Sex differences in pain-related biopsychosocial assessments in patients with axial spondyloarthritis

In axial spondyloarthritis (axSpA), (back)pain is the key symptom and often linked to inflammation. However, knowledge on sex-related differences in pain is limited. Therefore, our study aim was to explore sex differences in a broad spectrum of pain-related biopsychosocial assessments in patients with axSpA. Explorative cross-sectional study from Groningen Leeuwarden axSpA (GLAS) cohort. Following assessments were performed: pain-related questions 2–4 of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), quantitative sensory testing, including pain pressure threshold (PTT), temporal summation and conditioned pain modulation, and questionnaires assessing central sensitization, illness perception, coping strategies, anxiety/depression, and pain-related worrying. Effect sizes (ES) were interpreted as small (< 0.5), moderate (0.5–<0.8), or large (≥ 0.8). Univariable linear regression explored variables associated with BASDAI backpain question 2. 128 men and 73 women were included. Women scored higher on the BASDAI questions, had lower PPTs, higher CSI values (41.5 ± 13.6 vs. 30.6 ± 13.8; ES = 0.79) and used more often comforting cognitions (29.9 ± 4.1 vs. 27.8 ± 4.9; ES = 0.51), decreasing activity (21.0 ± 4.3 vs. 18.8 ± 4.5; ES = 0.49), and diverting attention (22.3 ± 3.9 vs. 20.1 ± 4.7; ES = 0.78) as coping strategies than men. Regression analysis demonstrated that factors associated with pain-related disease activity differ between sexes with varying R2. Our study suggests that men and women with axSpA show distinct patterns in pain-related biopsychosocial assessments. Women reported higher pain severity, different pain sensitivity, psychosocial profiles and associations with pain. These findings support the importance of addressing pain differently between sexes in clinical practice.