenters, the difference in pain report of females to experimenters of the same or the opposite sex was not quite statistically significant. This result is congruent with the relatively recent women’s movement. Women in the last 15 or so years are discouraged from assuming the powerless and vulnerable role and to be more assertive. However, although the difference among women in pain reports for male and female experimenters was not significant, there was a significant overall difference in pain report between the genders. Females reported higher levels of pain than males. This difference appears to be mainly due to the markedly lower level of pain that male subjects report to female experimenters. Of interest is that there was no significant difference of pain report when males and females reported their pain to members of the same gender. This result suggests that differences in pain sensitivity are not significant, but that the communication of pain is influenced by the social context - in this experiment by the presence of an attractive experimenter. The overall implications of this experiment is that pain report between the genders is not a simple difference of pain sensitivity. Rather it appears to be under social influence of the gender of the person to whom the report of pain is made. In this experiment, males were significantly influenced by gender, and they reported lower pain to an attractive female. Social factors apparently influence pain report. Although there has been research on characteristics of the subject that influences pain, these results indicate that the interaction between the subjects and the social environment should also be investigated.
Acknowledgements
The authors appreciate the comments and criticisms of David Cross, Ronald Friend, Sharon Krass, David Emmerich and the help of James Thorns.
References Chapman, C.R., New directions in the understanding and management of pain, Sot. Sci. Med., 19 (1984) 1261-1277. Craig, R.B., Social modelling influences: pain and context. In: R.A. Stembach (Ed.), The Psychology of Pain (2nd Edn.), Raven Press, New York, 1986. Fields, H.L., Pain, McGraw-Hill, New York, 1987. Gracely, R.H., McGrath, P. and Dubner, R., Narcotic analgesia: fentanyl reduces the intensity but not the unpleasantness of painful tooth pulp sensations, Science, 203 (1979) 1261-1263. Hardy, J.D., Wolff, H.G. and Goodell, H., Pain Sensations and Reactions, Hafner, New York, 1952. Karoly, P. and Jensen, M.P., Multimethod Assessment of Chronic Pain, Pergamon Press, New York, 1987.
72 7
Otto, M.W. and Dougher, M.J., Sex differences and personality factors in responsivity to pain, Percept. Motor Skills, 61 (1985) 383-390. 8 Sigall, H. and Aronson, E.. Liking for an evaluator as a function of her physical attractiveness and nature of the evaluations. J. Exp. Sot. Psycho]., 5 (1969) 93-100. 8a Snyder, M., Tanke, E.D. and Bescheid, E., Social perception and interpersonal behavior. On the self-fulfilling nature of social stereotypes. J. Pers. Sot. Psychol., 35 (1977) 656-666.
9
IO II
‘Tursky, B.. Jamner, L.D. and Friedman. R.. The pain perception profile: a psychophysical approach to the assessment of pain report, Behav. Ther.. 13 (1982) 376-394. Weisenberg, M., Pain and pain control, Psychol. Bull.. 84 (1977) 1008-7044. Westcott, T.B., Huesz, L.. Boswell. D. and Herold, P., Several variables of importance in the use of the cold pressor as a noxious stimulus in behavioral research, Percept. Motor Skills, 44 (1977) 401-402.
69
0304395991000588
PAIN 01715
The effects of experimenter gender on pain report in male and female subjects Fredric M. Levine and Laura Lee De Simone State University ofNew York, Stony Brook, NY (U.S.A.) (Received 22 February 1990. revision received 17 July 1990, accepted 18 July 1990)
An experiment was conducted that investigated the effect of experimenter gender on the report of pain of male and female subjects. In order to evoke gender-related motives, experimenters were selected for their attractiveness. Subjects were asked to rate cold pressor pain
SummarY
in front of either a male or female experimenter. The results indicated that males reported significantly less pain in front of a female experimenter than a male experimenter. The difference in female subjects was not significant although they tended to report higher pain to the male experimenter.
Key words: Pain report;
Sex; Experimenter
gender
Introduction
Pain report is complex and multidetermined. It is known to be influenced by physical, psychological, and social factors [e.g., 3,6]. According to Chapman [l, p. 12661, “All pain expression is determined in part by the social context in which it takes place.” The report of pain is virtually always conducted in the immediate or the eventual presence of a person, and usually in a person’s immediate presence, e.g., a physician asking about the patient’s pain level. Craig [2] presented compelling evidence of the importance of the social context upon pain report. The following experiment was specifically interested in the effect gender of the experimenters would have on pain report of male and female subjects. Traditionally, men are expected to be more stoic and be able to impress women with their macho abilities which include strength and ability to withstand pain. On the other hand, women have traditionally been encouraged to assume a more delicate role and to relate as being helpless, often specifically to bring out the protection of men. Previous research in the area of sex differences in pain has demonstrated either that females report higher pain levels than males or no significant differences between the genders. For example, Hardy et al. [5] found no pain threshold differences between males and well
Correspondenceto: Dr. Fredric M. Levine, Psychology University of New York, Stony Brook, NY, 11794-2500,
Dept., State U.S.A.
females using their radiant-heat stimulation method. Using the cold pressor method, Westcott et al. [ll] found that females had a lower tolerance for emersion of their hand in ice-water, as measured by verbal report and time in the ice-water. In a review of research on differences in pain as a function of gender, Weisenberg [lo] cited 4 studies of experimental pain that showed no differences in threshold between the genders and two that indicated males had a higher threshold. Weisenberg [lo] also cited 3 studies that indicated that males had a higher tolerance level for pain than females. No studies indicated that females had a higher threshold or tolerance level than males. Otto and Dougher [7] found that females reported higher pain levels than males. These investigators also reported that there was no interaction between the gender of the experimenters and the report of pain. The previous research, however, did not attempt to elicit sex role motives by creating conditions of sexual interests. If pain report is influenced by gender in the traditional role model manner, then males should report lower levels than females. However, it is not clear whether males would compete with another male in being better at dealing with pain, or if males will report less pain in front of a female. If females respond in the traditional gender role manner, it is expected that they would report higher pain levels to males than to another female. The current experiment attempted to maximize the likelihood of gender-influenced pain report by selection of the experimenters and by increasing interaction be-
70
tween the experimenters and the subjects. Snyder et al. [8a] found that male subjects related in a more positive manner to a woman they believed (through photographs) to be more attractive. Sigall and Aronson [8] had an attractive experimenter dress up in either an attractive or in an unattractive manner. When she was dressed in an attractive way, the male subjects were much more concerned about her evaluation. The current experimenters, therefore, were specifically selected to be attractive and instructed to dress in an attractive manner. If pain report can be influenced by social context effects, the experiment should be designed to provide the motivating conditions for the effect.
Method
Subjects The subjects were 35 male and 33 female undergraduates with an age range of 17-29 years (m = 19.13) who were meeting a psychology course requirement. Only subjects with no prior experimental exposure to the cold pressor task were used.
Apparatus The cold pressor test consisted of having subjects place their hands up to their wrists in a hard rubber bucket filled with ice-water and a layer of floating ice cubes. The water temperature was 0-1°C. Since pain is generally believed to have a sensory component and an affective component, the scales used were based on the Intensity and Affective pain rating scales from the Pain Perception Profile [9] and Gracely et al.‘s [4] SensoryIntensity and Unpleasantness scales. Pain Intensity was assessed by a numeric rating scale of exponentially spaced intervals (base 2) anchored with intensity words (e.g., mild, moderate, severe, etc.), and the Pain Affective scale used affective words (e.g., annoying, miserable, excruciating, etc.). Subjects were allowed to use any numeric value between the anchored items and even values higher than the maximum (32) value indicated on the scale. Thus the scale did not artifactually constrain subjects’ judgments. Both scales were posted in front of the subject. The order of presentation of the Affective and Intensity scales was randomly counterbalanced with the requirement that they be presented first an equal number of times. On an a priori basis, it was determined that withdrawal from the ice-water would be a meaningful response to the social situation, and all intervals during which the hand was withdrawn were scored 64, the next highest log base value. The first pain rating was considered a practice trial to establish a scale, and was not counted in the results.
Procedure Subjects were randomly assigned to either a male or female experimenter. Two undergraduate students (a male aged 23, and a female aged 28) were used as the experimenters. The experimenters were selected to be attractive and encouraged to dress in a manner which accentuated the stereotypical gender characteristics of masculinity and femininity. The male experimenter wore sleeveless or form fitting t-shirts, the female wore sweaters, A-line skirts and heels. Although the appearance of the experimenters was designed to elicit attraction, the procedure was conducted in a professional manner that required the experimenters to follow a script which delineated both verbal communications and movements. Instructions were read to all subjects. The experimenters were blind to the hypotheses. All directions were presented verbally to maximize subject--experimenter interactions, and subjects were required to verbally report pain ratings to the experimenter. Subjects were seated and told that the experiment was to measure different people’s response to pain. The pain scales were mounted on a wall in front of the subjects. The scales were explained to the subjects who were then required to place their non-dominant hand in the ice-water up to the wrist. Subjects reported their level of pain on both the Affective and the Intensity scales to the experimenter, who was seated at the same table. Pain reports were given every 15 set upon the flashing of a light. Full participation required 12 ratings (a total of 3 min in the cold pressor). Prior to participation subjects were advised that they could withdraw their hand from the cold pressor at any time without penalty. The experimenters recorded pain ratings from both the Affective and Intensity scales for each interval on standardized forms. The experimental session ended following the 12th rating or withdrawal from the cold pressor.
Results The Intensity measure of pain and the Affective measure correlated 0.99 and were essentially a high reliability coefficient. Since the results were identical for
TABLE 1 ANALYSIS
OF VARIANCE
Source of variation
SS
df
MS
F
Sig. of F
Sex Experimental class
74.71 2.33
1 1
74.71 2.33
15.23 0.47
0.001 0.493
Sex by experimental class
38.27
1
38.27
7.80
0.007
71
40
1 30
1 20
10
0
1
I
Same
1
Opposite
10
Sex of Experimenter Fig. 1. Means and S.D.s of
pain report.
both measures, only the results for the reactivity measure will be presented. Fig. 1 shows the means and standard deviations with the same or opposite sex experimenter. A 3-way analysis of variance with repeated measures on trials was performed. The results indicate that there was a significant effect due to sex of the subject. Female subjects reported significantly higher levels of pain than males (F= 15.30, P < 0.001). As shown in Table I, there was also a significant interaction between the class of the experimenter (the same or the opposite gender as the subject) and the gender of the subject (F = 7.80, P < 0.007). As shown in Fig. 1, men gave significantly lower pain ratings to the opposite sex than to another male (t = 2.53, P -c 0.02). Although females tended to give higher ratings to the opposite sex than to another female, the difference was not significant (t = 99, P -c 0.33). There were no differences between the pain reports of males and females when they rated pain for the same gender experimenter (t = 0.34, P > 0.40). The results indicated that males responded differentially to the gender of the experiment and reported significantly lower pain levels to a female than to a male. Although females tended to report higher levels of pain to a male experimenter than a female, the difference was not significant. There were no significant differences in pain report when males and females reported their level of pain to members of their own gender.
Discussion
Gender of the experimenter significantly influenced the report of cold pressor pain. Males reported significantly lower pain to a member of the opposite sex than to another male. This result is congruent with the standard gender role requirement of males appearing macho, and not allowing females to know they are weak. The results indicated that the male macho role was more influenced by females than by another male.
Although females tended to report higher pain to opposite gender experimenters, the difference in pain report of females to experimenters of the same or the opposite sex was not quite statistically significant. This result is congruent with the relatively recent women’s movement. Women in the last 15 or so years are discouraged from assuming the powerless and vulnerable role and to be more assertive. However, although the difference among women in pain reports for male and female experimenters was not significant, there was a significant overall difference in pain report between the genders. Females reported higher levels of pain than males. This difference appears to be mainly due to the markedly lower level of pain that male subjects report to female experimenters. Of interest is that there was no significant difference of pain report when males and females reported their pain to members of the same gender. This result suggests that differences in pain sensitivity are not significant, but that the communication of pain is influenced by the social context - in this experiment by the presence of an attractive experimenter. The overall implications of this experiment is that pain report between the genders is not a simple difference of pain sensitivity. Rather it appears to be under social influence of the gender of the person to whom the report of pain is made. In this experiment, males were significantly influenced by gender, and they reported lower pain to an attractive female. Social factors apparently influence pain report. Although there has been research on characteristics of the subject that influences pain, these results indicate that the interaction between the subjects and the social environment should also be investigated.
Acknowledgements
The authors appreciate the comments and criticisms of David Cross, Ronald Friend, Sharon Krass, David Emmerich and the help of James Thorns.
References Chapman, C.R., New directions in the understanding and management of pain, Sot. Sci. Med., 19 (1984) 1261-1277. Craig, R.B., Social modelling influences: pain and context. In: R.A. Stembach (Ed.), The Psychology of Pain (2nd Edn.), Raven Press, New York, 1986. Fields, H.L., Pain, McGraw-Hill, New York, 1987. Gracely, R.H., McGrath, P. and Dubner, R., Narcotic analgesia: fentanyl reduces the intensity but not the unpleasantness of painful tooth pulp sensations, Science, 203 (1979) 1261-1263. Hardy, J.D., Wolff, H.G. and Goodell, H., Pain Sensations and Reactions, Hafner, New York, 1952. Karoly, P. and Jensen, M.P., Multimethod Assessment of Chronic Pain, Pergamon Press, New York, 1987.
72 7
Otto, M.W. and Dougher, M.J., Sex differences and personality factors in responsivity to pain, Percept. Motor Skills, 61 (1985) 383-390. 8 Sigall, H. and Aronson, E.. Liking for an evaluator as a function of her physical attractiveness and nature of the evaluations. J. Exp. Sot. Psycho]., 5 (1969) 93-100. 8a Snyder, M., Tanke, E.D. and Bescheid, E., Social perception and interpersonal behavior. On the self-fulfilling nature of social stereotypes. J. Pers. Sot. Psychol., 35 (1977) 656-666.
9
IO II
‘Tursky, B.. Jamner, L.D. and Friedman. R.. The pain perception profile: a psychophysical approach to the assessment of pain report, Behav. Ther.. 13 (1982) 376-394. Weisenberg, M., Pain and pain control, Psychol. Bull.. 84 (1977) 1008-7044. Westcott, T.B., Huesz, L.. Boswell. D. and Herold, P., Several variables of importance in the use of the cold pressor as a noxious stimulus in behavioral research, Percept. Motor Skills, 44 (1977) 401-402.
