Gender Differences Associated with Pain Characteristics and Treatment in Taiwanese Oncology Outpatients

  • Liang, Shu-Yuan (College of Nursing, National Taipei University of Nursing and Health Sciences) ;
  • Wang, Tsae-Jyy (College of Nursing, National Taipei University of Nursing and Health Sciences) ;
  • Wu, Shu-Fang (College of Nursing, National Taipei University of Nursing and Health Sciences) ;
  • Chao, Ta-Chung (Department of Medicine, School of Medicine, National Yang-Ming University) ;
  • Chuang, Yeu-Hui (School of Nursing, College of Nursing, Taipei Medical University) ;
  • Tsay, Shiow-Luan (College of Nursing, National Taipei University of Nursing and Health Sciences) ;
  • Tung, Heng-Hsin (College of Nursing, National Taipei University of Nursing and Health Sciences) ;
  • Lee, Ming-Der (Graduate Institute of Long-Term Care, National Taipei University of Nursing and Health Sciences)
  • Published : 2013.07.30


The purpose of this descriptive and comparative study was to examine gender differences relevant to pain intensity, opioid prescription patterns and opioid consumption in Taiwanese oncology outpatients. The 92 participants had been prescribed opioid analgesics for cancer-related pain at least once in the past week and were asked to complete the Brief Pain Inventory - Chinese questionnaire and to recall the dosage of each opioid analgesic that they had ingested within the previous 24 hours. For opioid prescriptions and consumption, all analgesics were converted to morphine equivalents. The results revealed a significant difference between males and female minimum pain thresholds (t = 2.38, p = 0.02) and current pain thresholds (t = 2.12, p = 0.04), with males reporting a higher intensity of pain than females. In addition, this study found that males tended to use prescribed opioid analgesics more frequently than females on the bases of both around the clock (ATC) (t = 1.90, p = 0.06) and ATC plus as needed (ATC + PRN) (t = 2.33, p = 0.02). However, there was no difference between males and females in opioid prescriptions on an ATC basis (t = 0.52, p = 0.60) or at an ATC + PRN basis (t = 0.40, p = 0.69). The results suggest that there may be a gender bias in the treatment of cancer pain, supporting the proposal of routine examination of the effect of gender on cancer pain management. These findings suggest that clinicians should be particularly aware of potential gender differences during pain monitoring and the consumption of prescribed opioid analgesics.


Cancer;pain;opioids;gender differences;Taiwan outpatients


  1. Cepeda MS, Farrar JT, Baumgarten M, et al (2003). Side effects of opioids during short-term administration: Effect of age, gender, and race. Clin Pharmacol Ther, 74, 102-12.
  2. Chang M, Chang Y, Chiou J, et al (2002). Overcoming patient-related barriers to cancer pain management for home care patients: A pilot study. Cancer Nurs, 25, 470-6.
  3. Cleeland CS, Ryan KM (1994). Pain assessment: Global use of the Brief Pain Inventory. Annals of the Academy of Medicine, Singapore, 23, 129-38.
  4. Cleeland CS, Gonin R, Hatfield AK, et al (1994). Pain and its treatment in outpatients with metastatic cancer. New Engl J Med, 330, 592-6.
  5. Dao TT, LeResche L (2000). Gender differences in pain. J Orofac Pain, 14, 169-84.
  6. Donovan KA, Taliaferro LA, Brock CW, Bazargan S (2008). Sex differences in the adequacy of pain management among patients referred to a multidisciplinary cancer pain clinic. J Pain Symptom Manage, 36, 167-72.
  7. Eggen AE (1993). The Tromso study: Frequency and predicting factors of analgesic drug use in a free-living population (12-56 years). J Clin Epidemiol, 46, 1297-304.
  8. Edrington JM, Paul S, Dodd M, et al (2004). No evidence for sex differences in the severity and treatment of cancer pain. J Pain Symptom Manage, 28, 225-32.
  9. Fillingim R, Maixner W (1995). Gender differences in responses to noxious stimuli. Pain Forum, 4, 209-21.
  10. Ger LP, Ho ST, Wan JJ, et al (1998). The prevalence and severity of cancer pain: a study of newly diagnosed cancer patients in Taiwan. J Pain Symptom Manage, 15, 285-93.
  11. Grond S, Zech D, Diefenbach C, et al (1994). Prevalence and pattern of symptoms in patients with cancer pain: A prospective evaluation of 1635 cancer patients referred to a pain clinic. J Pain Symptom Manage, 9, 372-82.
  12. Jacox A, Carr DB, Payne R, et al (1994). Management of cancer pain: Adults. In: Clinical practice guideline no.9 (no. 94-0592). Rockville, MD: U. S. Department of Health and Human Services, Public Health Service.
  13. Jarlbaek L, Andersen M, Hallas J, et al (2005). Use of opioids in a Danish population-based cohort of cancer patients. J Pain Symptom Manage, 29, 336-43.
  14. Keefe FJ, Affleck G, France CR, et al (2004).Gender differences in pain, coping, and mood in individuals having osteoarthritic knee pain: a within-day analysis, Pain, 110, 571-7.
  15. Lai YH, Keefe FJ, Sun WZ, et al (2002). Relationship between pain specific beliefs and adherence to analgesic regimens in Taiwanese cancer patients: A preliminary study. J Pain Symptom Manage, 24, 415-23.
  16. Liang SY, Li CC, Wu SF, et al (2010). The prevalence and impact of pain among Taiwamese oncology outpatients. Pain Manage Nurs, 2, 197-205.
  17. Lin CC (2001). Congruity of cancer pain perceptions between Taiwanese patients and family caregivers: Relationship to patients' concerns about reporting pain and using analgesics. J Pain Symptom Manage, 21, 18-26.
  18. McDonald DD (1994). Gender and ethnic stereotyping and narcotic analgesic administration. Res Nurs Health, 17, 45-9.
  19. Miaskowski C, Gear RW, Levine JD (2000). Sex related differences in analgesic responses. In R. B. Fillingim (Ed.). Sex, gender and pain: Progress in pain research and management. Seattle, WA: IASP Press.
  20. Miaskowski C, Levine JD (1999). Does opioid analgesia show a gender preference for female? Pain Forum, 8, 34-44.
  21. Miaskowski C (2004). Gender differences in pain, fatigue, and depression in patients with cancer. J Natl Cancer Inst Monogr, 32, 139-43.
  22. Nissen LM, Tett SE, Cramond T, et al (2001). Opioid analgesic prescribing and use - An audit of analgesic prescribing by general practitioners and The Multidisciplinary Pain Centre at Royal Brisbane Hospital. Brit J Clin Pharmaco, 52, 693-8.
  23. Parker G (1993). Disability, caring, and marriage: The experience of younger couples when a partner is disabled after marriage. Br J Soc Work, 23, 565-80.
  24. Reyes-Gibby CC, Ba Duc N, Phi Yen N, et al (2006). Status of cancer pain in Hanoi, Vietnam: A hospital-wide survey in a tertiary cancer treatment center. J Pain Symptom Manage, 31, 431-9.
  25. Reynolds L, Rauck R, Webster L, et al (2004). Relative analgesic potency of fentanyl and sufentanil during intermediate-term infusions in patients after long-term opioid treatment for chronic pain. Pain, 110, 182-8.
  26. Stromgren AS, Groenvold M, Petersen MA, et al (2004). Pain characteristics and treatment outcome for advanced cancer patients during the first week of specialized palliative care. J Pain Symptom Manage, 27, 104-13.
  27. Tzeng JI, Chou LF, Lin, CC (2006). Concerns about reporting pain and using analgesics among Taiwanese postoperative patients. Pain, 7, 860-6.
  28. Turk DC, Okifuji A (1999). Does sex make a difference in the prescription of treatments and the adaptation to chronic pain by cancer and non-cancer patients? Pain, 82, 139-48.
  29. Unruh AM (1996). Gender variations in clinical pain experience. Pain, 65, 123-67.
  30. Wang KY, Ho ST, Ger, LP, et al (1997). Patient barriers to cancer pain management: from the viewpoint of the cancer patients receiving analgesics in a teaching hospital of Taiwan. Acta Anaesthesiologica Sinica, 35, 201-8.
  31. Wang XS, Mendoza TR, Gao SZ, et al (1996). The Chinese version of the Brief Pain Inventory (BPI-C): Its development and use in a study of cancer pain. Pain, 67, 407-16.
  32. Yates P, Aranda S, Edwards H, et al (2004). Family caregivers' experiences and involvement with cancer pain management. J Palliat Care, 20, 287-96.
  33. Yates P, Dewar A, Edwards H, et al (1998). The prevalence and perception of pain amongst hospital in-patients. J Clin Nurs, 7, 521-30.
  34. Yu HY, Tang FI, Yeh MC, et al (2011). Use, perceived effectiveness and gender differences of pain relief strategies among the community dwelling elderly in Taiwan. Pain Manage Nurs, 12, 41-9.

Cited by

  1. Morphine: Patient Knowledge and Attitudes in the Central Anatolia Part of Turkey vol.15, pp.12, 2014,
  2. Clinical Study on Fluvoxamine Combined with Oxycodone Prolonged-Release Tablets in Treating Patients with Moderate to Severe Cancer Pain vol.15, pp.23, 2015,
  3. Gender Difference in Cancer Patients’ Adherence to Analgesics and Related Outcomes of Pain Management vol.41, pp.6, 2018,