Pain is a unique personal experience showing variability where gender and sex related effects might contribute. The mechanisms underlying the differences between women and men are currently unknown but are likely to be complex and involving interactions between biological, sociocultural and psychological aspects.
In women, painful experimental stimuli are generally reported to produce a greater intensity of pain than in men. Clinical pain is often reported with higher severity and frequency, longer duration, and present in a greater number of body regions in women than in men. Women are also more likely to experience a number of painful conditions such as fibromyalgia, temporomandibular dysfunction, migraine, rheumatoid arthritis and irritable bowel syndrome. With regard to biological factors, quantitative as well as qualitative differences in the endogenous pain inhibitory systems have been implicated, as well as an influence of gonadal hormones. Psychosocial factors like sex role beliefs, pain coping strategies, and pain related expectancies may also contribute to the differences. Being exposed to repeated painful visceral events (eg menses, labour) during life may contribute to an increased sensitivity to, and greater prevalence of, pain among women.
When assessing the outcome of pharmacological and non-pharmacological therapies in pain treatment, the factors of gender and sex should be taken into account as the response to an intervention may differ. Preferably, treatment recommendations should be based on studies using both women and men as the norm. Due to variability in results, findings from animal studies and experiments in healthy subjects should be interpreted with care.
Get full access to this article
View all access options for this article.
References
1.
CollettBJ, BerkleyK.Task force on fact sheets for the global year against pain ‘Pain in Women’ 2007/28. The IASP Global Year against pain in women. Pain2007;132(Suppl1):S1–2.
2.
HoldcroftAI, BerkleyKJ. Sex and gender differences in pain. In: Wall and Melzack's Textbook of Pain (5th ed.), edited by McMahon SB and Koltzenberg M. Edinburgh, UK: Elsevier, 2005, p. 1181–1197.
3.
BingeforsK, IsacsonD.Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain - a gender perspective. Eur J Pain2004;8(5):435–50.
4.
IsacsonD, BingeforsK.Epidemiology of analgesic use: a gender perspective. Eur J Anaesthesiol Suppl2002;26:5–15.
5.
FillingimRB. Sex, Gender and Pain. Progress in pain research and management, vol 17. IASP press 2000.
6.
MogilJS, ChandaML. The case for the inclusion of female subjects in basic science studies of pain. Pain2005;117(1–2):1–5.
7.
ChenW, WoodsSL, PuntilloKA. Gender differences in symptoms associated with acute myocardial infarction: a review of the research. Heart Lung2005;34(4):240–7.
8.
MiaskowskiC.Gender differences in pain, fatigue, and depression in patients with cancer. J Natl Cancer Inst Monogr2004;(32):139–43.
9.
EttingerSM. Myocardial infarction and unstable angina: gender differences in therapy and outcomes. Curr Womens Health Rep2003;3(2):140–8.
10.
LevineJD, KhasarSG, GreenPG. Neurogenic inflammation and arthritis. Ann N Y Acad Sci2006;1069:155–67.
11.
FillingimRB, MaixnerW, KincaidS, SilvaS.Sex differences in temporal summation but not sensory-discriminative processing of thermal pain. Pain1998;75(1):121–7.
12.
RhudyJL, WilliamsAE. Gender differences in pain: do emotions play a role?Gend Med2005;2(4):208–26.
13.
RobinsonME, GagnonCM, RileyJL, PriceDD. Altering gender role expectations: effects on pain tolerance, pain threshold, and pain ratings. J Pain2003;4(5):284–8.
14.
PoolGJ, SchweglerAF, TheodoreBR, FuchsPN. Role of gender norms and group identification on hypothetical and experimental pain tolerance. Pain2007;129(1–2):122–9.
15.
LevineFM, De SimoneLL. The effects of experimenter gender on pain report in male and female subjects. Pain1991;44(1):69–72.
16.
GijsbersK, NicholsonF.Experimental pain thresholds influenced by sex of experimenter. Percept Mot Skills2005;101(3):803–7.
17.
AloisiAM. Gonadal hormones and sex differences in pain reactivity. Clin J Pain2003;19(3):168–74.
18.
HeitkemperM, JarrettM, BondEF, ChangL.Impact of sex and gender on irritable bowel syndrome. Biol Res Nurs2003;5(1):56–65.
19.
ChangL, HeitkemperMM. Gender differences in irritable bowel syndrome. Gastroenterology2002;123(5):1686–701.
20.
DinaOA, AleyKO, IsenbergW, MessingRO, LevineJD. Sex hormones regulate the contribution of PKCepsilon and PKA signalling in inflammatory pain in the rat. Eur J Neurosci2001;13(12):2227–33.
21.
BerkleyKJ. Sex differences in pain. Behav Brain Sci1997;20(3):371–80.
22.
CoyleDE, SehlhorstCS, BehbehaniMM. Intact female rats are more susceptible to the development of tactile allodynia than ovariectomized female rats following partial sciatic nerve ligation (PSNL). Neurosci Lett1996;203(1):37–40.
23.
GearRW, GordonNC, HellerPH, PaulS, MiaskowskiC, LevineJD. Gender difference in analgesic response to the kappa-opioid pentazocine. Neurosci Lett1996;205(3):207–9.
24.
BeckerJB, ArnoldAP, BerkleyKJ, BlausteinJD, EckelLA, HampsonE, Strategies and methods for research on sex differences in brain and behavior. Endocrinology2005;146(4):1650–73.
25.
CahillL.Why sex matters for neuroscience. Nat Rev Neurosci2006;7(6):477–84.
26.
ZimmerC, BaslerHD, VedderH, LautenbacherS.Sex differences in cortisol response to noxious stress. Clin J Pain2003;19(4):233–9.
27.
al'AbsiM, PetersenKL, WittmersLE. Adrenocortical and hemodynamic predictors of pain perception in men and women. Pain2002;96(1–2):197–204.
28.
CanliT, DesmondJE, ZhaoZ, GabrieliJD. Sex differences in the neural basis of emotional memories. Proc Natl Acad Sci U S A2002;99(16):10789–94.
29.
Hinojosa-LabordeC, ChapaI, LangeD, HaywoodJR. Gender differences in sympathetic nervous system regulation. Clin Exp Pharmacol Physiol1999;26(2):122–6.
30.
GirdlerSS, LightKC. Hemodynamic stress responses in men and women examined as a function of female menstrual cycle phase. Int J Psychophysiol1994;17(3):233–48.
31.
RobinsonME, WiseEA, GagnonC, FillingimRB, PriceDD. Influences of gender role and anxiety on sex differences in temporal summation of pain. J Pain2004;5(2):77–82.
32.
SarlaniE, GraceEG, ReynoldsMA, GreenspanJD. Sex differences in temporal summation of pain and aftersensations following repetitive noxious mechanical stimulation. Pain2004;109(1–2):115–23.
33.
JosephEK, ParadaCA, LevineJD. Hyperalgesic priming in the rat demonstrates marked sexual dimorphism. Pain2003;105(1–2):143–50
34.
AloisiAM, Della SetaD, RendoC, CeccarelliI, ScaramuzzinoA, FarabolliniF.Exposure to the estrogenic pollutant bisphenol A affects pain behavior induced by subcutaneous formalin injection in male and female rats. Brain Res2002;937(1–2):1–7.
35.
NaliboffBD, BermanS, ChangL, DerbyshireSW, SuyenobuB, VogtBA, MandelkernM, MayerEAy. Sex-related differences in IBS patients: central processing of visceral stimuli. Gastroenterology2003;124(7):1738–47.
36.
OuyangA, WrzosHF. Contribution of gender to pathophysiology and clinical presentation of IBS: should management be different in women?Am J Gastroenterol2006;101(12Suppl):S602–9.
37.
CraftRM, MogilJS, AloisiAM. Sex differences in pain and analgesia: the role of gonadal hormones. Eur J Pain2004;8(5):397–411.
38.
BennettHL, GustafssonJA, KeastJR. Estrogen receptor expression in lumbosacral dorsal root ganglion cells innervating the female rat urinary bladder. Auton Neurosci2003;105(2):90–100.
39.
McEwenB.Estrogen actions throughout the brain. Recent Prog Horm Res2002;57:357–84.
40.
PapkaRE, Storey-WorkleyM.Estrogen receptor-alpha and -beta coexist in a subpopulation of sensory neurons of female rat dorsal root ganglia. Neurosci Lett2002;319(2):71–4.
41.
CuiS, GoldsteinRS. Expression of estrogen receptors in the dorsal root ganglia of the chick embryo. Brain Res2000;882(1–2):236–40.
42.
WoolleyCS. Estrogen-mediated structural and functional synaptic plasticity in the female rat hippocampus. Horm Behav1998;34(2):140–8.
43.
JiY, TangB, TraubRJ. Modulatory effects of estrogen and progesterone on colorectal hyperalgesia in the rat. Pain2005;117(3):433–42.
44.
LaCroix-FralishML, RutkowskiMD, WeinsteinJN, MogilJS, DeleoJA. The magnitude of mechanical allodynia in a rodent model of lumbar radiculopathy is dependent on strain and sex. Spine2005;30(16):1821–7.
45.
NemmaniKV, GriselJE, StoweJR, Smith-CarlissR, MogilJS. Modulation of morphine analgesia by site-specific N-methyl-Daspartate receptor antagonists: dependence on sex, site of antagonism, morphine dose, and time. Pain2004;109(3):274–83.
46.
HuchoTB, DinaOA, KuhnJ, LevineJD. Estrogen controls PKCepsilon-dependent mechanical hyperalgesia through direct action on nociceptive neurons. Eur J Neurosci2006;24(2):527–34.
47.
FalkensteinE, TillmannHC, ChristM, FeuringM, WehlingM.Multiple actions of steroid hormones—a focus on rapid, nongenomic effects. Pharmacol Rev2000;52(4):513–56.
48.
EvrardHC, WillemsE, HaradaN, BalthazartJ.Specific innervation of aromatase neurons by substance P fibers in the dorsal horn of the spinal cord in quail. J Comp Neurol2003;465(2):309–18.
49.
CyrM, GhribiO, ThibaultC, MorissetteM, LandryM, Di PaoloT.Ovarian steroids and selective estrogen receptor modulators activity on rat brain NMDA and AMPA receptors. Brain Res Rev2001;37(1–3):153–61.
50.
MarvizonJC, McRobertsJA, EnnesHS, SongB, WangX, JintonL, Two N-methyl-D-aspartate receptors in rat dorsal root ganglia with different subunit composition and localization. J Comp Neurol2002;446(4):325–41.
51.
CairnsBE, SvenssonP, WangK, CastrillonE, HupfeldS, SessleBJ, Arendt-NielsenL.Ketamine attenuates glutamate-induced mechanical sensitization of the masseter muscle in human males. Exp Brain Res2006;169(4):467–72.
52.
CairnsBE, SvenssonP, WangK, HupfeldS, Graven-NielsenT, SessleBJ, Activation of peripheral NMDA receptors contributes to human pain and rat afferent discharges evoked by injection of glutamate into the masseter muscle. J Neurophysiol2003;90(4):2098–105.
53.
DuJ, ZhouS, CoggeshallRE, CarltonSM. N-methyl-D-aspartate-induced excitation and sensitization of normal and inflamed nociceptors. Neuroscience2003;118(2):547–62.
54.
ZhouS, BonaseraL, CarltonSM. Peripheral administration of NMDA, AMPA or KA results in pain behaviors in rats. Neuroreport1996;7(4):895–900.
55.
HuchoTB, DinaOA, LevineJD. Epac mediates a cAMP-to-PKC signaling in inflammatory pain: an isolectin B4(+) neuron-specific mechanism. J Neurosci2005;25(26):6119–26.
56.
KhasarSG, McCarterG, LevineJD. Epinephrine produces a beta-adrenergic receptor-mediated mechanical hyperalgesia and in vitro sensitization of rat nociceptors. J Neurophysiol1999;81(3):1104–12.
57.
McRobertsJA, CoutinhoSV, MarvizonJC, GradyEF, TognettoM, SenguptaJN, Role of peripheral N-methyl-D-aspartate (NMDA) receptors in visceral nociception in rats. Gastroenterology2001;120(7):1737–48.
58.
OlivarT, LairdJM. Differential effects of N-methyl-D-aspartate receptor blockade on nociceptive somatic and visceral reflexes. Pain1999;79(1):67–73.
59.
ManniL, LundebergT, FioritoS, BoniniS, VignetiE, AloeL.Nerve growth factor release by human synovial fibroblasts prior to and following exposure to tumor necrosis factor-alpha, interleukin-1 beta and cholecystokinin-8: the possible role of NGF in the inflammatory response. Clin Exp Rheumatol2003;21(5):617–24.
60.
JansenGB, TorkvistL, LofgrenO, RaudJ, LundebergT.Effects of calcitonin gene-related peptide on tissue survival, blood flow and neutrophil recruitment in experimental skin flaps. Br J Plast Surg1999;52(4):299–303.
61.
BileviciuteI, LundebergT, EkblomA, TheodorssonE.Substance P-, neurokinin A-, calcitonin gene-related peptide-and neuropeptide Y-like immunoreactivity (-LI) in rat knee joint synovial fluid during acute monoarthritis is not correlated with concentrations of neuropeptide-LI in cerebrospinal fluid and plasma. Neurosci Lett1994;167(1–2):145–8.
62.
LundebergT.Peripheral effects of sensory nerve stimulation (acupuncture) in inflammation and ischemia. Scand J Rehabil Med Suppl1993;29:61–86.
63.
RaudJ, LundebergT, Brodda-JansenG, TheodorssonE, HedqvistP.Potent anti-inflammatory action of calcitonin gene-related peptide. Biochem Biophys Res Commun1991;180(3):1429–35.
64.
LarssonJ, EkblomA, HenrikssonK, LundebergT, TheodorssonE.Immunoreactive tachykinins, calcitonin gene-related peptide and neuropeptide Y in human synovial fluid from inflamed knee joints. Neurosci Lett1989;100(1–3):326–30.
65.
MogilJS, MiermeisterF, SeifertF, StrasburgK, ZimmermannK, ReinoldH, Variable sensitivity to noxious heat is mediated by differential expression of the CGRP gene. Proc Natl Acad Sci USA2005;102(36):12938–43.
66.
MalcangioM, FernandesK, TomlinsonDR. NMDA receptor activation modulates evoked release of substance P from rat spinal cord. Br J Pharmacol1998;125(8):1625–6.
67.
LiuH, MantyhPW, BasbaumAI. NMDA-receptor regulation of substance P release from primary afferent nociceptors. Nature1997;386(6626):721–4.
68.
MarvizonJC, MartinezV, GradyEF, BunnettNW, MayerEA. Neurokinin 1 receptor internalization in spinal cord slices induced by dorsal root stimulation is mediated by NMDA receptors. J Neurosci1997;17(21):8129–36.
69.
HerreroJF, LairdJM, Lopez-GarciaJA. Wind-up of spinal cord neurones and pain sensation: much ado about something?Prog Neurobiol2000;61(2):169–203.
70.
BermanS, MunakataJ, NaliboffBD, ChangL, MandelkernM, SilvermanD, Gender differences in regional brain response to visceral pressure in IBS patients. Eur J Pain2000;4(2):157–72.
71.
StaudR, RobinsonME, VierckCJ Jr, PriceDD. Diffuse noxious inhibitory controls (DNIC) attenuate temporal summation of second pain in normal males but not in normal females or fibromyalgia patients. Pain2003;101(1–2):167–74.
72.
McRobertsJA, LiJ, EnnesHS, MayerEA. Sex-dependent differences in the activity and modulation of N-methyl-d-aspartic acid receptors in rat dorsal root ganglia neurons. Neuroscience2007;148(4):1015–20.
73.
LiJ, McRobertsJA, EnnesHS, TrevisaniM, NicolettiP, MittalY, Experimental colitis modulates the functional properties of NMDA receptors in dorsal root ganglia neurons. Am J Physiol Gastrointest Liver Physiol2006;291(12):G219–28.
74.
LevinER. Integration of the extranuclear and nuclear actions of estrogen. Mol Endocrinol2005;19(8):1951–9.
75.
ZivadinovicD, GametchuB, WatsonCS. Membrane estrogen receptor-alpha levels in MCF-7 breast cancer cells predict cAMP and proliferation responses. Breast Cancer Res2005;7(1):R101–12.
76.
BjörnströmL, SjöbergM.Estrogen receptor-dependent activation of AP-1 via non-genomic signalling. Nucl Recept2004;2(1):3.
77.
BiR, BroutmanG, FoyMR, ThompsonRF, BaudryM.The tyrosine kinase and mitogen-activated protein kinase pathways mediate multiple effects of estrogen in hippocampus. Proc Natl Acad Sci USA2000;97(7):3602–7.
78.
WoolleyCS, WeilandNG, McEwenBS, SchwartzkroinPA. Estradiol increases the sensitivity of hippocampal CA1 pyramidal cells to NMDA receptor-mediated synaptic input: correlation with dendritic spine density. J Neurosci1997;17(5):1848–59.
79.
GazzaleyAH, WeilandNG, McEwenBS, MorrisonJH. Differential regulation of NMDAR1 mRNA and protein by estradiol in the rat hippocampus. J Neurosci1996;16(21):6830–38.
80.
KatoS, EndohH, MasuhiroY, KitamotoT, UchiyamaS, SasakiH, Activation of the estrogen receptor through phosphorylation by mitogen-activated protein kinase. Science1995;270(5241):1491–4.
81.
VyklickyL, Knotkova-UrbancovaH.Can sensory neurones in culture serve as a model of nociception?Physiol Res1996;45(1):1–9.
82.
CairnsBE, WangK, HuJW, SessleBJ, Arendt-NielsenL, SvenssonP.The effect of glutamate-evoked masseter muscle pain on the human jaw-stretch reflex differs in men and women. J Orofac Pain2003;17(4):317–25.
83.
SvenssonP, CairnsBE, WangK, HuJW, Graven-NielsenT, Arendt-NielsenL, Glutamate-evoked pain and mechanical allodynia in the human masseter muscle. Pain2003;101(3):221–7.
84.
CarltonSM, HargettGL, CoggeshallRE. Localization and activation of glutamate receptors in unmyelinated axons of rat glabrous skin. Neurosci Lett1995;197(1):25–8.
85.
AloisiAM, BachioccoV, CostantinoA, StefaniR, CeccarelliI, BertacciniA, Cross-sex hormone administration changes pain in transsexual women and men. Pain2007;132(Suppl 1):S60–7.
86.
CairnsBE. The influence of gender and sex steroids on craniofacial nociception. Headache2007;47(2):319–24.
87.
CraftRM, UlibarriC, LeitlMD, SumnerJE. Dose- and time-dependent estradiol modulation of morphine antinociception in adult female rats. Eur J Pain2007; Sep 12;[Epub ahead of print].
88.
KubaT, Quinones-JenabV.The role of female gonadal hormones in behavioral sex differences in persistent and chronic pain: clinical versus preclinical studies. Brain Res Bull2005;66(3):179–88.
89.
NagS, MokhaSS. Activation of alpha2-adrenoceptors in the trigeminal region produces sex-specific modulation of nociception in the rat. Neuroscience2006;142(4):1255–62.
90.
MogilJS, WilsonSG, CheslerEJ, RankinAL, NemmaniKV, LariviereWR, The melanocortin-1 receptor gene mediates female-specific mechanisms of analgesia in mice and humans. Proc Natl Acad Sci U S A2003;100(8):4867–72.
91.
HanJS. Acupuncture and endorphins. Neurosci Lett2004;361(1–3):258–61.
92.
Le BarsD.The whole body receptive field of dorsal horn multireceptive neurones. Brain Res Brain Res Rev2002;40(1–3):29–44.
93.
RainvilleP.Brain mechanisms of pain affect and pain modulation. Curr Opin Neurobiol2002;12(2):195–204.
94.
BasbaumAI, FieldsHL. Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry. Annu Rev Neurosci1984;7:309–38.
95.
BodnarRJ, KleinGE. Endogenous opiates and behavior: 2004. Peptides2005;26(12):2629–711.
96.
MillanMJ. Descending control of pain. Prog Neurobiol2002;66(6):355–474.
97.
ZubietaJK, SmithYR, BuellerJA, XuY, KilbournMR, JewettDM, mu-opioid receptor-mediated antinociceptive responses differ in men and women. J Neurosci2002;22(12):5100–7.
98.
FillingimRB, GearRW. Sex differences in opioid analgesia: clinical and experimental findings. Eur J Pain2004;8(5):413–25.
99.
TershnerSA, MitchellJM, FieldsHL. Brainstem pain modulating circuitry is sexually dimorphic with respect to mu and kappa opioid receptor function. Pain2000;85(1–2):153–9.
100.
BernalSA, MorganMM, CraftRM. PAG mu opioid receptor activation underlies sex differences in morphine antinociception. Behav Brain Res2007;177(1):126–33.
101.
GearRW, MiaskowskiC, GordonNC, PaulSM, HellerPH, LevineJD. The kappa opioid nalbuphine produces gender-and dose-dependent analgesia and antianalgesia in patients with postoperative pain. Pain1999;83(2):339–45.
102.
AnderssonS, LundebergT.Acupuncture-from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses1995;45(3):271–81.
103.
LiuLJ, DuHL, JinYC, ChenJW. [Effects of combined acupuncture and medicine therapy on the breast tissue and expressions of estrogen receptor subgroups in the rat of hyperplasia of mammary glands.]Zhongguo Zhen Jiu2007;27(4):279–83.
104.
YaoX, WangXQ, MaSL, ChenBY. Electroacupuncture stimulates the expression of prolactin-releasing peptide (PrRP) in the medulla oblongata of ovariectomized rats. Neurosci Lett2007;411(3):243–8.
105.
ZhaoH, TianZ, FengY, ChenB.Circulating estradiol and hypothalamic corticotropin releasing hormone enhances along with time after ovariectomy in rats: effects of electroacupuncture. Neuropeptides2005;39(4):433–8.
106.
DahlinL, LundI, LundebergT, MolanderC.Vibratory stimulation increase the electro-cutaneous sensory detection and pain thresholds in women but not in men. BMC Complement Altern Med2006;6:20.
107.
LundI, LundebergT, KowalskiJ, SvenssonE.Gender differences in electrical pain threshold responses to transcutaneous electrical nerve stimulation (TENS)Neurosci Lett2005;375(2):75–80.
108.
NäslundJ, NäslundUB, OdenbringS, LundebergT.Sensory stimulation (acupuncture) for the treatment of idiopathic anterior knee pain. J Rehabil Med2002;34(5):231–8.
HabekD, Cerkez HabekJ, Bobić-VukovićM, VujićB.Efficacy of Acupuncture for the treatment of primary dysmenorrhea. Gynakol Geburtshilfliche Rundsch2003;43(4):250–3.
111.
WhiteAR. Areview of controlled trials of acupuncture for women's reproductive health care. J Fam Plann Reprod Health Care2003;29(4):233–6.
112.
ZhiLX. Randomized controlled study on superficial needling for treatment of primary dysmenorrhea. Zhongguo Zhen Jiu2007;27(1):18–21.
113.
GongP, ZhangMM, WangQ, WuZJ, HuangXT, WangW[Effect of acupuncture at Sanyinjiao (SP6) on glucose metabolism in the patient of dysmenorrhea.]Zhongguo Zhen Jiu2006;26(1):51–5.
114.
PouresmailZ, IbrahimzadehR.Effects of acupressure and ibuprofen on the severity of primary dysmenorrhea. J Tradit Chin Med2002;22(3):205–10.
115.
JunEM, ChangS, KangDH, KimS.Effects of acupressure on dysmenorrhea and skin temperature changes in college students: a non-randomized controlled trial. Int J Nurs Stud2007;44(6):973–81.
116.
ChenHM, ChenCH. Effects of acupressure at the Sanyinjiao point on primary dysmenorrhoea. J Adv Nurs2004;48(4):380–7.
117.
PennickVE, YoungG.Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev2007;(2):CD001139.
118.
LundI, LundebergT, LönnbergL, SvenssonE.Decrease of pregnant women's pelvic pain after acupuncture: a randomized controlled single-blind study. Acta Obstet Gynecol Scand2006;85(1):12–9.
119.
EldenH, LadforsL, OlsenMF, OstgaardHC, HagbergH.Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. BMJ2005;330(7494):761–6.
120.
KvorningN, HolmbergC, GrennertL, AbergA, AkesonJ.Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstet Gynecol Scand2004;83(3):246–50.
121.
WedenbergK, MoenB, NorlingA.A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstet Gynecol Scand2000;79(5):331–5.
122.
HighfieldES, LauferMR, SchnyerRN, KerrCE, ThomasP, WaynePM. Adolescent endometriosis-related pelvic pain treated with acupuncture: two case reports. J Altern Complement Med2006;12(3):317–22.
123.
SunYZ, ChenHL. [Controlled study on Shu-Mu point combination for treatment of endometriosis.]Zhongguo Zhen Jiu2006;26(12):863–5.
124.
XiangD, SituY, LiangX, ChengL, ZhangG.Ear acupuncture therapy for 37 cases of dysmenorrhea due to endometriosis. J Tradit Chin Med2002;22(4):282–5.
125.
ButrickCW. Patients with chronic pelvic pain: endometriosis or interstitial cystitis/painful bladder syndrome?JSLS2007;11(2):182–9.
126.
AlraekT, BaerheimA.The effect of prophylactic acupuncture treatment in women with recurrent cystitis: kidney patients fare better. J Altern Complement Med2003;9(5):651–8.
127.
RohrböckRB, HammerJ, VogelsangH, TalleyNJ, HammerHF. Acupuncture has a placebo effect on rectal perception but not on distensibility and spatial summation: a study in health and IBS. Am J Gastroenterol2004;99(10):1990–7.
128.
XiaoWB, LiuYL. Rectal hypersensitivity reduced by acupoint TENS in patients with diarrhea-predominant irritable bowel syndrome: a pilot study. Dig Dis Sci2004;49(2):312–9.
129.
XingJ, LariveB, MekhailN, SofferE.Transcutaneous electrical acustimulation can reduce visceral perception in patients with the irritable bowel syndrome: a pilot study. Altern Ther Health Med2004;10(1):38–42.
ForbesA, JacksonS, WalterC, QuraishiS, JacynaM, PitcherM.Acupuncture for irritable bowel syndrome: a blinded placebo-controlled trial. World J Gastroenterol2005;11(26):4040–4.
133.
LundebergT, LundI.Did ‘The Princess on the Pea’ suffer from fibromyalgia syndrome? The influence on sleep and the effects of acupuncture. Acupunct Med2007;25(4):184–97.
134.
LundebergT, LundI.Are reviews based on sham acupuncture procedures in fibromyalgia syndrome (FMS) valid?Acupunct Med2007;25(3):100–6.
135.
LundebergT, LundI, NäslundJ.Acupuncture – self-appraisal and the reward system. Acupunct Med2007;25(3):87–99.
136.
LundI, LundebergT.Aspects of pain, its assessment and evaluation from an acupuncture perspective. Acupunct Med2006;24(3):109–17.
137.
LundI, LundebergT.Are minimal, superficial or sham acupuncture procedures acceptable as inert placebo controls?Acupunct Med2006;24(1):13–5.
138.
Stener-VictorinE, HumaidanP.Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med2006;24(4):157–163.
139.
HumaidanP, BrockK, BungumL, Stener-VictorinE.Pain relief during oocyte retrieval - exploring the role of different frequencies of electro-acupuncture. Reprod Biomed Online2006;13(1):120–5.
140.
GejervallAL, Stener-VictorinE, MollerA, JansonPO, WernerC, BerghC.Electro-acupuncture versus conventional analgesia: a comparison of pain levels during oocyte aspiration and patients’ experiences of well-being after surgery. Hum Reprod2005;20(3): 728–35.
141.
HumaidanP, Stener-VictorinE.Pain relief during oocyte retrieval with a new short duration electro-acupuncture technique - an alternative to conventional analgesic methods. Hum Reprod2004;19(6):1367–72.
142.
Stener-VictorinE, WaldenstromU, WiklandM, NilssonL, HagglundL, LundebergT.Electro-acupuncture as a peroperative analgesic method and its effects on implantation rate and neuropeptide Y concentrations in follicular fluid. Hum Reprod2003;18(7):1454–60.
143.
Stener-VictorinE, WaldenstromU, NilssonL, WiklandM, JansonPO. A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod1999;14(10):2480–4.
