Gender, pain and the development of a questionnaire to study their relationship

BACKGROUND AND AIMS: Binominal sex differences (male/female) have been extensively examined in pain research, revealing a trend wherein individuals categorized as female exhibit heightened sensitivity to pain compared to those categorized as male. However, this categorization might be inadequate to capture the diversity of the entire population and elucidate the observed variations in pain experiences. A gender context model of pain encompasses a complex interplay of psychosocial factors, including social expectations, cultural influences and individual perceptions. Hence, it is important that tools are developed to map these interactions. This protocol aims to develop a questionnaire that comprehensively maps gender and gender beliefs about pain, that can be linked to experimental pain outcomes and employed in clinical settings. METHODS: An English questionnaire will be developed containing statements regarding gender conceptualization, gender identity and gender roles in pain, which are scored on a Likert scale. Based on preliminary considerations the authors will develop a first version of the questionnaire, which will be revised based on the input of an international multidisciplinary expert committee. Afterwards, online sequential funnel- based focus groups existing of participants with different profiles will go back and forth with the expert committee, to revise until data saturation is achieved. Five of these focus groups (n/group = 5 – 8) will be organized: a gender-diverse group, a neuro-diverse group, a socio-economically diverse group, a culturally diverse group and a group of pain patients. Finally, the finished questionnaire’s reliability and validity will be tested. Content validity will be assessed by the expert committee through a content validity index, content validity ratio and inter-rater agreement. Internal consistency through Cronbach’s alpha and test-retest reliability through an intraclass correlation coefficient and Kappa coefficient will be assessed in a larger, seperate sample (n = 200 - 400). RESULTS: The result will be a questionnaire with items that can be organized into various continua which we hypothesize to be interrelated. In a data-driven approachwe will then be able to construct different profiles related to intrapersonal gender and pain dynamics. CONCLUSIONS: This new assessment tool will be useful for clinical pain practice and pain research and has the potential to provide valuable insights into the underlying mechanisms of the interaction between pain and gender and for tailoring therapeutic pain interventions.