Sex differences in fear of pain: item-level analysis of the Fear of Pain Questionnaire III

Abstract

Objectives

This study aimed to investigate sex differences in fear of pain (FOP) measured by the Fear of Pain Questionnaire III (FPQ-III) in a nonclinical sample. The FPQ-III is a self-report inventory measuring FOP, with 30 items, divided into three subscales: Severe, Minor and Medical Pain.

Methods

A total of 185 subjects participated (49.7% females) in this study. Sex differences on overall FOP, the subscales, and at item level were examined. One-way analysis of variance tested the association between sex and FOP, measured by overall FOP and the subscales. Ordinal regression analysis enabled item-level analysis of the FPQ-III and was conducted to explore further specificity of FOP in males compared to females.

Results

Overall FOP and fear of Severe Pain was significantly higher in females than in males, as measured by the FPQ-Total and the FPQ-Severe. Moreover, females were more likely to report higher FOP than males on 16 items (p<0.05). Further inspection revealed that females scored significantly higher than males on all items on the Severe Pain subscale. When controlling for multiple comparisons six items reached significance (p<0.001). Five of these items belonged to the subscale Severe Pain. When controlling for overall FOP one item, also from the Severe Pain subscale, reached significance (p<0.001).

Conclusion

There are sex differences in severe FOP, with higher FOP in females compared to males. Potential explanations are sex differences in the 1) psychosocial mechanisms of fear and anxiety, and 2) emotional reactions to and interpretation of FPQ-III Severe Pain items.

Keywords:

• fear of pain
• FOP
• fear of pain questionnaire III
• FPQ-III
• pain
• sex differences

Acknowledgments

The study was supported by the Bial Foundation and the University of Tromsø, Tromsø, Norway. The publication charges were funded by a grant from the publication fund of UiT, The Arctic University of Norway. The authors would like to acknowledge Logan Hart BA, Yale Child Study Center and Dr Frederick Shic, PhD, at University of Washington for their contributions.

Author contributions

Both authors contributed in the data analysis. SMV wrote the manuscript with contributions from RAØ. Both authors read and approved the final manuscript.

Disclosure

The authors report no conflicts of interest in this work.