Effects of ethnicity and gender role expectations of pain on experimental pain: A cross-cultural study

Background Gender role expectations of pain (GREP) have been shown to mediate sex differences in experimental pain. Few studies have investigated the role of ethnicity in shaping GREP. The aim of this study was to examine interactions between ethnicity and GREP on experimentally induced pressure and ischaemic pain in Libyan and white British students in their respective countries. Methods Libyan (n=124) and white British (n=51) students completed a GREP questionnaire and their response to experimental pain was measured. Blunt pressure pain threshold (PPT) was measured over the 1st interosseous muscle using algometry. Pain intensity and pain unpleasantness (100mm visual analogue scale) were measured at 1-min intervals during a submaximal effort tourniquet test on the forearm. Results Multivariate analysis of variance detected significant effects for Sex and Ethnicity on pain measurements. Men had higher PPTs than women (p<0.001). Libyans had higher PPTs than white British participants (p<0.001). There were significant effects for Sex and Ethnicity for pain intensity ratings (p<0.01) but no significant differences between the sexes in pain unpleasantness (p>0.05). Libyan participants had higher pain intensity (p<0.01) and pain unpleasantness (p<0.05) ratings compared with white British participants. There were effects for Sex and Ethnicity for all GREP dimensions. Libyan participants exhibited stronger stereotypical views in GREP than white British participants (p<0.001). Conclusions GREP was the mediator of sex but not ethnic differences in pain report, suggesting that gender stereotypical attitudes to pain account for differences in pain expression between men and women.